Childhood Cancer Therapy Affecting Reproductive Tissues
| . | Reproductive Effect . | Predisposing Therapy . | Modifying Factors . |
|---|---|---|---|
| Sex | |||
| Both | Altered pubertal timing (precocious, early, rapid tempo), delayed puberty, gonadotropin insufficiency or deficiency | Hypothalamic-pituitary radiation | Altered pubertal timing more common after low-dose radiation at 18–24 Gy, gonadotropin insufficiency more common after radiation at more than 30 Gy |
| Female | Acute ovarian failure (ovarian failure within 5 y of diagnosis), premature menopause (cessation of menses before age 40 y) | Alkylating-agent chemotherapy, radiation affecting the female reproductive system (whole abdomen, pelvis, lumbosacral spine, total body), oophorectomy | Older age at treatment due at higher risk |
| Uterine vascular insufficiency, uterine growth impairment | Radiation affecting the uterus (whole abdomen, pelvis, lumbosacral spine, total body) | History of Wilms tumor and associated Müllerian anomalies | |
| Vaginal fibrosis or stenosis | Radiation affecting the vagina | History of hypogonadism (estrogen insufficiency), history of chronic graft-versus-host disease | |
| Sexual dysfunction, dyspareunia | Pelvic surgery, hysterectomy, radiation affecting the uterus or vagina | History of hypogonadism (estrogen insufficiency) | |
| Spontaneous abortion, neonatal death, premature labor, neonate with low birth wt, fetal malposition | Radiation affecting the uterus (whole abdomen, pelvis, lumbosacral spine, total body) | History of Wilms tumor and associated Müllerian anomalies | |
| Male | Azoospermia oligospermia | Alkylating-agent chemotherapy, radiation affecting the male reproductive system (pelvic, testicular, total body), orchiectomy (bilateral) | Prepubertal status at treatment does not reduce risk |
| Retrograde ejaculation, anejaculation erectile dysfunction | Pelvic surgery (retroperitoneal node or tumor dissection, cystectomy, radical prostatectomy), radiation to pelvis, bladder, or spine | History of hypogonadism (androgen insufficiency) |
| . | Reproductive Effect . | Predisposing Therapy . | Modifying Factors . |
|---|---|---|---|
| Sex | |||
| Both | Altered pubertal timing (precocious, early, rapid tempo), delayed puberty, gonadotropin insufficiency or deficiency | Hypothalamic-pituitary radiation | Altered pubertal timing more common after low-dose radiation at 18–24 Gy, gonadotropin insufficiency more common after radiation at more than 30 Gy |
| Female | Acute ovarian failure (ovarian failure within 5 y of diagnosis), premature menopause (cessation of menses before age 40 y) | Alkylating-agent chemotherapy, radiation affecting the female reproductive system (whole abdomen, pelvis, lumbosacral spine, total body), oophorectomy | Older age at treatment due at higher risk |
| Uterine vascular insufficiency, uterine growth impairment | Radiation affecting the uterus (whole abdomen, pelvis, lumbosacral spine, total body) | History of Wilms tumor and associated Müllerian anomalies | |
| Vaginal fibrosis or stenosis | Radiation affecting the vagina | History of hypogonadism (estrogen insufficiency), history of chronic graft-versus-host disease | |
| Sexual dysfunction, dyspareunia | Pelvic surgery, hysterectomy, radiation affecting the uterus or vagina | History of hypogonadism (estrogen insufficiency) | |
| Spontaneous abortion, neonatal death, premature labor, neonate with low birth wt, fetal malposition | Radiation affecting the uterus (whole abdomen, pelvis, lumbosacral spine, total body) | History of Wilms tumor and associated Müllerian anomalies | |
| Male | Azoospermia oligospermia | Alkylating-agent chemotherapy, radiation affecting the male reproductive system (pelvic, testicular, total body), orchiectomy (bilateral) | Prepubertal status at treatment does not reduce risk |
| Retrograde ejaculation, anejaculation erectile dysfunction | Pelvic surgery (retroperitoneal node or tumor dissection, cystectomy, radical prostatectomy), radiation to pelvis, bladder, or spine | History of hypogonadism (androgen insufficiency) |
See www.survivorshipguidelines.org for health risks to other organs and tissues resulting from treatment of childhood cancer. Adapted, with permission from Elsevier, from Hudson MM. Survivors of childhood cancer: coming of age. Hematol Oncol Clin North Am. 2008;22(2):218.