Utility of pediatric female fertility preservation discussions following pelvic radiation
- 97 Downloads
While many childhood cancers are curable with therapy, adverse consequences in fertility exist. We sought to assess the number of female patients with pelvic tumors receiving radiation therapy, and the proportion that undergo measures for fertility preservation (FP).
A total of 53 female patients treated with pelvic tumors from 2000 to 2016 were retrospectively identified.
19 (34%) of these patients underwent pelvic radiation therapy (pXRT). Three of the patients received pXRT for palliative treatment. Of the 19 female patients receiving pXRT, six (31%) were prepubertal and 13 (68%) were postpubertal. Three patients (16%) had documentation of a discussion of FP measures prior to pXRT. One was prepubertal and the others were post-pubertal. Six patients (32%) were evaluated by endocrinology after radiation therapy, diagnosed with ovarian failure, and placed on hormone therapy. Current guidelines recommend discussion of FP in pre-and postpubertal patients with cancer. This 16-year retrospective review of female patients that underwent pXRT for pelvic tumors demonstrated < 17% of patients have documentation of a discussion of FP measures.
Female pediatric patients who underwent chemotherapy and pXRT suffer a high rate of premature ovarian failure, high morbidity and mortality as well as low rates of documented FP discussions. Based on these findings we have established a multi-disciplinary fertility preservation team available for consultation and a protocol for discussing and documenting the impact of pXRT, along with other treatments, on fertility.
Level of evidence
KeywordsPelvic radiation Fertility preservation Chemotherapy Ovarian function Pelvic tumor
The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
Study conception and design: ASP, JMF, and SRS. Acquisition of data: RMR and ASP. Analysis and interpretation of data: RMR, SDS, JMF and SRS. Drafting of manuscript: RMR and SRS. Critical revision of manuscript: RMR, SDS and SRS.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
- 1.Gatta G, Zigon G, Capocaccia R, Coebergh JW, Desandes E, Kaatsch P, Pastore G, Peris-Bonet R, Stiller CA (2009) Survival of European children and young adults with cancer diagnosed 1995–2002. Eur J Cancer (Oxford: 1990) 45(6):992–1005. https://doi.org/10.1016/j.ejca.2008.11.042 CrossRefGoogle Scholar
- 2.Leisenring WM, Mertens AC, Armstrong GT, Stovall MA, Neglia JP, Lanctot JQ, Boice JD Jr, Whitton JA, Yasui Y (2009) Pediatric cancer survivorship research: experience of the childhood cancer survivor study. J Clin Oncol 27(14):2319–2327. https://doi.org/10.1200/jco.2008.21.1813 CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Loren AW, Mangu PB, Beck LN, Brennan L, Magdalinski AJ, Partridge AH, Quinn G, Wallace WH, Oktay K (2013) Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 31(19):2500–2510. https://doi.org/10.1200/jco.2013.49.2678 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Shnorhavorian M, Harlan LC, Smith AW, Keegan THM, Lynch CF, Prasad PK, Cress RD, Wu X-C, Hamilton AS, Parsons HM, Keel G, Charlesworth SE, Schwartz SM (2015) Fertility preservation knowledge, counseling, and actions among adolescent and young adult patients with cancer: a population-based study. Cancer 121(19):3499–3506. https://doi.org/10.1002/cncr.29328 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Green DM, Kawashima T, Stovall M, Leisenring W, Sklar CA, Mertens AC, Donaldson SS, Byrne J, Robison LL (2009) Fertility of female survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol 27(16):2677–2685. https://doi.org/10.1200/JCO.2008.20.1541 CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Taylor JF, Ott MA (2016) Fertility preservation after a cancer diagnosis: a systematic review of adolescents’, parents’, and providers’ perspectives, experiences, and preferences. J Pediatr Adolesc Gynecol 29(6):585–598. https://doi.org/10.1016/j.jpag.2016.04.005 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Raciborska A, Bilska K, Filipp E, Drabko K, Rogowska E, Chaber R, Pogorzala M, Polczynska K, Adrianowska N, Rodriguez-Galindo C, Maciejewski T (2015) Ovarian function in female survivors after multimodal Ewing sarcoma therapy. Pediatr Blood Cancer 62(2):341–345. https://doi.org/10.1002/pbc.25304 CrossRefPubMedGoogle Scholar