MALE GONADAL-FUNCTION AFTER CHEMOTHERAPY IN SURVIVORS OF CHILDHOOD MALIGNANCY

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.