Impact of Cranial Irradiation and Brain Tumor Location on Fertility: a Survey

 

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Abstract

Background:

As survival rates of patients with childhood brain tumors have increased to 75%, treatment related side effects are of particular importance. The present study evaluated questionnaire-based fertility characteristics in cancer survivors treated with irradiation to the hypo­thalamic-pituitary-axis.

Patients and Methods:

A nationwide survey was conducted in collaboration with the German Childhood Cancer Registry. Questionnaire and treatment data could be retrieved for 1110 former childhood cancer patients with cranial irradiation and/or chemotherapy.

Results:

Survivors receiving ≥30 gray vs. 18–29 gray and 0–17 gray to the pituitary gland reported less pregnancies or less with their partners (7.4% vs. 32.8% vs. 12.4%; p<0.001), were more often infertile (40% vs. 9.4% vs. 12.5%; p<0.001) and the female participants, had a higher frequency of permanent amenorrhea (16.7% vs. 1.7% vs. 0%; p<0.001).

Conclusion:

Irradiation of the pituitary gland ≥ 30 gray seemed to be associated with less pregnancies and increased permanent amenorrhea in women. Future studies need to be conducted to confirm these results. Increased knowledge of treatment related side effects might help brain tumor patients to improve their family planning if necessary by gonadotropine replacement.

Zusammenfassung

Hintergrund:

Durch steigende Überlebensraten von bis zu 75% bei Patienten mit Hirntumor im Kindesalter rücken Nebenwirkungen der Krebs­behandlung immer mehr in den Mittelpunkt des Interesses. Die vorliegende Studie beschreibt, basierend auf Fragebogendaten, die Fertilität bei Überlebenden nach einer Krebserkrankung mit Bestrahlung auf die Hypothalamus-Hyphophysen-Achse.

Patienten und Methode:

Es wurde eine bundesweite Umfrage in Zusammenarbeit mit dem deutschen Kinderkrebsregister durchgeführt. Fragebogen- und Behandlungsdaten konnten für 1 110 jetzt erwachsene ehemalige Kinderkrebs­patienten mit einer Schädelbestrahlung und/ oder Chemotherapie erhoben werden.

Ergebnisse:

Überlebende mit einer Bestrah­lungsdosis ≥30 Gray auf die Hypophyse (bzw. deren Partnerinnen) waren im Gegensatz zu Überlebenden, die 18–29 Gray bzw. 0–17 Gray erhielten, seltener schwanger (7,4% vs. 32,8% vs. 12,4%; p<0.001) und häufiger infertil (40% vs. 9,4% vs. 12,5%; p<0,001). Bei weiblichen Überlebenden fand sich häufiger eine permanente Amenorrhö (16,7% vs. 1,7% vs. 0%; p<0,001).

Schlussfolgerung:

Eine Bestrahlung der Hypophyse ≥ 30 Gray scheint mit einer geringeren Schwangerschaftsrate und, bei Frauen, einer erhöhten Rate an permanenter Amenorrhö assoziiert zu sein. Zukünftige Studien sollten durchgeführt werden, um die dargestellten Ergebnisse zu bestätigen. Bessere Kenntnisse über Nebenwirkungen der Krebsbehandlung bei ehemaligen Hirntumorpatienten können deren Familienplanung positiv beeinflussen, gegebenenfalls mit der Gabe von Gonadotropinen.

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