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    Late Effects of Treatment for Childhood Cancer (PDQ®): Treatment - Health Professional Information [NCI] - Late Effects of the Reproductive System

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    Recovery of gonadal function after cytotoxic chemotherapy and radiation therapy is possible. Dutch investigators used inhibin B as a surrogate marker of gonadal function in a cross-sectional, retrospective study of 201 male survivors of childhood cancer, with median follow-up 15.7 years (range, 3-37 years) from diagnosis. The median inhibin B level among the cohort increased based on serial measurements performed over a median of 3.3 years (range, 0.7-11.3 years). The probability of recovery of the serum inhibin B level was significantly influenced by baseline inhibin B level, but not age at diagnosis, age at study evaluation, interval between discontinuation of treatment and study evaluation, gonadal radiation, and alkylating agent dose score. These results suggest that recovery can occur but not if inhibin B is already at a critically low level.[32] Inhibin B and follicle-stimulating hormone levels are correlated with sperm concentration and often used to estimate the presence of spermatogenesis, however, limitations in the specificity and positive predictive value of these tests have been reported.[33] Hence, male survivors should be advised that semen analysis is the most accurate assessment of adequacy of spermatogenesis.

    Ovary

    The frequency of ovarian failure after abdominal radiation therapy is related to both the age of the woman at the time of irradiation and the radiation therapy dose received by the ovaries. Whole-abdomen irradiation produces severe ovarian damage. Seventy-one percent of women in one series failed to enter puberty, and 26% had premature menopause after receiving whole-abdominal radiation therapy doses of 2,000 cGy to 3,000 cGy.[34] Other studies reported similar results in women treated with whole-abdomen irradiation [35] or craniospinal irradiation [36,37] during childhood.

    Ovarian function may be impaired after treatment with combination chemotherapy that includes an alkylating agent and procarbazine such as MOPP; MVPP (nitrogen mustard [mechlorethamine], vinblastine, procarbazine, and prednisone); ChlVPP (chlorambucil, vinblastine, procarbazine, and prednisone); MDP (doxorubicin, prednisone, procarbazine, vincristine, and cyclophosphamide); or the combination of COP (cyclophosphamide, vincristine, and procarbazine) with ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, and dacarbazine). Amenorrhea was reported in 11% after MOPP (2 of 18 girls treated at age 2 to 15 years), 31% after MDP (10 of 31 girls treated at age 9.0 to 15.2 years), and 13% after ChIVPP (3 of 23 girls treated at age 6.1 to 20.0 years),[16,38,39] but in 0% after COP/ABVD (0 of 17 girls treated at age 4 to 20 years).[40]

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