Reproductive outcomes for survivors of childhood cancer.
Reproductive outcomes for survivors of childhood cancer.
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DOI：
10.1097/aog.0b013e3181f87c4b
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发表时间：
2010-11
影响因子：
7.2
通讯作者：
Hudson MM
中科院分区：
文献类型：
--
作者：
Hudson MM
由于儿科癌症治疗的显著进展，预计80%的儿童和青少年诊断患有癌症的长期生存率。不孕症仍然是儿童时期接受癌症治疗的成年人经历的最常见和改变生活的并发症之一。手术、放疗或化疗对下丘脑-垂体-性腺轴的任何组成部分都有负面影响，可能会影响儿童癌症幸存者的生殖结局。不孕的风险一般与癌症涉及的组织或器官以及细胞毒性治疗的具体类型、剂量和组合有关。除了抗癌治疗外，治疗时的年龄、性别和可能的遗传因素也会影响永久性不孕的风险。在可能的情况下，当代方案限制细胞毒性治疗的累积剂量，以优化生殖潜力。如果需要进行绝育治疗来控制癌症，则应在开始治疗前探索生育力保护措施。对于保持生育能力的儿童癌症幸存者来说，癌症治疗对后代造成的健康风险是主要问题。辐射对卵巢和子宫功能的影响与妊娠并发症有关，包括自然流产、早产、胎位不正和低出生体重。先天性畸形、遗传性疾病和癌症的风险似乎很低，但具有生殖系癌症易感突变的幸存者所生后代的癌症风险除外。本文综述了影响儿童癌症幸存者生育和妊娠结局的癌症治疗因素的研究。所提供的数据应有助于提供预防性咨询和年龄和性别适当的干预措施，以优化儿童癌症幸存者的生殖结果。
Due to remarkable progress in therapy for pediatric cancer, long-term survival is expected for 80% of children and adolescents diagnosed with cancer. Infertility remains one of the most common and life-altering complications experienced by adults treated for cancer during childhood. Surgery, radiation, or chemotherapy that negatively affects any component of the hypothalamic-pituitary-gonadal axis may compromise reproductive outcomes in childhood cancer survivors. The risk of infertility is generally related to the tissues or organs involved in cancer and the specific type, dose, and combination of cytotoxic therapy. In addition to anticancer therapy, age at treatment, sex, and likely genetic factors influence the risk of permanent infertility. When possible, contemporary protocols limit cumulative doses of cytotoxic therapy in an effort to optimize reproductive potential. If sterilizing therapy is required for cancer control, fertility preservation measures should be explored before initiation of therapy. For childhood cancer survivors who maintain fertility, health risks to offspring resulting from their cancer treatment are major concerns. Radiation affecting ovarian and uterine function has been linked to pregnancy complications including spontaneous abortion, preterm labor, fetal malposition and low birth weight. The risk of congenital malformations, genetic disorders, and cancer appears to be low, with the exception of cancer risk in offspring born to survivors with germline cancer-predisposing mutations. This review will summarize research about cancer treatment factors impacting fertility and pregnancy outcomes of childhood cancer survivors. The data presented should facilitate the delivery of preventive counseling and age- and gender-appropriate interventions to optimize reproductive outcomes in childhood cancer survivors.