Gonadal Dysfunction After Radiotherapy

  • Michaela Riepl
  • Silvia Reitz
Chapter
Part of the Medical Radiology book series (MEDRAD)

Abstract

Up to now there has been little attention paid to the long-term side effects of cancer treatment on gonadal function. However, there are now more long-time survivors, particularly younger patients, who worry about their sexual function and fertility. Gonadal dysfunction following cancer therapy is influenced not only by radiotherapy to the tumor itself, but also by anatomic, physiological and endocrine processes as well as by the patient’s psychology and behavior. The tumor may involve the gonads or the hormone producing glands. Surgical therapy may include ovarectomy, (semi) castration, or resection of pituitary tissue, impairing sexual function or hormonal status. Radical retroperitoneal lymph node dissection may cause retrograde ejaculation or impotence in men (Gerl et al. 1993). Most therapy regimens also include chemotherapy and many cytotoxic drugs, particularly al- kylating agents (Viviani et al. 1985; Chapman et al. 1979), cause severe and permanent disturbances in both testicular and ovarian function (Waxman et al. 1982). Moreover, psychological aspects, such as family, relationships, and social responses to the tumor also play an important role.

Keywords

Acute Lymphoblastic Leukemia Total Body Irradiation Ovarian Function Ovarian Failure Gonadal Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Ash P (1980) The influence of radiation on fertility in man. Br J Radiol 53: 271–278PubMedCrossRefGoogle Scholar
  2. Barth V, Hums R (1990) Serumhormone und Spermiogramm-veränderungen bei Patienten mit malignen Hodentumoren nach Strahlen-und Zytostatikatherapie. Z Urol Nephrol 83: 291–295PubMedGoogle Scholar
  3. Belinson JL, Doherty M, McDay JB (1984) A new technique for ovarian transposition. Surg Gynecol Obstet 139: 157–160Google Scholar
  4. Blatt J, Poplack DG, Sherins RJ (1981) Testicular function in boys after chemotherapy for acute lymphoblastic leukemia. N Engl J Med 304: 1121–1124PubMedCrossRefGoogle Scholar
  5. Brauner R, Czernichow P, Cramer P, Schaison G, Rappa-port R (1983) Leydig-cell function in children after direct testicular irradiation for acute lymphoblastic leukemia. N Engl J Med 309: 25–28PubMedCrossRefGoogle Scholar
  6. Byrne J, Mulvihill JJ, Myers MH et al (1987) Effects of treatment on fertility. N Engl J Med 317: 1315–1321PubMedCrossRefGoogle Scholar
  7. Byrne J, Mulvihill JJ, Conelly RR et al (1988) Reproductive problems and birth defects in survivors of Wilm’s tumor and their relatives. Med Pediatr Oncol 16: 233–240PubMedCrossRefGoogle Scholar
  8. Chambers SK, Chambers JT, Kier R, Peschel RE (1991) Sequelae of lateral ovarian transposition in irradiated cervical cancer patients. Int J Radiat Oncol Biol Phys 20: 1305–1308PubMedCrossRefGoogle Scholar
  9. Chapman RM, Sutcliffe SB (1981) Protection of ovarian function by oral contraceptives in women receiving chemotherapy for Hodgkin’s disease. Blood 58: 849–851PubMedGoogle Scholar
  10. Chapman RM, Sutcliffe SB (1986) The effects of chemotherapy and radiotherapy on fertility and their prevention. Rec Adv Clin Oncol 2: 239–251Google Scholar
  11. Chapman RM, Sutcliffe SB, Malpas JS (1979) Cytotoxic-induced ovarian failure in women with Hodgkin’s disease. I. Hormone function. JAMA 242: 1877–1881PubMedCrossRefGoogle Scholar
  12. Constine LS, Woolf PD, Cann D, Mick G, McCormick K, Raubertas RF, Rubin P (1993) Hypothalamic-pituitary dysfunction after radiation for brain tumors. N Engl J Med 328: 87–94PubMedCrossRefGoogle Scholar
  13. Fossa SD, Klepp O, Aakvaag A, Moine K (1980) Testicular function after combined chemotherapy for metastatic testicular cancer. Int J Androl 3: 59–65PubMedCrossRefGoogle Scholar
  14. Fraas BA, Kinsella TJ, Harrington FS, Glatstein E (1985) Peripheral dose to the testes: the design and clinical use of a practical and effective gonadal shield. Int J Radiat Oncol Biol Phys 11: 609–615CrossRefGoogle Scholar
  15. Fritz-Niggli H (1991) Strahlengefährdung/Strahlenschutz. Ein Leitfaden für die Praxis, 3rd edn. Huber, BernGoogle Scholar
  16. Gaetini A, DeSimone M, Urgesi A, Levis A, Resegotti A, Ragona R, Anglesio S (1988) Lateal high ovaropexy: An original surgical technique for protection of the ovaries during curative radiotherapy for Hodgkin’s disease. J Surg Oncol 39: 22–28PubMedCrossRefGoogle Scholar
  17. Gerl A, Clemm C, Wilmanns W (1993) Gonadale Funktionsstörungen nach Therapie von Hodentumoren. Dtsch Med Wochenschr 118:683PubMedGoogle Scholar
  18. Giri N, Vowels MR, Barr AL, Mameghan H (1992) Successful pregnancy after total body irradiation and bone marrow transplantation for acute leukaemia. Bone Marrow Transplant 10: 93–95PubMedGoogle Scholar
  19. Grabenbauer GG, Sauer R (1991) Hodenseminome-Zielvolumen, Dosierung und Technik der externen Radiotherapie. Bildgebung 58 [Suppl1]: 53–55PubMedGoogle Scholar
  20. Grabenbauer GG, Girke P, Wildt L, Müller RG, Herbst M, Sauer R (1991) Ovaropexie und die Behandlung des Morbus Hodgkin. Strahlenther Oncol 167: 273–276Google Scholar
  21. Greiner R (1982) Die Erholung der Spermatogenese nach fraktionierter, niedrig dosierter Bestrahlung der männlichen Gonaden. Strahlentherapie 158(6): 342–355PubMedGoogle Scholar
  22. Greiner R (1985) Wirkung der Strahlen-und Chemotherapie auf die Gonadenfunktion. Münch Med Wochenschr 127: 870–874Google Scholar
  23. Hahn EW, Feingold SM, Simpson L, Batata M (1982) Recovery from aspermia induced by low-dose radiation in seminoma patients. Cancer 50: 337–340PubMedCrossRefGoogle Scholar
  24. Haie-Meder C, Mlika-Cabanne N, Michel G et al (1993) Radiotherapy after ovarian transposition: ovarian function and fertility preservation. Int J Radiat Oncol Biol Phys 25: 419–424PubMedCrossRefGoogle Scholar
  25. Hamre MR, Robinson LL, Nesbit ME, Sather HN, Meadows AT, Ortega JA (1987) Effects of radiation on ovarian function in long-term survivors of childhood acute lymphoblastic leukemia: a report from the Childrens Cancer Study Group. J Clin Oncol 5: 1759–1765PubMedGoogle Scholar
  26. Hawkins MM, Smith RA (1989) Pregnancy outcomes in childhood cancer survivors: probable effects of abdominal irradiation. Int J Cancer 43: 399–402PubMedCrossRefGoogle Scholar
  27. Heller CG, Wootton P, Rowley MJ, Lalli M, Brusca DR (1966) Action of radiation on human spermatogenesis. Exc Med Found Int Congr Ser 112: 408–410Google Scholar
  28. Horning SJ, Hoppe RT, Kaplan HS, Rosenberg SA (1981) Female reproductive potential after treatment for Hodg-kin’s disease. N Engl J Med 304: 1377–1382PubMedCrossRefGoogle Scholar
  29. Jewett MA, Thachil JV, Harris JF (1983) Exocrine function of testis with germinal testicular tumor. Br Med J 286: 1849–1850CrossRefGoogle Scholar
  30. Kimmig B, Kober B, Fehrentz D (1980) Gonadenbelastung bei der Strahlentherapie des retroperitonealen Lymphsystems. Therapiewoche 30: 3445–3448Google Scholar
  31. Kubo H, Shipley WU (1982) Reduction of the scatter dose to the testicle outside the radiation treatment fields. Int J Radiat Oncol Biol Phys 8: 1741–1745PubMedCrossRefGoogle Scholar
  32. Lam KS, Tse VK, Wang C, Veung RT, Ho JH (1991) Effects of cranial irradiation on hypothalamic-pituitary function — a 5-year longitudinal study in patients with nasopharyngeal carcinoma. Q J Med 78(287): 165–176PubMedGoogle Scholar
  33. Leporrier M, von Theobald P, Roffe JL, Muller G (1987) A new technique to protect ovarian function before pelvic irradiation. Cancer 60: 2201–2204PubMedCrossRefGoogle Scholar
  34. Lintern-Moore S, Peters H, Moore GPM, Faber M (1974) Follicular development in the infant human ovary. J Reprod Fertil 39: 53–64PubMedCrossRefGoogle Scholar
  35. Littley MD, Shaley SM, Morgenstern GR, Deakin DP (1991) Endocrine and reproductive dysfunction following fractionated total body irradiation in adults. Q J Med 78(287): 265–274PubMedGoogle Scholar
  36. Lushbaugh CC, Casarett GW (1976) The effects of gonadal irradiation in clinical radiation therapy: a review. Cancer 37: 1111–1120PubMedCrossRefGoogle Scholar
  37. Nahhas WA, Nisce LZ, D’Angio GJ, Lewis JL (1971) Lateral ovarian transposition. Obstet Gynecol 38: 785–788PubMedCrossRefGoogle Scholar
  38. Nicholson HS, Byrne J (1983) Fertility and pregnancy after treatment for cancer during childhood or adolescence. Cancer 71: 3392–3399CrossRefGoogle Scholar
  39. Oakberg EF (1956) A description of spermatogenesis in the mouse and the use in analysis of the cycle of the seminiferous epithelium. Am J Anat 99: 507–516PubMedCrossRefGoogle Scholar
  40. Ogilvy-Stuart AL, Clark DJ, Wallace WH, Gibson BE, Stevens RF, Shalet SM, Donaldson MD (1992) Endocrine deficit after fractionated total body irradiation. Arch Dis Child 67: 1107–1110PubMedCrossRefGoogle Scholar
  41. Ray GR, Trueblood HW, Enright LP, Kaplan HS, Nelsen TS (1970) Oophoropexy: a means of preserving ovarian function following pelvic megavoltage radiotherapy for Hodgkin’s disease. Radiology 96: 175–180PubMedGoogle Scholar
  42. Redman J, Davis R, Evenson D et al (1986) Prospective randomized trial of testosterone cypionate to prevent sterility in men treated with chemotherapy for Hodgkin’s disease: Preliminary results. In: Proceedings of the 14th international cancer congress, Budapest. Karger, Basel, p440Google Scholar
  43. Rowley MJ, Leach DR, Warner GA, Heller CG (1974) Effects of graded doses of ionizing radiation on the human testis. Radiat Res 59: 665–678PubMedCrossRefGoogle Scholar
  44. Sandemann TF (1966) The effects of X-irradiation on male human fertility. Br J Radiol 39: 901–907CrossRefGoogle Scholar
  45. Shalet SM, Hann IM, Lendon M, Morris Jones PH, Beardwell CG (1981) Testicular function after combination chemotherapy in childhood for acute lymphoblastic leukemia. Arch Dis Child 56: 275–278PubMedCrossRefGoogle Scholar
  46. Shalet SM, Tsatsoulis A, Whitehead E, Read G (1989) Vulnerability of the human Leydig cell to radiation damage is dependent upon age. J Endocrinol 120: 161–165PubMedCrossRefGoogle Scholar
  47. Sherins RJ (1993) Gonadal dysfunction. In: De Vita, Hell-man, Rosenberg (eds) Cancer, principles and practice in oncology, 4th edn. Lippincott, Philadelphia, pp 2395–2406Google Scholar
  48. Thomas PRM, Winstantly D, Peckham MJ, Austin DE, Murray MAF, Jacobs HS (1976) Reproductive and endocrine function in patients with Hodgkin’s disease: effects of oophoropexy and irradiation. Br J Cancer 33: 226–231PubMedCrossRefGoogle Scholar
  49. UNSCEAR — United Nations Scientific Committee on the Effects of Atomic Radiation (1988) Sources, effects and risks of ionizing radiation. Report to the General Assembly, with annexes. United Nations Publications, New York, p 35Google Scholar
  50. Viviani S, Santoro A, Ragni G, Bonfante V, Bestetti O, Bonadonna G (1985) Gonadal toxicity after combination chemotherapy for Hodgkin’s disease: comparative results of MOPP and ABVD. Eur J Clin Oncol 21: 601–605CrossRefGoogle Scholar
  51. Waxman JH, Terry YA, Wrigley PFM, Malpas JS, Rees LH, Besser GM, Lister TA (1982) Gonadal function in Hodgkin’s disease: long-term follow-up of chemotherapy. Br Med J 285: 1612–1613CrossRefGoogle Scholar
  52. Weissbach L, Lange CE, Rodermund CE, Zwicker A, Gropp A, Pothmann W (1974) Fertilitätsstörungen bei behandelten Hodentumorpatienten. Urologe [A] 13: 80–85Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • Michaela Riepl
    • 1
  • Silvia Reitz
    • 2
  1. 1.Strahlentherapeutische Klinik und PoliklinikUniversität Erlangen-NürnbergErlangenGermany
  2. 2.Institut und Poliklinik für StrahlentherapieTechnische UniversitätMünchenGermany

Personalised recommendations