Ovarian function in female survivors after multimodal Ewing sarcoma therapy.
With advances in cancer care, more young women with Ewing sarcoma (ES) survive after treatment. Thus, we sought to analyze the ovarian function in prepubertal, pubertal and postpubertal females and young women receiving multimodal therapy for ES, and to identify patients at risk of infertility on whom fertility preservation would be indicated.



Twenty-seven female survivors of ES were included in this retrospective multiinstitutional study. Patients were classified into four groups according to the treatment received: chemotherapy (CHT) without pelvic radiation (pRT), chemotherapy and pRT, CHT and autologous hematopoietic cell stem rescue (aHSCT) without pRT, and CHT + pRT + aHSCT. The ovarian function and fertility outcomes were analyzed.



At a median follow-up of 5.7 years from diagnosis, and at median age at follow-up of 16.3 years, 67% of the survivors had premature ovarian insufficiency, including all patients receiving pelvic RT and 87.5% of patients who underwent aHSCT, independent of chemoprotection. Thirty-seven percent of patients had a clinical syndrome of premature menopause. The relative risk (RR) of premature ovarian insufficiency of a survivor was 3.9 (p 0.03) for pRT, and 2.4 (p 0.07) for aHSCT. On multivariate analysis, radiation therapy was a significant predictor of higher risk of premature ovarian insufficiency over chemotherapy alone.



A large proportion of women receiving multimodal therapy for ES develop premature ovarian insufficiency. Patients and guardians should be informed about the reproductive potential and strategies for preservation of ovarian function should be considered individually. Pediatr Blood Cancer 2015;62:341-345. © 2014 Wiley Periodicals, Inc.
Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland.
Anna
A
Raciborska
Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland.
Katarzyna
K
Bilska
Department of Obstetrics and Gynecology, Institute of Mother and Child, Warsaw, Poland.
Ewa
E
Filipp
Department of Pediatric Hematology, Oncology and Transplant, Medical University of Lublin, Lublin, Poland.
Katarzyna
K
Drabko
Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland.
Elżbieta
E
Rogowska
Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland.
Radosław
R
Chaber
Department of Pediatric Hematology and Oncology Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
Monika
M
Pogorzała
Department of Pediatric Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland.
Katarzyna
K
Połczyńska
Department of Paediatric Hematology and Oncology, Medical University of Lodz, Lodz, Poland.
Natalia
N
Adrianowska
Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts.
Carlos
C
Rodriguez-Galindo
Department of Obstetrics and Gynecology, Institute of Mother and Child, Warsaw, Poland.
Tomasz
T
Maciejewski
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000009:adverse effects*; D005260:Female; D005298:Fertility / Q000187:drug effects* / Q000528:radiation effects*; D059247:Fertility Preservation / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008594:Menopause, Premature / Q000502:physiology*; D010053:Ovary / Q000502:physiology; D016649:Primary Ovarian Insufficiency / Q000503:physiopathology*; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000628:therapy*; D055815:Young Adult
D000970:Antineoplastic Agents
Ewing sarcoma; chemotherapy; ovarian function; radiotherapy