Endocrine Abstracts

Introduction: Survival rates in childhood cancer survivors (CCS) have enormously increased in the last 40 years. However, this improvement has been achieved at the expense of serious late effects, including the potential for severe gonadal damage. Here we report the effects of anticancer therapies on gonadal function in male long-term survivors of childhood cancer.

Methods: We estimated, at the last follow up available, the prevalence of primary hypogonadism, central hypogonadism and spermatogenesis damage in 151 male CCS mainly treated for hematologic malignancies (72%), brain tumors (13%) or sarcomas (7%). Since CCS are often reluctant to provide semen sample, in the absence of semen analysis we considered to have spermatogenesis damage all male patients with FSH values >10 IU/l and/or inhibin B <100 pg/ml. Statistical analysis was performed comparing the prevalence of gonadal dysfunction by treatments and some patient characteristics, using the χ² test.

Result: Mean age at the last follow up was 25.6 years (S.D.=5.1). Median follow-up time was 16.0 years. At the last follow-up visit, 69 patients (46%, CI=38–54) showed gonadal dysfunction. Central hypogonadism was found in four brain tumor and in one acute lymphoblastic leukemia survivors who underwent cranial irradiation. Primary hypogonadism was found in 14 patients, mainly cured for hematologic malignancies (71%) or medulloblastoma (14%), all of them treated with radiation therapy involving the testis. Spermatogenesis damage was found in 50 CCS (33%). The main risk factors for gonadal dysfunction were radiation therapy involving the testis, busulfan, platinum-based chemotherapy agents, cyclophosphamide and hematopoietic cell transplantation (Fig. 1).

Conclusion: Male CCS have a very high risk to develop impaired spermatogenesis and, to a lower extent, primary or central hypogonadism. Semen cryopreservation is mandatory in post-pubertal patients. Moreover, new reliable techniques of fertility preservation in pre-pubertal males are needed.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.