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Sakashita K, Komori K, Morokawa H, Kurata T. Screening and interventional strategies for the late effects and toxicities of hematological malignancy treatments in pediatric survivors. Expert Rev Hematol 2024; 17:313-327. [PMID: 38899398 DOI: 10.1080/17474086.2024.2370559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 06/17/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Advancements in pediatric cancer treatment have increased patient survival rates; however, childhood cancer survivors may face long-term health challenges due to treatment-related effects on organs. Regular post-treatment surveillance and early intervention are crucial for improving the survivors' quality of life and long-term health outcomes. The present paper highlights the significance of late effects in childhood cancer survivors, particularly those with hematologic malignancies, stressing the importance of a vigilant follow-up approach to ensure better overall well-being. AREAS COVERED This article provides an overview of the treatment history of childhood leukemia and lymphoma as well as outlines the emerging late effects of treatments. We discuss the various types of these complications and their corresponding risk factors. EXPERT OPINION Standardizing survivorship care in pediatric cancer aims to improve patient well-being by optimizing their health outcomes and quality of life. This involves early identification and intervention of late effects, requiring collaboration among specialists, nurses, and advocates, and emphasizing data sharing and international cooperation.
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Affiliation(s)
- Kazuo Sakashita
- Department of Hematology and Oncology, Nagano Children's Hospital, Azumino, Japan
| | - Kazutoshi Komori
- Department of Hematology and Oncology, Nagano Children's Hospital, Azumino, Japan
| | - Hirokazu Morokawa
- Department of Hematology and Oncology, Nagano Children's Hospital, Azumino, Japan
| | - Takashi Kurata
- Department of Hematology and Oncology, Nagano Children's Hospital, Azumino, Japan
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Karalexi MA, Kontogeorgi A, Papaioannou G, Neofytou S, Messaropoulos P, Moschovi M, Kalantaridou SN. Fertility status in childhood cancer survivors of hematological malignancies: a systematic review. Hormones (Athens) 2023; 22:211-221. [PMID: 36964890 DOI: 10.1007/s42000-023-00443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 02/14/2023] [Indexed: 03/26/2023]
Abstract
Stunning advances in treatment modalities implemented in children with hematological malignancies have led to 5-year overall survival rates exceeding 85%. However, this growing population of long-term survivors has raised significant concerns about their fertility status throughout adulthood, while specific treatment- and non-treatment-related factors appear to possibly affect fertility through distinct mechanisms. We aimed to comprehensively review the published literature on the association between treatment-related factors and risk of impaired fertility in childhood hematological cancer survivors. We searched PubMed up to March 2021 to identify eligible studies published during the last two decades. A narrative synthesis of the results was performed, although no meta-analysis was feasible due to the small number of studies and the large heterogeneity of evidence. Five studies on 2020 survivors of childhood leukemia were deemed eligible. The qualitative data synthesis showed significant fertility deficits in survivors treated with cranial radiotherapy and chemotherapy for childhood leukemia. Two studies examined biochemical measures of reduced ovarian reserve, providing some evidence that the levels of anti-Müllerian hormone can be used as a proxy for diminished ovarian reserve. The current findings should facilitate the delivery of age- and gender-appropriate interventions to optimize reproductive outcomes in childhood hematological cancer survivors.
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Affiliation(s)
- Maria A Karalexi
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Str, 12462, Athens, Greece.
| | - Adamantia Kontogeorgi
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Str, 12462, Athens, Greece
| | - George Papaioannou
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Str, 12462, Athens, Greece
| | - Spyridoula Neofytou
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Pantelis Messaropoulos
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Str, 12462, Athens, Greece
| | - Maria Moschovi
- Pediatric Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Sophia N Kalantaridou
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Str, 12462, Athens, Greece
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Anderson RA, Cameron D, Clatot F, Demeestere I, Lambertini M, Nelson SM, Peccatori F. Anti-Müllerian hormone as a marker of ovarian reserve and premature ovarian insufficiency in children and women with cancer: a systematic review. Hum Reprod Update 2022; 28:417-434. [PMID: 35199161 PMCID: PMC9071067 DOI: 10.1093/humupd/dmac004] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/18/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Female patients undergoing anticancer treatment are at elevated risk of adverse ovarian outcomes including infertility and premature ovarian insufficiency (POI), which is associated with short- and long-term health risks. Anti-Müllerian hormone (AMH) is a key biomarker of ovarian reserve, but its role prior to and after cancer treatment is less well understood. OBJECTIVE AND RATIONALE To conduct a systematic review evaluating AMH as a biomarker of ovarian reserve and POI before and after anticancer treatment, which has become a pressing clinical issue in reproductive medicine. There are a large number of observational studies, but differences in patient groups, cancer diagnoses and study design make this a confusing field that will benefit from a thorough and robust review. SEARCH METHODS A systematic literature search for AMH in women with cancer was conducted in PubMed, Embase and Cochrane Central Register of Controlled Trials up to 1 April 2021. Bias review was conducted using the Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) protocol along with qualitative assessment of quality. Exploratory subgroups were established based on age, cancer type and length of follow-up. OUTCOMES Ninety-two publications (N = 9183 patients) were included in this analysis after quality and bias review. Reduced/undetectable AMH was consistently identified in 69/75 studies (92%) following chemotherapy or radiotherapy, with reductions ranging from 42% to concentrations below the limit of detection, and many reporting mean or median declines of ≥90%. Where longitudinal data were analysed (42 studies), a majority (33/42 (79%)) of studies reported at least partial recovery of AMH at follow-up, however, effect estimates were highly variable, reflecting that AMH levels were strongly impacted by anticancer treatment (i.e. the chemotherapy regimen used and the number of treatment cycles need), with recovery and its degree determined by treatment regimen, age and pre-treatment AMH level. In 16/31 (52%) publications, oligo/amenorrhoea was associated with lower post-treatment AMH consistent with impending POI, although menstruation and/or pregnancy were reported in patients with low or undetectable AMH. Long-term (>5 years) follow-up of paediatric patients following cancer treatment also found significantly lower AMH compared with control groups in 14/20 (70%) of studies, with very variable effect sizes from complete loss of AMH to full recovery depending on treatment exposure, as in adult patients. WIDER IMPLICATIONS AMH can be used to identify the damaging effect of cancer treatments on ovarian function. This can be applied to individual women, including pre-pubertal and adolescent girls, as well as comparing different treatment regimens, ages and pre-treatment AMH levels in populations of women. While there was evidence for its value in the diagnosis of POI after cancer treatment, further studies across a range of diagnoses/treatment regimens and patient ages are required to clarify this, and to quantify its predictive value. A major limitation for the use of AMH clinically is the very limited data relating post-treatment AMH levels to fertility, duration of reproductive lifespan or time to POI; analysis of these clinically relevant outcomes will be important in further research.
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Affiliation(s)
- Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK,Correspondence address. MRC Centre for Reproductive Health, The Queen’s Medical Research Institute, Edinburgh BioQuarter, 47 Little France Crescent, Edinburgh EH16 4TJ, UK. Tel: +44-(0)-131-242-6386; E-mail:https://orcid.org/0000-0002-7495-518X
| | - David Cameron
- Edinburgh University Cancer Centre, IGMM, Edinburgh, UK
| | | | - Isabelle Demeestere
- Fertility clinic, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Matteo Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy,Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow, UK,NIHR Bristol Biomedical Research Centre, Bristol, UK,The Fertility Partnership, Oxford, UK
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Torella M, Riemma G, De Franciscis P, La Verde M, Colacurci N. Serum Anti-Müllerian Hormone Levels and Risk of Premature Ovarian Insufficiency in Female Childhood Cancer Survivors: Systematic Review and Network Meta-Analysis. Cancers (Basel) 2021; 13:6331. [PMID: 34944951 PMCID: PMC8699404 DOI: 10.3390/cancers13246331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Female childhood cancer survivors (CCS) might have impaired ovarian reserves, especially after alkylating agents or radiotherapy. The purpose of this systematic review and network meta-analysis is to evaluate the role of serum anti-Müllerian hormone (AMH) for ovarian reserve screening and the risk of premature ovarian insufficiency (POI) according to the subtype of childhood cancer. (2) Methods: PRISMA-NMA guidelines were followed. We carried out a network meta-analysis based on a random effects model for mixed multiple treatment comparisons to rank childhood cancers effects on fertility by surface under the cumulative ranking curve (SUCRA). Studies were selected only if they had an age-matched control group. Quality assessment was performed using Newcastle-Ottawa Scale. The co-primary outcomes were mean AMH levels and the incidence of POI. (3) Results: A total of 8 studies (1303 participants) were included. Women treated for a neuroblastoma during infancy were more likely to be ranked first for impaired AMH levels (SUCRA = 65.4%), followed by mixed CCS (SUCRA = 29.6%). The greatest rates of POI were found in neuroblastoma survivors (SUCRA = 42.5%), followed by acute lymphoid leukemia (SUCRA = 26.3%) or any other neoplasia (SUCR A = 20.5%). (4) Conclusions: AMH represents a trustworthy approach for ovarian reserve screening. Direct and indirect comparisons found no differences in mean AMH levels and POI risk between subtypes of CCS and healthy controls. SUCRA analysis showed that female neuroblastoma survivors were more at risk for reduced serum AMH levels and increased risk of POI.
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Affiliation(s)
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (M.T.); (P.D.F.); (M.L.V.); (N.C.)
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Krawczuk‐Rybak M, Płonowski M, Leszczyńska E, Latoch E, Sawicka‐Żukowska M, Muszyńska‐Rosłan K, Skalska‐Sadowska J, Wachowiak J, Sga‐Pondel D, Kazanowska B, Chybicka A, Stachowicz‐Stencel T, Stefanowicz J, Malinowska I, Matysiak M, Kotan A, Wysocki M, Pobudejska‐Pieniążek A, Szczepański T, Przybyszewski B, Badowska W, Szymańska‐Miller D, Kowalczyk JR, Kamieńska E, Urasiński T, Wawrzeńczyk A, Żelazowska‐Rutkowska B, Cylwik B. The influence of different intensity of treatment on hormonal markers of gonadal function in acute lymphoblastic leukemia survivors. Hematol Oncol 2019; 37:609-616. [DOI: 10.1002/hon.2681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Maryna Krawczuk‐Rybak
- Department of Pediatric Oncology and HematologyMedical University of Bialystok Bialystok Poland
| | - Marcin Płonowski
- Department of Pediatric Oncology and HematologyMedical University of Bialystok Bialystok Poland
| | - Elżbieta Leszczyńska
- Department of Pediatric Oncology and HematologyMedical University of Bialystok Bialystok Poland
| | - Eryk Latoch
- Department of Pediatric Oncology and HematologyMedical University of Bialystok Bialystok Poland
| | | | | | - Jolanta Skalska‐Sadowska
- Department of Pediatric Hematology and Oncology and Hematopoietic Stem Cell Transplantation, Institute of PediatricsUniversity of Medical Sciences Poznan Poland
| | - Jacek Wachowiak
- Department of Pediatric Hematology and Oncology and Hematopoietic Stem Cell Transplantation, Institute of PediatricsUniversity of Medical Sciences Poznan Poland
| | - Dorota Sga‐Pondel
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow TransplantationWroclaw Medical University Wroclaw Poland
| | - Bernarda Kazanowska
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow TransplantationWroclaw Medical University Wroclaw Poland
| | - Alicja Chybicka
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow TransplantationWroclaw Medical University Wroclaw Poland
| | | | - Joanna Stefanowicz
- Department of Pediatrics, Hematology and OncologyMedical University of Gdansk Gdansk Poland
| | - Iwona Malinowska
- Department of Pediatric Hematology and OncologyMedical University of Warsaw Warsaw Poland
| | - Michał Matysiak
- Department of Pediatric Hematology and OncologyMedical University of Warsaw Warsaw Poland
| | - Andrzej Kotan
- Department of Pediatric Hematology and Oncology, Collegium MedicumNicolaus Copernicus University Bydgoszcz Poland
| | - Mariusz Wysocki
- Department of Pediatric Hematology and Oncology, Collegium MedicumNicolaus Copernicus University Bydgoszcz Poland
| | | | - Teresa Szczepański
- Department of Pediatric Hematology and OncologyMedical University of Silesia Zabrze Poland
| | | | - Wanda Badowska
- Department of Hematology and OncologyChildren State Hospital Olsztyn Poland
| | | | - Jerzy R. Kowalczyk
- Department of Pediatric Hematology/OncologyMedical University Lublin Poland
| | - Elżbieta Kamieńska
- Department of Pediatrics, Hematology and OncologyPomeranian Medical University Szczecin Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hematology and OncologyPomeranian Medical University Szczecin Poland
| | - Anna Wawrzeńczyk
- Department of Pediatric Oncology and HematologyW. Buszkowski Children's Hospital Kielce Poland
| | | | - Bogdan Cylwik
- Department of Pediatric Laboratory DiagnosticsMedical University of Bialystok Białystok Poland
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Somigliana E, Terenziani M, Filippi F, Bergamini A, Martinelli F, Mangili G, Peccatori F, Vercellini P. Chemotherapy-related damage to ovarian reserve in childhood cancer survivors: interpreting the evidence. J Assist Reprod Genet 2019; 36:341-348. [PMID: 30362055 PMCID: PMC6420530 DOI: 10.1007/s10815-018-1345-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/12/2018] [Indexed: 01/23/2023] Open
Abstract
Chemotherapy during childhood damages ovarian reserve and can affect future fertility. However, recent large epidemiological studies showed that the detrimental impact on fertility is less severe if women seek for pregnancy at a younger age. To explain this observation, we hypothesize that the detrimental effects of previous chemotherapy on the ovarian reserve may be attenuated in young adults for two main reasons. Firstly, recent evidence showed that the amount of ovarian reserve is not a critical factor for effective natural conceptions. Provided that the residual ovarian reserve allows regular ovulatory cycles, the chances of pregnancy are similar in women with intact or reduced ovarian reserve. Secondly, ovarian reserve depletion appears to be a phenomenon that is inversely related to the residual ovarian reserve rather than to age. From a mathematical perspective, this kind of regulation intrinsically attenuates the effects of an early loss of a significant amount of primordial follicles. In conclusion, the detrimental effects of chemotherapy on natural fertility may be less severe if women with a history of chemotherapy during childhood seek for pregnancy early. This information should be part of the counseling.
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Affiliation(s)
- Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
- Obstet-Gynecol Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy.
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Francesca Filippi
- Obstet-Gynecol Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alice Bergamini
- Obstet-Gynecol Department, San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Martinelli
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Giorgia Mangili
- Obstet-Gynecol Department, San Raffaele Scientific Institute, Milan, Italy
| | - Fedro Peccatori
- Fertility and Procreation Unit, Division of Gynaecologic Oncology, European Institute of Oncology, Milan, Italy
| | - Paolo Vercellini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Obstet-Gynecol Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Abstract
Over the last 50 years, the survival rates in children with acute lymphoblastic leukemia (ALL) have increased remarkably. The optimal use of antileukemic agents in cooperative group protocols, central nervous system-directed treatment, improvements in supportive care, and recognition of biological, clinical, and treatment response characteristics that predict patients with a higher or a lower risk of treatment failure have improved 5-year event-free survival rates, reaching more than 85%, and 5-year overall survival rates, reaching more than 90%. Consequently, it has become increasingly important to characterize the occurrence of long-term late effects. ALL treatments have been associated with increased risks for adverse outcomes such as late mortality, secondary malignancies, and neurological, cardiac, endocrine, and social/psychological disorders. In recent decades, cooperative groups in Europe and in the United States have provided essential information about the long-term effects of ALL therapy, giving recommendations for screening as well as facilitating new approaches for reducing late-term morbidity and mortality. Current frontline protocols continue to examine ways to lower the intensity and amount of therapy to reduce late effects, whereas survivorship studies attempt to predict such adverse effects precisely and develop targeted prevention and treatment strategies.
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Affiliation(s)
- Hande Kızılocak
- Istanbul University-Cerrahpaşa Faculty of Medicine, Department of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Fatih Okcu
- Texas Children’s Hematology and Oncology Centers, Baylor College of Medicine, Department of Pediatrics, Division of Hematology and Oncology, Houston, TX, USA
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Łuczak J, Bagłaj M. Selecting treatment method for ovarian masses in children - 24 years of experience. J Ovarian Res 2017; 10:59. [PMID: 28893324 PMCID: PMC5594432 DOI: 10.1186/s13048-017-0353-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidemiology and pathology of ovarian tumors in the pediatric population are very different of these encountered in women. Few attempts have been made to analyze the whole spectrum of ovarian pathology in children, and only some of them included series of more than 200 cases. We performed a retrospective analysis of clinical and diagnostic aspects of ovarian tumors and tumor-like lesions in girls in order to identify the characteristics associated with malignancy with an attempt to elaborate a clinical management algorithm. RESULTS The study group comprised 214 patients operated on for ovarian tumor in years 1991-2014 at the pediatric surgical center. Non-neoplastic ovarian lesion was diagnosed in 127 females. Sixty-five patients had a benign tumor and 22 had a malignant lesion. Abdominal pain was the most common symptom in the non-malignant lesion group. Patients with ovarian malignancy presented predominantly with abdominal distension and palpable mass. In the non-malignant group imaging studies revealed cystic lesion in 124 patients (68.89%) and solid mass in 10 (5.55%). Malignant lesion showed a solid or mixed structure in all cases. Positive tumor markers were noted in 14 (13.7%) patients with a benign lesion and in 14 (70%) with ovarian malignancy. Large lesions were found in 77.3% of girls with a malignant mass, while only in 32.8% of patients with a benign lesion (p < 0.001). In the group of solid tumors positive tumor marker results occurred more frequently in patients with diagnosed malignant tumors (p < 0.05). Positive tumor markers, large size of the lesion and age below 14 years were independent variables differentiating malignant tumors from non-malignant lesions (p = 0.00000). CONCLUSIONS Predominantly solid structures noted on imaging studies, large dimension and positive tumor markers are clinical predictors of malignancy. A diagnosis of purely cystic lesions with negative markers or of a small size should be an indication for a gonad-sparing procedure. Treatment guidelines for ovarian lesions in children should be established on the basis of multicenter prospective studies and introduced as soon as possible in order to improve and unify the ovarian preservation rates across the pediatric surgical centers.
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Affiliation(s)
- Justyna Łuczak
- Pediatric Surgery and Urology Department, Wroclaw Medical University, 52 M. Sklodowskiej Curie ST, 50-369, Wroclaw, Poland.
| | - Maciej Bagłaj
- Pediatric Surgery and Urology Department, Wroclaw Medical University, 52 M. Sklodowskiej Curie ST, 50-369, Wroclaw, Poland
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Meissner J, Tichy D, Katzke V, Kühn T, Dietrich S, Schmitt T, Ziepert M, Kuhnt E, Rixecker T, Zorn M, Witzens-Harig M, Pfreundschuh M, Ho A. Long-term ovarian function in women treated with CHOP or CHOP plus etoposide for aggressive lymphoma. Ann Oncol 2015; 26:1771-6. [DOI: 10.1093/annonc/mdv227] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/04/2015] [Indexed: 01/01/2023] Open
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Thomas-Teinturier C, Allodji RS, Svetlova E, Frey MA, Oberlin O, Millischer AE, Epelboin S, Decanter C, Pacquement H, Tabone MD, Sudour-Bonnange H, Baruchel A, Lahlou N, De Vathaire F. Ovarian reserve after treatment with alkylating agents during childhood. Hum Reprod 2015; 30:1437-46. [DOI: 10.1093/humrep/dev060] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 02/23/2015] [Indexed: 11/13/2022] Open
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The effect of childhood cancer therapy on ovarian reserve and pubertal development. Reprod Biomed Online 2014; 30:175-80. [PMID: 25498597 DOI: 10.1016/j.rbmo.2014.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 10/04/2014] [Accepted: 10/15/2014] [Indexed: 11/22/2022]
Abstract
The effects of childhood cancer therapy on ovarian reserve tests and on pubertal development within 5 years were compared with a control group. The study group was composed of 41 patients who underwent chemotherapy during pre-menarche (subgroup A; n = 15) and after menarche (subgroup B; n = 26); the control group was composed of 44 patients admitted with non-cancer related diseases (in total n = 85). Mean total ovarian volume and total antral follicle counts on ultrasound examination were significantly lower in the study group compared with the control group (3.5 ± 2.3 versus 5.2 ± 2.4 ml; P = 0.001; and 3.4 ± 3.3 versus 8.6 ± 3.5; P < 0.001, respectively). Mean FSH level was significantly higher in the study group (13.5 ± 16.2 versus 7.3 ± 2.7 mIU/ml; P = 0.017). Anti-Müllerian hormone levels in subgroup A were significantly higher than in subgroup B (1.8 ± 0.1 versus 1.5 ± 0.08 pg/dl; P = 0.034). In conclusion ovarian volume, antral follicle count and FSH can be used for evaluating the harmful effect of cancer chemotherapy on ovarian follicles. Post-menarche, Anti-Müllerian values reveal that ovarian follicles are more sensitive to the devastating effects of cytotoxic treatment.
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Abstract
Cancer treatments, including chemotherapy, radiotherapy and surgery can be damaging to reproductive organs and can decrease fertility in women of reproductive age. For women who may wish to try to preserve their fertility, it's important for clinicians to discuss potential options with women before the initiation of cancer treatment to maintain as many preservation options as possible. Embryo cryopreservation, oocyte cryopreservation and ovarian tissue cryopreservation are potential options, but most of these methods are still considered experimental and may not be an option for every woman.
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Barnes N, Chemaitilly W. Endocrinopathies in survivors of childhood neoplasia. Front Pediatr 2014; 2:101. [PMID: 25295241 PMCID: PMC4172013 DOI: 10.3389/fped.2014.00101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/06/2014] [Indexed: 01/26/2023] Open
Abstract
Advancements in cancer treatments have increased the number of survivors of childhood cancers. Endocrinopathies are common complications following cancer therapy and may occur decades later. The objective of the current review is to address the main endocrine abnormalities detected in childhood cancer survivors including disorders of the hypothalamic-pituitary axis, thyroid, puberty, gonads, bone, body composition, and glucose metabolism.
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Affiliation(s)
- Nicole Barnes
- Division of Pediatric Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital , Memphis, TN , USA
| | - Wassim Chemaitilly
- Division of Pediatric Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital , Memphis, TN , USA ; Epidemiology and Cancer Control, St. Jude Children's Research Hospital , Memphis, TN , USA
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Sergent F, Istasse F, Coston AL, Piolat C, Pons JC, Hennebicq S. [Ovarian cryopreservation: evaluation of two surgical procedures]. ACTA ACUST UNITED AC 2013; 41:681-6. [PMID: 24200987 DOI: 10.1016/j.gyobfe.2013.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate various surgical techniques for partial oophorectomy cryopreservation. To evaluate the consequences of prior exposure to cytotoxic therapy on the quality of the ovary removed. PATIENTS AND METHODS Single center retrospective observational study over 4 years of women who had ovarian cryopreservation surgery for chemotherapy or radiotherapy which were at high risk of premature ovarian failure. Several techniques have been proposed: partial oophorectomy with clamping of the vascular gonadal pedicle (indirect tissue sample) without clamping (direct tissue sample) and partial oophorectomy with an automatic stapler. Ovarian tissue was immediately prepared for cryopreservation in the operating theatre. The whole sample was divided into small slices. For each ovary, a count of small slices was made. Additionally, one slice was examined to determine the presence of primordial follicles. RESULTS Ovary was successfully removed and cryopreserved in 13 patients. Two bleeding events occurred with the direct technique, without consequences for patients. The number of fragments obtained between indirect and direct techniques was respectively 19 vs 15, P=0.18; the number of primordial follicles was 38 vs 36, P=0.87. The automatic stapler consumed too much ovarian tissue to be interesting. There were fewer fragments, 15 vs 20, P<0.05 and primordial follicles, 35 vs 40, P=0.65, after a first cycle of chemotherapy. DISCUSSION AND CONCLUSION The vascular clamping technique is safer but with no difference in the quality of the sample tissue. One cycle of chemotherapy has a pejorative impact on the quality of the sample tissue.
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Affiliation(s)
- F Sergent
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Grenoble, C.S. 10217, 38043 Grenoble cedex 9, France; Université Joseph-Fourier, B.P. 53, 38041 Grenoble cedex 9, France.
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