Abstract
Childhood cancer treatments can cause female reproductive late effects. Radiation to the hypothalamic-pituitary-ovarian axis is associated with altered menarche, miscarriage, and implantation failure. Patients who receive chemotherapy and/or ovarian radiation are at risk of premature ovarian failure; the risk increases with increasing radiation dose, alkylating agent score, combination therapy, and older age at treatment. Ovarian reserve may be assessed using antimullerian hormone assay and ultrasound measurements of ovarian volume and antral follicle count; however, their efficacy is poorly established in this cohort. Fertility preservation options including cryopreservation, oophoropexy, and gonadotropin-releasing hormone analogues may be initiated prior to treatment, although most are still considered experimental. Uterine radiation has been linked to pregnancy complications including miscarriage, premature delivery, stillbirth, low-birth-weight and small-for-gestational-age infants. This paper summarises the literature on female reproductive late effects. The information should facilitate counseling and management of female survivors throughout their reproductive lives.
Highlights
Cancer is the second commonest cause of death in children in developed countries [1]
The purpose of this paper is to summarise the literature regarding the influence of childhood cancer therapies on female reproductive late effects, measures to assess ovarian reserve, and options for fertility preservation
Previous studies have demonstrated ovarian doses >10 Gy to be linked to a high risk of acute ovarian failure (AOF), especially doses >20 Gy which are associated with the highest rate, with over 70% of a study cohort of 3390 survivors developing AOF [34]
Summary
Cancer is the second commonest cause of death in children in developed countries [1]. Common childhood cancers include leukaemia, lymphoma, rhabdomyosarcoma, neuroblastoma, Wilms’ tumour, central nervous system tumours, and germ cell tumours [2, 3]. Most of these cancers are curable using chemotherapy, radiotherapy, or surgery, either alone or in combination [2, 4]. Late effects can either arise during treatment or shortly thereafter to persist as chronic conditions They may manifest years after the completion of therapy [4]. The purpose of this paper is to summarise the literature regarding the influence of childhood cancer therapies on female reproductive late effects, measures to assess ovarian reserve, and options for fertility preservation. Relevant references cited by the obtained literature were acquired independently
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