Endocrine Abstracts

Introduction: Effects on fertility have been seen as important late effects of treatment for childhood cancer.

Aim: To evaluate the impact of chemotherapy and radiotherapy treatment for childhood medulloblastoma on gonadal function.

Methods: Retrospective cohort study of all children treated for medulloblastoma (diagnosed from 2–18 years) in a single institution in the UK between 1983–2011 and a minimum relapse-free survival of two years. Data were obtained from medical records, including treatment and assessment of gonadal function (history, examination and biochemical assessment).

Results: Twenty four children treated for medulloblastoma between 1983 and 2011, with >2 years EFS (event free survival) were identified through a clinic database. Information was available on 20 patients (males n=12), median age 8.3 (range 2.4–13.4) years and disease free survival 14.3 (range 5.7–24) years. Treatment involved craniospinal irradiation (CSI; dose 32.5 Gy, 24–35 Gy) for all patients (n=20). Thirteen of these patients received additional chemotherapy (CT) including CCNU (doses 505 mg/m², range 150–720), the majority of them following the ‘PACKER’ protocol.

Of the 20 survivors 10 (50%) had impaired gonadal function. Three (15%) had hypogonadotrophic hypogonadism (HH). Seven patients (35%) had primary gonadal impairment (males n=3), all of which had received CT and CSI.

Of the 13 patients treated with CT and CSI, 54% (7) had primary gonadal impairment. No patients treated with CSI alone, developed primary gonadal impairment.

Discussion: The results show that 54% of children treated for medulloblastoma with CT and CSI have developed primary gonadal impairment. Primary gonadal impairment was not seen following CSI alone, although HH is widely recognized.

Long-term follow up in patients who received CT for medulloblastoma is therefore necessary to monitor their gonadal function. Fertility preservation, where possible, should be considered in patients receiving CT for medulloblastoma.