open access

Vol 89, No 5 (2018)
REVIEW PAPERS Gynecology
Published online: 2018-05-30
Get Citation

Reproductive health of female childhood cancer survivors

Rūta Žulpaitė, Žana Bumbulienė
DOI: 10.5603/GP.a2018.0048
·
Pubmed: 30084481
·
Ginekol Pol 2018;89(5):280-286.

open access

Vol 89, No 5 (2018)
REVIEW PAPERS Gynecology
Published online: 2018-05-30

Abstract

Current treatment schemes of childhood cancer are usually effective enough to enable successful management of the disease. With the high rates of survival, another problem arises because patients often suffer much later from side effects of the toxic therapy. A common complication caused by cancer treatment is impairment of the female reproductive system including dysfunction of the hypothalamus and hypophysis, the killing of gonadal cells, and uterine injury. This may lead to altered pubertal timing, gonadotropin insufficiency or deficiency, acute ovarian failure, premature ovarian insufficiency, sexual dysfunction, and complicated pregnancy. The severity of these side effects depends a lot on the patient’s age at treatment and the particularities of their chemo- and/or radiotherapy regimens. While some types of cancer require aggressive treatment, and therefore negative side effects cannot be avoided, strategies which preserve the patient’s reproductive potential are essential. Such strategies are more established in the treatment of adult women, however there are also promising opportunities in the treatment of pediatric oncology patients. Ovar­ian transposition is already widely applied before pelvic radiotherapy. Cryopreservation of ovarian tissue, cryopreservation and in vitro maturation of immature oocytes, or cryopreservation of mature oocytes when the patient’s age is appropriate, have also shown to have promising results in pediatric patients. Concurrent combinations of several techniques can also be successful. Counselling of pediatric patients and their families is challenging, and the urgent commencement of anticancer therapies often discourages attempts to preserve the girl’s reproductive system. Given that successful methods of fertility preserva­tion are already accessible, it is crucial not to leave this topic aside at the time of diagnosis.

Abstract

Current treatment schemes of childhood cancer are usually effective enough to enable successful management of the disease. With the high rates of survival, another problem arises because patients often suffer much later from side effects of the toxic therapy. A common complication caused by cancer treatment is impairment of the female reproductive system including dysfunction of the hypothalamus and hypophysis, the killing of gonadal cells, and uterine injury. This may lead to altered pubertal timing, gonadotropin insufficiency or deficiency, acute ovarian failure, premature ovarian insufficiency, sexual dysfunction, and complicated pregnancy. The severity of these side effects depends a lot on the patient’s age at treatment and the particularities of their chemo- and/or radiotherapy regimens. While some types of cancer require aggressive treatment, and therefore negative side effects cannot be avoided, strategies which preserve the patient’s reproductive potential are essential. Such strategies are more established in the treatment of adult women, however there are also promising opportunities in the treatment of pediatric oncology patients. Ovar­ian transposition is already widely applied before pelvic radiotherapy. Cryopreservation of ovarian tissue, cryopreservation and in vitro maturation of immature oocytes, or cryopreservation of mature oocytes when the patient’s age is appropriate, have also shown to have promising results in pediatric patients. Concurrent combinations of several techniques can also be successful. Counselling of pediatric patients and their families is challenging, and the urgent commencement of anticancer therapies often discourages attempts to preserve the girl’s reproductive system. Given that successful methods of fertility preserva­tion are already accessible, it is crucial not to leave this topic aside at the time of diagnosis.

Get Citation

Keywords

childhood cancer, reproductive health, fertility preservation

About this article
Title

Reproductive health of female childhood cancer survivors

Journal

Ginekologia Polska

Issue

Vol 89, No 5 (2018)

Pages

280-286

Published online

2018-05-30

DOI

10.5603/GP.a2018.0048

Pubmed

30084481

Bibliographic record

Ginekol Pol 2018;89(5):280-286.

Keywords

childhood cancer
reproductive health
fertility preservation

Authors

Rūta Žulpaitė
Žana Bumbulienė

References (42)
  1. Gatta G, Botta L, Rossi S, et al. EUROCARE Working Group. Childhood cancer survival in Europe 1999-2007: results of EUROCARE-5--a population-based study. Lancet Oncol. 2014; 15(1): 35–47.
  2. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013; 49(6): 1374–1403.
  3. Nilsson J, Jervaeus A, Lampic C, et al. 'Will I be able to have a baby?' Results from online focus group discussions with childhood cancer survivors in Sweden. Hum Reprod. 2014; 29(12): 2704–2711.
  4. Hudson MM. Reproductive outcomes for survivors of childhood cancer. Obstet Gynecol. 2010; 116(5): 1171–1183.
  5. Lambalk CB, van Disseldorp J, de Koning CH, et al. Testing ovarian reserve to predict age at menopause. Maturitas. 2009; 63(4): 280–291.
  6. Overbeek A, van den Berg MH, van Leeuwen FE, et al. Chemotherapy-related late adverse effects on ovarian function in female survivors of childhood and young adult cancer: A systematic review. Cancer Treat Rev. 2017; 53: 10–24.
  7. Wallace WH, Anderson RA, Irvine DS. Fertility preservation for young patients with cancer: who is at risk and what can be offered? Lancet Oncol. 2005; 6(4): 209–218.
  8. Chemaitilly W, Mertens AC, Mitby P, et al. Acute ovarian failure in the childhood cancer survivor study. J Clin Endocrinol Metab. 2006; 91(5): 1723–1728.
  9. Green DM, Sklar CA, Boice JD, et al. Ovarian failure and reproductive outcomes after childhood cancer treatment: results from the Childhood Cancer Survivor Study. J Clin Oncol. 2009; 27(14): 2374–2381.
  10. Follin C, Erfurth EM. Long-Term Effect of Cranial Radiotherapy on Pituitary-Hypothalamus Area in Childhood Acute Lymphoblastic Leukemia Survivors. Curr Treat Options Oncol. 2016; 17(9): 50.
  11. Stephen MD, Zage PE, Waguespack SG. Gonadotropin-dependent precocious puberty: neoplastic causes and endocrine considerations. Int J Pediatr Endocrinol. 2011; 2011: 184502.
  12. Chemaitilly W, Sklar CA. Endocrine complications in long-term survivors of childhood cancers. Endocr Relat Cancer. 2010; 17(3): R141–R159.
  13. Wallace W, Thomson AB, Kelsey TW. The radiosensitivity of the human oocyte. Human Reproduction. 2003; 18(1): 117–121.
  14. Ben-Aharon I, Meizner I, Granot T, et al. Chemotherapy-induced ovarian failure as a prototype for acute vascular toxicity. Oncologist. 2012; 17(11): 1386–1393.
  15. Elchuri SV, Patterson BC, Brown M, et al. Low Anti-Müllerian Hormone in Pediatric Cancer Survivors in the Early Years after Gonadotoxic Therapy. J Pediatr Adolesc Gynecol. 2016; 29(4): 393–399.
  16. Lunsford AJ, Whelan K, McCormick K, et al. Antimüllerian hormone as a measure of reproductive function in female childhood cancer survivors. Fertil Steril. 2014; 101(1): 227–231.
  17. Gao W, Liang JX, Yan Q. Exposure to radiation therapy is associated with female reproductive health among childhood cancer survivors: a meta-analysis study. J Assist Reprod Genet. 2015; 32(8): 1179–1186.
  18. Biedka M, Kuźba-Kryszak T, Nowikiewicz T, et al. Fertility impairment in radiotherapy. Contemp Oncol (Pozn). 2016; 20(3): 199–204.
  19. Irtan S, Orbach D, Helfre S, et al. Ovarian transposition in prepubescent and adolescent girls with cancer. Lancet Oncol. 2013; 14(13): e601–e608.
  20. Blumenfeld Z. Chemotherapy and fertility. Best Pract Res Clin Obstet Gynaecol. 2012; 26(3): 379–390.
  21. Lopes F, Smith R, Anderson RA, et al. Docetaxel induces moderate ovarian toxicity in mice, primarily affecting granulosa cells of early growing follicles. Mol Hum Reprod. 2014; 20(10): 948–959.
  22. Molgaard-Hansen L, Skou AS, Juul A, et al. Nordic Society of Pediatric Hematology and Oncology. Pubertal development and fertility in survivors of childhood acute myeloid leukemia treated with chemotherapy only: a NOPHO-AML study. Pediatr Blood Cancer. 2013; 60(12): 1988–1995.
  23. Dvorak CC, Gracia CR, Sanders JE, et al. NCI, NHLBI/PBMTC first international conference on late effects after pediatric hematopoietic cell transplantation: endocrine challenges-thyroid dysfunction, growth impairment, bone health, & reproductive risks. Biol Blood Marrow Transplant. 2011; 17(12): 1725–1738.
  24. Balduzzi A, Dalle JH, Jahnukainen K, et al. Fertility preservation issues in pediatric hematopoietic stem cell transplantation: practical approaches from the consensus of the Pediatric Diseases Working Party of the EBMT and the International BFM Study Group. Bone Marrow Transplant. 2017; 52(10): 1406–1415.
  25. Lara R, Carmen C, Sabine S. Fertility considerations and the pediatric oncology patient. Semin Pediatr Surg. 2016; 25(5): 318–322.
  26. Salama M, Isachenko V, Isachenko E, et al. Updates in preserving reproductive potential of prepubertal girls with cancer: Systematic review. Crit Rev Oncol Hematol. 2016; 103: 10–21.
  27. Soda I, Ishiyama H, Ono S, et al. Assessment of transposed ovarian movement: how much of a safety margin should be added during pelvic radiotherapy? J Radiat Res. 2015; 56(2): 354–359.
  28. Blumenfeld Z. How to preserve fertility in young women exposed to chemotherapy? The role of GnRH agonist cotreatment in addition to cryopreservation of embrya, oocytes, or ovaries. Oncologist. 2007; 12(9): 1044–1054.
  29. Estes SJ. Fertility Preservation in Children and Adolescents. Endocrinol Metab Clin North Am. 2015; 44(4): 799–820.
  30. Johnson EK, Finlayson C, Rowell EE, et al. Fertility Preservation for Pediatric Patients: Current State and Future Possibilities. J Urol. 2017; 198(1): 186–194.
  31. Noyes N, Porcu E, Borini A. Over 900 oocyte cryopreservation babies born with no apparent increase in congenital anomalies. Reproductive BioMedicine Online. 2009; 18(6): 769–776.
  32. Wallace W, Smith A, Kelsey T, et al. Fertility preservation for girls and young women with cancer: population-based validation of criteria for ovarian tissue cryopreservation. The Lancet Oncology. 2014; 15(10): 1129–1136.
  33. Ladanyi C, Mor A, Christianson MS, et al. Recent advances in the field of ovarian tissue cryopreservation and opportunities for research. J Assist Reprod Genet. 2017; 34(6): 709–722.
  34. Demeestere I, Simon P, Dedeken L, et al. Live birth after autograft of ovarian tissue cryopreserved during childhood. Hum Reprod. 2015; 30(9): 2107–2109.
  35. Wallace WH, Kelsey TW, Anderson RA. Fertility preservation in pre-pubertal girls with cancer: the role of ovarian tissue cryopreservation. Fertil Steril. 2016; 105(1): 6–12.
  36. Practice Committee of American Society for Reproductive Medicine. Ovarian tissue cryopreservation: a committee opinion. Fertil Steril. 2014; 101(5): 1237–1243.
  37. Kim SS, Lee WS, Chung MiK, et al. Long-term ovarian function and fertility after heterotopic autotransplantation of cryobanked human ovarian tissue: 8-year experience in cancer patients. Fertil Steril. 2009; 91(6): 2349–2354.
  38. Stern CJ, Gook D, Hale LG, et al. First reported clinical pregnancy following heterotopic grafting of cryopreserved ovarian tissue in a woman after a bilateral oophorectomy. Hum Reprod. 2013; 28(11): 2996–2999.
  39. Loren AW, Mangu PB, Beck LN, et al. American Society of Clinical Oncology. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013; 31(19): 2500–2510.
  40. Terenziani M, Spinelli M, Jankovic M, et al. PanCare Network. Practices of pediatric oncology and hematology providers regarding fertility issues: a European survey. Pediatr Blood Cancer. 2014; 61(11): 2054–2058.
  41. Diesch T, Rovo A, von der Weid N, et al. Fertility preservation practices in pediatric and adolescent cancer patients undergoing HSCT in Europe: a population-based survey. Bone Marrow Transplant. 2017; 52(7): 1022–1028.
  42. Font-Gonzalez A, Mulder RL, Loeffen EAH, et al. PanCareLIFE Consortium. Fertility preservation in children, adolescents, and young adults with cancer: Quality of clinical practice guidelines and variations in recommendations. Cancer. 2016; 122(14): 2216–2223.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl