C. Mustieles et al., MALE GONADAL-FUNCTION AFTER CHEMOTHERAPY IN SURVIVORS OF CHILDHOOD MALIGNANCY, Medical and pediatric oncology, 24(6), 1995, pp. 347-351
Investigations of adult patients have shown that chemotherapy causes g
onadal damage, but much less information is available about the impact
of chemotherapy on gonadal function in children with malignant diseas
e. At one time, being prepubertal during therapy was thought to confer
some protection against chemotherapy induced gonadal damage. However,
recent studies have indicated otherwise. We designed this study to as
sess gonadal function in 15 postpubertal males who had received polych
emotherapy for a malignant disease during childhood and we compared th
em with 13 control adults males. The mean age of the patients at the t
ime of the study was 18.2 +/- 3.6 years (range 13.8- 29.0), and when g
iven chemotherapy treatment was 10.2 +/- 3.0 years (range 6-16). At th
at time 12 were prepubertal and at the time of the study all were Tann
er V. The mean interval from the completion of treatment until the stu
dy was 6.42 years (range 2.0-16.5). All patients had received polychem
otherapy. We evaluated testicular size, sperm counts, LH and FSH after
GnRH test, and testosterone levels. Puberty had progressed normally i
n all patients. We found no significant differences in testosterone an
d basal LH levels between patients and controls. However, we detected
an appreciable-difference in peak LH levels (P < 0.05) and in basal an
d peak FSH levels (P < 0.001). Seven patients had exaggerated LH respo
nse to GnRH, indicating dysfunction of the Leydig cells. The results o
f semen analyses were: 8 patients had azoospermia, 3 oligospermia, and
1 patient had a normal semen analysis. All patients with semen abnorm
alities presented a basal and peak FSH higher than the mean +2 SD of t
he control group. In summary, we found no evidence of gonadal protecti
on in prepubertal patients. We found a high incidence of germinal cell
damage, whereas Leydig cell abnormalities were found less often. An e
ndocrine study of patients that have received chemotherapy is warrante
d. (C) 1995 Wiley-Liss, Inc.