Gonadal Function of Patients Treated With Cisplatin Based Chemotherapy for Germ Cell Cancer

Brennemann, W.; Stoffel‐Wagner, Birgit; Helmers, Andrew; Mezger, J.; Jager, Nynke G L; Klingmüller, Dietrich

doi:10.1016/s0022-5347(01)64333-7

Cited by 92 publications

(51 citation statements)

References 18 publications

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“…Previous studies have suggested greater dysfunction in patients receiving higher doses of cisplatin chemotherapy Bokemeyer et al, 1996;Gerl et al, 1997), vinblastine Bokemeyer et al, 1996) and ifosphamide (Brennemann et al, 1997). The majority of our chemotherapy-treated patients received etoposide rather than ifosphamide-or vinblastine-based chemotherapy and additionally almost a third of our patients received carboplatin rather than cisplatin.…”

Section: Discussionmentioning

confidence: 57%

“…A number of studies have shown that the gonadal dysfunction is greatest immediately after chemotherapy (Stuart et al, 1990;Brennemann et al, 1997Brennemann et al, , 1998. For instance, Brennemann et al (1997) in a cross-sectional study showed a higher rate of elevated LH and FSH levels in the first year compared to the number measured after 8 years of follow-up (LH 32% vs 3.6%, FSH 89% vs 64%). As the median follow-up of our cohort is over 10 years, this lower level of dysfunction may reflect that a degree of recovery of the pituitarygonadal axis has occurred with time.…”

Section: Discussionmentioning

confidence: 99%

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Fertility, gonadal and sexual function in survivors of testicular cancer

et al. 2005

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Modern treatments cure most testicular cancer patients, so an important goal is to minimise toxicity. Fertility and sexual functioning are key issues for patients. We have evaluated these outcomes in a cross-sectional study of long-term survivors of testicular cancer. In total, 680 patients treated between 1982 and 1992 completed the EORTC Qly-C-30(qc30) questionnaire, the associated testicular cancer specific module and a general health and fertility questionnaire. Patients have been subdivided according to treatment received: orchidectomy either alone (surveillance, S n ¼ 169), with chemotherapy (C, n ¼ 272), radiotherapy (R, n ¼ 158), or both chemotherapy and radiotherapy (C/RT n ¼ 81). In the surveillance group, 6% of patients had an elevated LH, 41% an elevated FSH and 11% a low (o10 nmol l À1 ) testosterone. Hormonal function deteriorated with additional treatment, but the effect in general was small. Low testosterone was more common in the C/RT group (37% P ¼ 0.006), FSH abnormalities were more common after chemotherapy (C 49%, C/RT 71% both Po0.005) and LH abnormalities after radiotherapy (11% Po0.01) and chemotherapy (10%, Po0.001). Baseline hormone data were available for 367 patients. After treatment, compared to baseline, patients receiving chemotherapy had significantly greater elevations of FSH (median rise of 6 (IQR 3 -9.25) iu l À1 compared to 3 (IQR 1 -5) iu l À1 for S; Po0.001) and a fall (compared to a rise in the surveillance group) in median testosterone levels (À2 (IQR À8.0 to À1.5) vs 1.0. (IQR À4.0 -4.0) Po0.001). Patients with low testosterone (but not elevated FSH) had lower quality of life scores related to sexual functioning on the testicular cancer specific module and lower physical, social and role functioning on the EORTC Qly C-30. Patients with a low testosterone also had higher body mass index and blood pressure. Treatment was associated with reduction in sexual activity and patients receiving chemotherapy had more concerns about fathering children. In total, 207 (30%) patients reported attempting conception of whom 159 (77%) were successful and a further 10 patients were successful after infertility treatment with an overall success rate of 82%. There was a lower overall success rate after chemotherapy (C 71%; CRT 67% compared to S 85% (P ¼ 0.028)). Elevated FSH levels were associated with reduced fertility (normal FSH 91% vs elevated 68% Po0.001). In summary, gonadal dysfunction is common in patients with a history of testicular cancer even when managed by orchidectomy alone. Treatment with chemotherapy in particular can result in additional impairment. Gonadal dysfunction reduces quality of life and has an adverse effect on patient health. Most patients retain their fertility, but the risk of infertility is likely to be increased by chemotherapy. Screening for gonadal dysfunction should be considered in the follow-up of testicular cancer survivors. Testicular cancer is the most common cancer of young men in their 20s and 30s. Since the advent of effective multiagent cisplatinu...

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Fertility, gonadal and sexual function in survivors of testicular cancer

et al. 2005

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“…19 A compensated impairment of the Leydig cell function could be observed up to 60 months following chemotherapy. Meanwhile, 68% of the patients showed increased FSH levels, indicating that spermatogenesis is more severely impaired than steroidogenesis.…”

Section: Discussionmentioning

confidence: 91%

Effects of oncological treatments on semen quality in patients with testicular neoplasia or lymphoproliferative disorders

Bisceglie¹,

Bertagna²,

Composto³

et al. 2013

Asian J Androl

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Pretherapy sperm cryopreservation in young men is currently included in good clinical practice guidelines for cancer patients. The aim of this paper is to outline the effects of different oncological treatments on semen quality in patients with testicular neoplasia or lymphoproliferative disorders, based on an 8-year experience of the Cryopreservation Centre of a large public hospital. Two hundred and sixty-one patients with testicular neoplasia and 219 patients with lymphoproliferative disorders who underwent chemotherapy and/or radiotherapy and pretherapy semen cryopreservation were evaluated. Sperm and hormonal parameters (follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, inhibin B levels) were assessed prior to and 6, 12, 18, 24 and 36 months after the end of cancer treatment. At the time of sperm collection, baseline FSH level and sperm concentration were impaired to a greater extent in patients with malignant testicular neoplasias than in patients with lymphoproliferative disorders. Toxic effects on spermatogenesis were still evident at 6 and 12 months after the end of cancer therapies, while an improvement of seminal parameters was observed after 18 months. In conclusion, an overall increase in sperm concentration was recorded about 18 months after the end of cancer treatments in the majority of patients, even if it was not possible to predict the evolution of each single case 'a priori '. For this reason, pretherapy semen cryopreservation should be considered in all young cancer patients.

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“…The issue of testosterone levels in men treated for TGCC was previously addressed by others (23)(24)(25). However, these studies did not clearly discriminate between treatment modalities and/or the post-treatment investigations were not performed at specific time points, allowing for more precise mapping of the process of Leydig cell recovery (Tables 3 and 4).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for post-treatment hypogonadism in testicular cancer patients.

Eberhard

Ståhl

Cwikiel

et al. 2008

European Journal of Endocrinology

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Objectives: Testicular germ-cell cancer (TGCC) patients are at risk of developing hypogonadism but no risk factors have yet been defined. Methods: Blood was collected from 143 TGCC patients (after orchidectomy, prior to further therapy (T0) and 6, 12, 24, 36 and 60 months (T6, T12, T24, T36 and T60) after therapy). Biological hypogonadism (BH) was defined as: serum testosterone below 10 nmol/l and/or LH O10 IU/l; odds ratios (ORs) for BH with BH at T0, age, stage of disease, testicular characteristics, and androgen receptor polymorphism as predictors were calculated as well as the OR for developing BH post-treatment (one to two cycles of adjuvant chemotherapy (ACT) versus three to four cycles of higher dose chemotherapy (HCT) versus adjuvant radiotherapy (RT)). Results: HCT increased the OR for BH at T6 (OR 22, 95% confidence interval (CI) 4.4-118) and T12 (OR 5.8, 95% CI 1.5-22). RT increased the OR at T6 (OR 10, 95% CI 2.1-47) and at T12 (OR 3.9, 95% CI 1.1-14). Microlithiasis predicted BH at T0 (OR 11, 95% CI 1.2-112), T12 (OR 3.9, 95% CI 1.1-13), T24 (OR 3.0, 95% CI 1.0-8.8), T36 (OR 5.4, 95% CI 1.7-17) and T60 (OR 4.4, 95% CI 1.2-16). BH at T0 was a risk for BH at T6 (OR 53,, T12 (OR 125, 95% CI 37-430), T24 (OR 88, 95% CI 26-300) and T36 (OR 121, 95% CI 32-460). Conclusions: It is clinically relevant that BH at T0 and testicular microlithiasis were predictive factors for post-treatment BH. HCT and RT gave temporary BH.

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Gonadal Function of Patients Treated With Cisplatin Based Chemotherapy for Germ Cell Cancer

Cited by 92 publications

References 18 publications

Fertility, gonadal and sexual function in survivors of testicular cancer

Fertility, gonadal and sexual function in survivors of testicular cancer

Effects of oncological treatments on semen quality in patients with testicular neoplasia or lymphoproliferative disorders

Risk factors for post-treatment hypogonadism in testicular cancer patients.

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