Dynamics of fertility impairment in childhood brain tumour survivors.
OBJECTIVE
Fertility impairment and recovery after chemo- and radiotherapy have been reported in both male and female childhood cancer survivors, but little is known about the dynamics. Our aim, therefore, was to describe the development of fertility impairment and possible recovery in childhood brain tumour survivors.


METHODS
In this longitudinal study, we included 144 survivors, who were treated in two German paediatric oncology centres between 2000 and 2005. Fertility parameters were retrieved from medical records up to 12 years after diagnosis.


RESULTS
Participants with age ≥13 years and formerly cranial irradiation ≥30 Gray (n = 23), including 83 % (n = 19) with craniospinal irradiation ≥30 Gray, had a higher median FSH concentration compared to 29 patients without chemoradiotherapy: 8.3 IU/l (IQR 6.5-11.2) versus 4.1 IU/l (IQR 3.2-5.1) 2 years after initial treatment; 8.9 IU/l (IQR 8.5-10.8) versus 4.2 IU/l (IQR 2.4-6.7) after 8 years; and 7.1 IU/l (IQR 6.7-7.7) versus 3.5 IU/l (IQR 2.8-4.2) after 10 years. Altogether, 11/65 women reported the occurrence of amenorrhoea 6.0 years (range 1-10) after diagnosis. Five of these women later developed a regular menstrual cycle without hormone replacement therapy. Patients' chance of recovery from fertility impairment was increased with time since diagnosis (p = 0.074).


CONCLUSIONS
Signs of fertility impairment such as amenorrhoea and elevated FSH levels were observed at variable time points between 1 and 12 years after chemoradiotherapy. Decreasing FSH levels were observed 1-7 years after elevation and were interpreted either as an atrophy of the pituitary gland or as recovery from fertility impairment.
Department of Paediatric Oncology/Haematology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Pädiatrie m. S. Onkologie/Hämatologie/Stammzelltransplantation, Augustenburger Platz 1, Mittelallee 6a, 13353, Berlin, Germany.
C
C
Pfitzer
C-M
CM
Chen
T
T
Wessel
T
T
Keil
A
A
Sörgel
T
T
Langer
D
D
Steinmann
A
A
Borgmann-Staudt
D000328:Adult; D000367:Age Factors; D000568:Amenorrhea / Q000209:etiology; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D001932:Brain Neoplasms / Q000628:therapy*; D002648:Child; D016371:Cranial Irradiation / Q000009:adverse effects*; D005260:Female; D005298:Fertility / Q000187:drug effects* / Q000528:radiation effects*; D005640:Follicle Stimulating Hormone / Q000097:blood; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007246:Infertility / Q000097:blood* / Q000453:epidemiology / Q000209:etiology*; D008137:Longitudinal Studies; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D009929:Organ Size; D010053:Ovary / Q000187:drug effects / Q000528:radiation effects; D011879:Radiotherapy Dosage; D012075:Remission, Spontaneous; D017741:Survivors; D013737:Testis / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects; D013997:Time Factors
D000970:Antineoplastic Agents; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone