Utility of pediatric female fertility preservation discussions following pelvic radiation

  • Rebecca M. Rentea
  • Ashwini S. Poola
  • Joy M. Fulbright
  • Shawn D. St. Peter
  • Sohail R. Shah
Original Article



While many childhood cancers are curable with therapy, adverse consequences in fertility exist. We sought to assess the number of female patients with pelvic tumors receiving radiation therapy, and the proportion that undergo measures for fertility preservation (FP).


A total of 53 female patients treated with pelvic tumors from 2000 to 2016 were retrospectively identified.


19 (34%) of these patients underwent pelvic radiation therapy (pXRT). Three of the patients received pXRT for palliative treatment. Of the 19 female patients receiving pXRT, six (31%) were prepubertal and 13 (68%) were postpubertal. Three patients (16%) had documentation of a discussion of FP measures prior to pXRT. One was prepubertal and the others were post-pubertal. Six patients (32%) were evaluated by endocrinology after radiation therapy, diagnosed with ovarian failure, and placed on hormone therapy. Current guidelines recommend discussion of FP in pre-and postpubertal patients with cancer. This 16-year retrospective review of female patients that underwent pXRT for pelvic tumors demonstrated < 17% of patients have documentation of a discussion of FP measures.


Female pediatric patients who underwent chemotherapy and pXRT suffer a high rate of premature ovarian failure, high morbidity and mortality as well as low rates of documented FP discussions. Based on these findings we have established a multi-disciplinary fertility preservation team available for consultation and a protocol for discussing and documenting the impact of pXRT, along with other treatments, on fertility.

Level of evidence



Pelvic radiation Fertility preservation Chemotherapy Ovarian function Pelvic tumor 



The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Author contributions

Study conception and design: ASP, JMF, and SRS. Acquisition of data: RMR and ASP. Analysis and interpretation of data: RMR, SDS, JMF and SRS. Drafting of manuscript: RMR and SRS. Critical revision of manuscript: RMR, SDS and SRS.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.


  1. 1.
    Gatta G, Zigon G, Capocaccia R, Coebergh JW, Desandes E, Kaatsch P, Pastore G, Peris-Bonet R, Stiller CA (2009) Survival of European children and young adults with cancer diagnosed 1995–2002. Eur J Cancer (Oxford: 1990) 45(6):992–1005.  https://doi.org/10.1016/j.ejca.2008.11.042 CrossRefGoogle Scholar
  2. 2.
    Leisenring WM, Mertens AC, Armstrong GT, Stovall MA, Neglia JP, Lanctot JQ, Boice JD Jr, Whitton JA, Yasui Y (2009) Pediatric cancer survivorship research: experience of the childhood cancer survivor study. J Clin Oncol 27(14):2319–2327.  https://doi.org/10.1200/jco.2008.21.1813 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Fallat ME, Hutter J (2008) Preservation of fertility in pediatric and adolescent patients with cancer. Pediatrics 121(5):e1461–e1469.  https://doi.org/10.1542/peds.2008-0593 CrossRefPubMedGoogle Scholar
  4. 4.
    Loren AW, Mangu PB, Beck LN, Brennan L, Magdalinski AJ, Partridge AH, Quinn G, Wallace WH, Oktay K (2013) Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 31(19):2500–2510.  https://doi.org/10.1200/jco.2013.49.2678 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Campbell JE, Assanasen C, Robinson RD, Knudtson JF (2016) Fertility preservation counseling for pediatric and adolescent cancer patients. J Adolesc Young Adult Oncol 5(1):58–63.  https://doi.org/10.1089/jayao.2015.0040 CrossRefPubMedGoogle Scholar
  6. 6.
    Shnorhavorian M, Harlan LC, Smith AW, Keegan THM, Lynch CF, Prasad PK, Cress RD, Wu X-C, Hamilton AS, Parsons HM, Keel G, Charlesworth SE, Schwartz SM (2015) Fertility preservation knowledge, counseling, and actions among adolescent and young adult patients with cancer: a population-based study. Cancer 121(19):3499–3506.  https://doi.org/10.1002/cncr.29328 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Waring AB, Wallace WHB (2000) Subfertility following treatment for childhood cancer. Hospital Medicine 61(8):550–557.  https://doi.org/10.12968/hosp.2000.61.8.1398 CrossRefPubMedGoogle Scholar
  8. 8.
    Ogilvy-Stuart AL, Shalet SM (1993) Effect of radiation on the human reproductive system. Environ Health Perspect 101(Suppl 2):109–116.  https://doi.org/10.1289/ehp.93101s2109 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Sonmezer M, Oktay K (2004) Fertility preservation in female patients. Hum Reprod Update 10(3):251–266.  https://doi.org/10.1093/humupd/dmh021 CrossRefPubMedGoogle Scholar
  10. 10.
    Wallace WHB, Thomson AB, Saran F, Kelsey TW (2005) Predicting age of ovarian failure after radiation to a field that includes the ovaries. Int J Radiat Oncol Biol Phys 62(3):738–744.  https://doi.org/10.1016/j.ijrobp.2004.11.038 CrossRefPubMedGoogle Scholar
  11. 11.
    Long CJ, Ginsberg JP, Kolon TF (2016) Fertility preservation in children and adolescents with cancer. Urology 91:190–196.  https://doi.org/10.1016/j.urology.2015.10.047 CrossRefPubMedGoogle Scholar
  12. 12.
    Runco DV, Taylor JF, Helft PR (2017) Ethical barriers in adolescent oncofertility counseling. J Pediatr Hematol Oncol 39(1):56–61.  https://doi.org/10.1097/mph.0000000000000713 CrossRefPubMedGoogle Scholar
  13. 13.
    Green DM, Kawashima T, Stovall M, Leisenring W, Sklar CA, Mertens AC, Donaldson SS, Byrne J, Robison LL (2009) Fertility of female survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol 27(16):2677–2685.  https://doi.org/10.1200/JCO.2008.20.1541 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Taylor JF, Ott MA (2016) Fertility preservation after a cancer diagnosis: a systematic review of adolescents’, parents’, and providers’ perspectives, experiences, and preferences. J Pediatr Adolesc Gynecol 29(6):585–598.  https://doi.org/10.1016/j.jpag.2016.04.005 CrossRefPubMedGoogle Scholar
  15. 15.
    Raciborska A, Bilska K, Filipp E, Drabko K, Rogowska E, Chaber R, Pogorzala M, Polczynska K, Adrianowska N, Rodriguez-Galindo C, Maciejewski T (2015) Ovarian function in female survivors after multimodal Ewing sarcoma therapy. Pediatr Blood Cancer 62(2):341–345.  https://doi.org/10.1002/pbc.25304 CrossRefPubMedGoogle Scholar
  16. 16.
    Burns KC, Hoefgen H, Strine A, Dasgupta R (2018) Fertility preservation options in pediatric and adolescent patients with cancer. Cancer.  https://doi.org/10.1002/cncr.31255 PubMedGoogle Scholar
  17. 17.
    Demeestere I, Simon P, Dedeken L, Moffa F, Tsepelidis S, Brachet C, Delbaere A, Devreker F, Ferster A (2015) Live birth after autograft of ovarian tissue cryopreserved during childhood. Hum Reprod (Oxf Engl) 30(9):2107–2109.  https://doi.org/10.1093/humrep/dev128 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryChildren’s Mercy Hospital-University of Missouri Kansas CityKansas CityUSA
  2. 2.Department of Hematology and OncologyChildren’s Mercy Hospital-University of Missouri Kansas CityKansas CityUSA
  3. 3.Division of Pediatric SurgeryTexas Children’s Hospital/Baylor College of MedicineHoustonUSA

Personalised recommendations