Fertility of female survivors of childhood cancer: A report from the Childhood Cancer Survivor study Journal Article


Authors: Green, D. M.; Kawashima, T.; Stovall, M.; Leisenring, W.; Sklar, C. A.; Mertens, A. C.; Donaldson, S. S.; Byrne, J.; Robison, L. L.
Article Title: Fertility of female survivors of childhood cancer: A report from the Childhood Cancer Survivor study
Abstract: Purpose This study was undertaken to determine the effect, if any, of treatment for cancer diagnosed during childhood or adolescence on fertility. Patients and Methods We reviewed the fertility of female participants in the Childhood Cancer Survivor Study (CCSS), which consisted of 5-year survivors, and a cohort of randomly selected siblings who responded to a questionnaire. Medical records of all members of the cohort were abstracted to obtain chemotherapeutic agents administered; the cumulative dose of drug administered for several drugs of interest; and the doses, volumes, and dates of administration of all radiation therapy. Results There were 5,149 female CCSS participants, and there were 1,441 female siblings of CCSS participants who were age 15 to 44 years. The relative risk (RR) for survivors of ever being pregnant was 0.81 (95% CI, 0.73 to 0.90; P<.001) compared with female siblings. In multivariate models among survivors only, those who received a hypothalamic/pituitary radiation dose >= 30 Gy (RR, 0.61; 95% CI, 0.44 to 0.83) or an ovarian/uterine radiation dose greater than 5 Gy were less likely to have ever been pregnant (RR, 0.56 for 5 to 10 Gy; 95% CI, 0.37 to 0.85; RR, 0.18 for >10 Gy; 95% CI, 0.13 to 0.26). Those with a summed alkylating agent dose (AAD) score of three or four or who were treated with lomustine or cyclophosphamide were less likely to have ever been pregnant. Conclusion This large study demonstrated that fertility is decreased among female CCSS participants. The risk factors identified may be utilized for pretreatment counseling of patients and their parents. J Clin Oncol 27:2677-2685. (C) 2009 by American Society of Clinical Oncology
Keywords: cranial irradiation; irradiation; reconstruction; long-term survivors; acute lymphoblastic-leukemia; hodgkins-disease; total-body; ovarian failure; gonadal-function; abdominal irradiation; pubertal development; dose
Journal Title: Journal of Clinical Oncology
Volume: 27
Issue: 16
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2009-06-01
Start Page: 2677
End Page: 2685
Language: English
ACCESSION: ISI:000266454600018
DOI: 10.1200/jco.2008.20.1541
PROVIDER: wos
PMCID: PMC2690392
PUBMED: 19364965
Notes: --- - Article - "Source: Wos"
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  1. Charles A Sklar
    271 Sklar