Testicular function following chemotherapy
Testicular function following chemotherapy
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DOI：
10.1093/humupd/7.4.363
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发表时间：
2001-07-01
影响因子：
13.3
通讯作者：
Shalet, SM
中科院分区：
文献类型：
--
作者：
Howell, SJ;Shalet, SM
睾丸功能障碍是许多恶性肿瘤治疗中使用的细胞毒性化疗的常见长期后遗症。睾丸功能受到影响的程度与剂量和药剂有关。用于淋巴瘤治疗的标准多药方案对生发上皮功能的影响已被广泛研究。在绝大多数患者中，含有丙卡巴肼的方案会导致无精子症，但较新形式的化疗的长期性腺毒性要小得多。在大多数男性中，骨髓移植前用作准备的大剂量化疗也与不可逆转的生发上皮衰竭有关。用顺铂和卡铂方案治疗睾丸癌导致大多数男性暂时性无精子症和少精子症，5年后80%恢复到正常精子症。也有证据表明，在接受细胞毒性药物治疗的一部分男性中，间质细胞轻度受损，尽管这一点的临床意义尚不清楚。在潜在的绝育治疗中，已经考虑了几种保留睾丸功能的方法。目前，精子库仍然是唯一被证实的方法，尽管通过激素操作来促进精子发生的恢复和睾丸生殖细胞的冷冻保存是未来的可能性。
Testicular dysfunction is a common long-term sequela of cytotoxic chemotherapy used in the treatment of many malignancies. The degree to which testicular function is affected is dose- and agent-dependent. The impact on germinal epithelial function of standard multi-agent regimens used in the treatment of lymphomas has been widely studied. Procarbazine-containing regimens result in azoospermia in the vast majority of patients, but much lesser degrees of long-term gonadotoxicity are apparent with the newer forms of chemotherapy. High-dose chemotherapy used as preparation before bone marrow transplant is also associated with irreversible germinal epithelial failure in the majority of men. Treatment of testicular cancer with cisplatin and carboplatin regimens leads to temporary azoo- and oligozoospermia in most men, with a recovery to normospermia in 80% by 5 years. There is also evidence of mild Leydig cell impairment in a proportion of men treated with cytotoxic agents, although the clinical significance of this is not clear. Several methods of preserving testicular function during potentially sterilizing treatment have been considered. At present, sperm banking remains the only proven method, although hormonal manipulation to enhance recovery of spermatogenesis and cryopreservation of testicular germ cells are possibilities for the future.