Resume
Parmi les agents anti-cancéreux, ceux qui interagissent directement avec l'ADN sont les plus toxiques pour les cellules de la lignée germinale. L'atteinte de ces cellules est essentiellement le fait des agents alkylants dont la toxicité est dose-dépendante. La rapidité et la qualité de récupération de la spermatogénèse est essentiellement fonction de la sévérité de l'atteinte des spermatogonies souches. Les études expérimentales conduites chez la souris et le rat ont permis de progresser dans la connaissance des mécanismes de la toxicité germinale des agents cytotoxiques, mais ces données ne sont pas toujours superposables à celles observées en clinique. Les études ont essentiellement été conduites chez les patients porteurs de tumeurs germinales du testicule ou de maladie de Hodgkin. Du fait de leur curabilité potentielle et de leur fréquente survenue chez le sujet jeune, elles représentent en effet les situations cliniques dans lesquelles il est essentiel d'essayer de préserver la fertilité du sujet. Le choix des protocoles chimiothérapiques les moins toxiques pour la lignée germinale, à résultat thérapeutique équivalent, est actuellement un moyen de réduire au maximum le risque d'azoospermie définitive. Ce risque n'est cependant jamais nul justifiant le recours systématique à l'auto-conservation de gamètes avant toute chimiothérapie chez un sujet susceptible de développer un projet de paternité.
Abstract
Among the chemotherapeutic drugs, those interacting with DNA are the more toxic for the germinal epithelium. Alkylating agents heavily affect these germ cells with a dose dependant toxicity. The incidence of recovery and length of time to recover normal spermatogenesis depend on the extent of damage to earlier forms of the germ cells. Experimental studies conducted on rodents improved the knowledge of the toxic mechanism of the drugs, which are in fact quite different of the clinical situation. Preservation of fertility is essential in hodgkin's disease and testis cancer because of their high curability rate and their incidence in young people.
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Chevreau, C., Huguet, F. Chimiothérapie anticancéreuse et fertilité masculine. Androl. 5, 458–464 (1995). https://doi.org/10.1007/BF03034529
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DOI: https://doi.org/10.1007/BF03034529