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Dynamics of fertility impairment in childhood brain tumour survivors

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Purpose

Fertility impairment and recovery after chemo- and radiotherapy have been reported in both male and female childhood cancer survivors, but little is known about the dynamics. Our aim, therefore, was to describe the development of fertility impairment and possible recovery in childhood brain tumour survivors.

Methods

In this longitudinal study, we included 144 survivors, who were treated in two German paediatric oncology centres between 2000 and 2005. Fertility parameters were retrieved from medical records up to 12 years after diagnosis.

Results

Participants with age ≥13 years and formerly cranial irradiation ≥30 Gray (n = 23), including 83 % (n = 19) with craniospinal irradiation ≥30 Gray, had a higher median FSH concentration compared to 29 patients without chemoradiotherapy: 8.3 IU/l (IQR 6.5–11.2) versus 4.1 IU/l (IQR 3.2–5.1) 2 years after initial treatment; 8.9 IU/l (IQR 8.5–10.8) versus 4.2 IU/l (IQR 2.4–6.7) after 8 years; and 7.1 IU/l (IQR 6.7–7.7) versus 3.5 IU/l (IQR 2.8–4.2) after 10 years. Altogether, 11/65 women reported the occurrence of amenorrhoea 6.0 years (range 1–10) after diagnosis. Five of these women later developed a regular menstrual cycle without hormone replacement therapy. Patients’ chance of recovery from fertility impairment was increased with time since diagnosis (p = 0.074).

Conclusion

Signs of fertility impairment such as amenorrhoea and elevated FSH levels were observed at variable time points between 1 and 12 years after chemoradiotherapy. Decreasing FSH levels were observed 1–7 years after elevation and were interpreted either as an atrophy of the pituitary gland or as recovery from fertility impairment.

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Acknowledgments

This longitudinal study was supported by the Berliner Krebsgesellschaft e.V., the Kind Philipp Foundation for Leukaemia Research (Kind-Philipp-Stiftung für Leukämieforschung) in the Association of Sponsors for the Promotion of German Science (Stifterverband für die Deutsche Wissenschaft) and by the Charité University Medical Center Berlin. We are grateful to Dr. Birgit Spors for analysing the MRI scans.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standard

All human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Authors and Affiliations

  1. Department of Paediatric Oncology/Haematology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Pädiatrie m. S. Onkologie/Hämatologie/Stammzelltransplantation, Augustenburger Platz 1, Mittelallee 6a, 13353, Berlin, Germany

    C. Pfitzer & A. Borgmann-Staudt

  2. Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany

    C.-M. Chen & T. Keil

  3. Berlin School of Public Health (BSPH), Charité - Universitätsmedizin Berlin, Berlin, Germany

    C.-M. Chen

  4. Department of Paediatric Endocrinology, Charité – Universitätsmedizin Berlin, Berlin, Germany

    T. Wessel

  5. Department of Immunology and Oncology, Department of Paediatrics, Erlangen University Hospital, Erlangen, Germany

    A. Sörgel & T. Langer

  6. Department of Radiotherapy and Special Oncology, Hannover Medical School, Hannover, Germany

    D. Steinmann

  7. Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany

    T. Keil

  8. Department of Radiotherapy, University Hospital of Münster, Münster, Germany

    D. Steinmann

Authors
  1. C. Pfitzer
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  2. C.-M. Chen
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  3. T. Wessel
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  4. T. Keil
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  5. A. Sörgel
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  6. T. Langer
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  7. D. Steinmann
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  8. A. Borgmann-Staudt
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Corresponding author

Correspondence to A. Borgmann-Staudt.

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Pfitzer, C., Chen, CM., Wessel, T. et al. Dynamics of fertility impairment in childhood brain tumour survivors. J Cancer Res Clin Oncol 140, 1759–1767 (2014). https://doi.org/10.1007/s00432-014-1702-7

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  • DOI: https://doi.org/10.1007/s00432-014-1702-7

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