Impact of cytotoxic treatment on long-term fertility in patients with germ-cell cancer

More than half of the patients with testicular germ-cell cancer show impair ed spermatogenesis before undergoing cytotoxic treatment The known pre-trea tment infertility and the reversibility of the fertility problems observed in some after successful anti-cancer treatment have so far prevented an ass essment of the true role of cytotoxic therapy in long-term fertility, The i ntroduction of wait and-see strategies (surveillance) for testicular cancer patients and recent prospective trials comparing patients with and without cytotoxic treatment have provided the means for estimating the extent to w hich treatment itself affects long-term fertility. Whether or not spermatog enesis is irreversibly impaired by chemotherapy is determined by the cumula tive dose of cisplatin: at doses below 400 mg/m(2) long-term effects on spe rm production as well as on endocrine function are unlikely to occur. Highe r doses should be expected to cause long-term losses of exocrine and endocr ine gonadal function. In contrast, for adjuvant retroperitoneal radiotherap y in stage I seminoma patients, no data are available comparing long-term g onadal function with patients on surveillance. However, using modern radiat ion techniques, radiation doses to the para-aortic field (<30 Gy) and testi s shielding providing testis scatter radiation (<30 cG), radiation-induced impairment of fertility is very unlikely. (C) 1999 Wiley-Liss, Inc.