QL-24 * FERTILITY PRESERVATION IN PATIENTS WITH PRIMARY BRAIN TUMORS (PBTS)

Abstract

BACKGROUND: There have been modest gains in survival of younger patients with PBTs. Given their improving prognosis, more patients of child-bearing age see procreation as feasible. The goals of this study were to describe the patients referred for fertility preservation (FP) counseling, determine which patients pursued FP, and investigate the fertility outcomes of these patients. METHODS: This was an IRB-approved retrospective review of PBT patients, ages 18-45, who were referred for FP counseling with a nurse specialist between 2009-2013. RESULTS: There were 69 patients referred for FP counseling: 38 men (mean age 32.9) and 31 women (mean age 31.9). Median KPS was 90. Eighty-eight percent had gliomas; 57% grade III and 17% grade IV. Other tumor types included CNS lymphoma, ependymoma, meningioma, and pineoblastoma. Sixty-seven percent were referred for counseling at initial diagnosis, while 33% were referred at recurrence/progressive disease. Of the patients referred for counseling, 50 (73%) pursued referral to a sperm bank or reproductive endocrinologist (87% of men, 55% of women). There was no statistically significant difference in referral acceptance by age, race, marital status, religion, or tumor grade. Patients were more likely to accept referral if they had no prior children (p = 0.048). After treatment with chemotherapy (including temozolomide and lomustine) and radiation, three men conceived naturally and two men conceived using banked sperm. Two women conceived naturally, one after radiation therapy and one with an untreated low grade glioma. No women conceived from cryopreserved eggs or embryos to date. CONCLUSIONS: Despite the historically poor prognosis of patients with PBTs, there is significant interest in FP among these patients, particularly if they have no prior children. Therefore, oncology clinicians must develop strategies to incorporate FP counseling into practice. Further investigation into clinician referral patterns, patient satisfaction with information provided about fertility, and outcomes of FP is warranted.