Fertility in men after treatment for stage 1 and 2A seminoma
Fertility in men after treatment for stage 1 and 2A seminoma
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DOI：
10.1097/01.coc.0000135736.18493.dd
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发表时间：
2004-12-01
影响因子：
2.6
通讯作者：
Buchholz, TA
中科院分区：
文献类型：
--
作者：
Nalesnik, JG;Sabanegh, ES;Buchholz, TA
本文的目的是评估男性在根治性腹股沟睾丸切除术和精原细胞瘤放射治疗 (RT) 后的长期生育能力和对生育能力的态度，并评估在治疗前向精原细胞瘤患者提供精子冷冻保存的频率。在 3 个机构（威尔福德霍尔空军医疗中心、布鲁克陆军医疗中心和菲茨西蒙斯陆军医疗中心）进行了一项回顾性审查，以确定 1975 年至 1997 年间接受过 1 期或 2A 期精原细胞瘤治疗的患者。212 名符合 1 期或 2A 期精原细胞瘤选择标准的患者中，有 73 名（34%）为本次分析提供了信息。鉴于许多患者在本研究开始时已更换工作地点或已脱离军队，因此这被认为是一个很好的缓解率。我们对 1975 年至 1997 年间在选定的治疗机构接受睾丸精原细胞瘤治疗的 73 名患者的 RT 和肿瘤委员会记录进行了审查。患者完成了问卷调查和电话访谈，重点关注先前的生育能力、生育（更多）孩子的愿望、其他生育影响因素（精索静脉曲张、隐睾、感染和勃起功能障碍）以及有关冷冻保存的医生咨询的发生率。所有患者都被要求获得当前的精液分析（SA）。 11 名 (15%) 患者报告称，自 RT 完成后，他们曾尝试生育孩子。 11 人中有 7 人 (64%) 在 RT 后平均 3.5 年内成功怀孕（范围：1 个月至 5 年）。在4对不成功的夫妇中，一对患有严重的女性因素不孕问题，另一对患有器质性勃起功能障碍。第三名患者过去有过输精管结扎手术史，并随后进行了输精管结扎复通术。九名患者提供了 SA。平均精子计数和活力分别为 24.2 Mil/mL（范围：5-81 Mil/mL）和 63.1%（范围：30-90%）（正常 SA 值：计数 = 20-250 Mil/mL，活力 >50%，体积 = 1.5-5.0 mL）。没有患者无精子症。放射治疗的总体平均时间间隔为 7.9 年。放疗后的辐射剂量和时间与 SA 结果或受孕均不相关。 73 名男性中只有 16 名（22%）接受过咨询医生的治疗前精子冷冻保存服务。结论是：(1)通过睾丸切除术和放疗治疗早期精原细胞瘤的患者有大于50%的机会恢复正常精液参数，并且都至少恢复部分精子发生； 2) 使用现代屏蔽和 RT 门户，精子发生的恢复与治疗辐射剂量无关； (3)大多数接受治疗的想要孩子的患者能够怀孕； (4) 精子冷冻保存对于精原细胞瘤患者来说仍然是一个未得到充分利用的选择。
The purpose of this article is to assess the long-term fertility and attitudes towards fecundity in men after radical inguinal orchiectomy and radiation therapy (RT) for seminoma, and also to assess how often sperm cryopreservation is being offered to patients with seminoma prior to treatment. A retrospective review was conducted at 3 institutions (Wilford Hall Air Force Medical Center, Brooke Army Medical Center, and Fitzsimmons Army Medical Center) to identify patients who had undergone treatment of stage 1 or 2A seminoma during the period from 1975 to 1997. Seventy-three of 212 (34%) patients meeting the selection criteria of stage 1 or 2A seminoma provided information for this analysis. This was thought to be a good response rate, given that many of the patients had changed duty stations or had separated from the military by the time this study started. We performed a review of RT and tumor board records of 73 patients who were treated for testicular seminoma at selected treatment facilities from 1975 to 1997. Patients completed questionnaires and phone interviews that focused on prior fertility, the desire to father (more) children, other fertility-affecting factors (varicocele, cryptorchidism, infection, and erectile dysfunction), and incidence of physician counseling with regard to cryopreservation. All patients were asked to obtain a current semen analysis (SA). Eleven (15%) patients reported that they had tried to father children since completion of their RT. Seven of 11 (64%) successfully achieved pregnancy within a mean time of 3.5 years since RT (range: 1 month to 5 years). Of the 4 couples that were not successful, 1 had severe female factor infertility problems and a second had organic erectile dysfunction. A third had a past surgical history remarkable for vasectomy with subsequent vasectomy reversal. Nine patients provided SA. Mean sperm count and motility were 24.2 Mil/mL (range: 5-81 Mil/mL) and 63.1% (range: 30-90%), respectively (normal SA values: count = 20-250 Mil/mL, motility >50%, and volume = 1.5-5.0 mL). No patients were azoospermic. Overall mean time interval from radiation therapy was 7.9 years. Radiation dose and time since RT did not correlate with either SA results or conception. Only 16 of 73 (22%) men had been offered pretreatment sperm cryopreservation by their counseling physician. It is concluded that (1) patients who are treated for early stage seminoma by orchiectomy and RT have greater than a 50% chance of regaining normal semen parameters, and all regain at least some spermatogenesis; 2) recovery of spermatogenesis is not related to therapeutic radiation dose with the use of modern shielding and RT portals; (3) the majority of treated patients who desire children can conceive; and (4) sperm cryopreservation remains an underutilized option for seminoma patients.