Abstract
Purpose
To evaluate the prevalence of gonadal dysfunction and the associated risk factors in a cohort of male childhood cancer survivors (CCS).
Methods
Gonadal function was evaluated measuring FSH, LH, inhibin B and total testosterone levels. Patients with total testosterone <3 ng/dl were considered to have hypogonadism. Patients with FSH >10 UI/l and inhibin B <100 pg/ml were considered to have spermatogenesis damage (SD). To assess the impact of risk factors, we estimated crude and adjusted OR performing logistic regression models.
Results
One hundred and ninety-nine male CCS were enrolled; the median follow-up time was 14.01 years. SD was diagnosed in 68 patients, 16 CCS had primary hypogonadism, and 13 had central hypogonadism. The prevalence of gonadal dysfunction (SD or primary hypogonadism) was 45 %, similar in the three considered periods of pediatric cancer diagnosis (1985–1989, 1990–1999, >2000). The adjusted risk of gonadal dysfunction was higher in patients treated with radiotherapy (OR = 8.72; 95 % CI 3.94–19.30) and in those exposed to both alkylating and platinum-derived agents (OR = 9.22; 95 % CI 2.17–39.23). Sarcomas were the cancer diagnosis associated with the higher risk of gonadal dysfunction (OR = 3.69; 95 % CI 1.11–12.22). An extremely high rate of gonadal dysfunction was detected in patients who underwent hematopoietic stem cell transplantation and/or total body irradiation.
Conclusions
Gonadal dysfunction still remains a significant late effect of anticancer therapies; thus, it is mandatory to inform patients (and parents) about this risk, and semen cryopreservation should be offered to all boys who are able to produce semen.
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Acknowledgments
The authors would like to acknowledge UGI (Unione Genitori Italiani contro il tumore dei bambini), for the ongoing support to clinical and research activities of the Transition Unit for Childhood Cancer Survivors.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Brignardello, E., Felicetti, F., Castiglione, A. et al. Gonadal status in long-term male survivors of childhood cancer. J Cancer Res Clin Oncol 142, 1127–1132 (2016). https://doi.org/10.1007/s00432-016-2124-5
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DOI: https://doi.org/10.1007/s00432-016-2124-5