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Impact of chemotherapy and radiotherapy in childhood on fertility in adulthood: the FeCt—survey of childhood cancer survivors in Germany

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Abstract

Purpose

Improved treatment for childhood cancer has led to better survival rates of 83 % today. However, long-term side effects including infertility of pediatric patients receiving oncologic treatment remain unclear. We examined the association of chemotherapy and radiotherapy with infertility in survivors of pediatric cancer.

Methods

A questionnaire on fertility was sent to adult survivors listed in the German Childhood Cancer Registry. Fertility status was defined based on information on attempts to conceive, pregnancies, births, menstrual cycle and previous fertility test results.

Results

Therapeutic data were obtained from treatment optimization trials. We included 618 childhood cancer survivors (384 women) who reported information allowing us to classify their current fertility status as ‘fertile/probably fertile’ or ‘probably infertile’. Thirty-one percent of 83 female and 29 % of 117 male survivors reported infertility based on previous fertility tests. ‘Probably infertile’ adult survivors were more likely to have received pelvic radiotherapy (women: adjusted OR 20.24, 95 % CI 4.69–87.29; men: 12.22; 1.18–126.70) than those who were ‘fertile/probably fertile’. Etoposide, particularly ≥5,000 mg/m2 in women, and carboplatin and/or cisplatin in both sexes seemed to have independent risk potential for infertility. Similarly, cancer treatment during or post-puberty compared to treatment before puberty showed a trend toward increased infertility, particularly in male survivors.

Conclusions

Patients and families need to be informed about fertility-preserving measures prior to and also after chemotherapy and radiotherapy.

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Abbreviations

CI:

Confidence interval

GCCR:

German Childhood Cancer Registry

GPOH:

German Society for Pediatric Oncology and Hematology

Gy:

Gray

OR:

Odds ratio

SPSS:

Statistical Package for the Social Sciences

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Acknowledgments

This nationwide survey was supported by the German Childhood Cancer Foundation (Deutsche Kinderkrebsstiftung). This endowment has the purpose of improving the outcome, treatment and the quality of life of children suffering from cancer by making a significant contribution to optimizing treatment by funding projects aiming to reduce late effects and the evaluation of new approaches to treatment. Furthermore, the study was supported by the Charité University Medical Center in Berlin and the Kind-Philipp Foundation for research in Leukemia (Kind-Philipp-Stiftung für Leukämieforschung) in the Association of Sponsors for the Promotion of German Science (Stifterverband für die Deutsche Wissenschaft) by granting a PhD scholarship. We are grateful to Irene Jung and Dr. Peter Kaatsch of the German Childhood Cancer Registry, Institute of Medical Epidemiology, Biometrics and Informatics (IMBEI), at the University Medical Center of the Johannes-Gutenberg-University Mainz; to all study teams of the German Treatment Optimization Trials; and to all study participants.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Pediatric Oncology/Hematology/Stem Cell Transplantation, Charité University Medical Center Berlin, Campus Virchow-Klinikum, Otto-Heubner-Centrum für Kinder- und Jugendmedizin, Augustenburger Platz 1, Mittelallee 6a, 13353, Berlin, Germany

    Simone Reinmuth, Rosa Rendtorff, Magdalena Balcerek, Günter Henze & Anja Borgmann-Staudt

  2. Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center Berlin, 10098, Berlin, Germany

    Cynthia Hohmann, Steve Holzhausen & Thomas Keil

  3. Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstraße 21-23, 91054, Erlangen, Germany

    Andreas Müller

  4. Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97080, Würzburg, Germany

    Thomas Keil

Authors
  1. Simone Reinmuth
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  2. Cynthia Hohmann
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  3. Rosa Rendtorff
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  4. Magdalena Balcerek
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  5. Steve Holzhausen
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  6. Andreas Müller
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  7. Günter Henze
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  8. Thomas Keil
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  9. Anja Borgmann-Staudt
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Corresponding author

Correspondence to Anja Borgmann-Staudt.

Additional information

Thomas Keil and Anja Borgmann-Staudt have contributed equally to this work.

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Reinmuth, S., Hohmann, C., Rendtorff, R. et al. Impact of chemotherapy and radiotherapy in childhood on fertility in adulthood: the FeCt—survey of childhood cancer survivors in Germany. J Cancer Res Clin Oncol 139, 2071–2078 (2013). https://doi.org/10.1007/s00432-013-1527-9

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  • DOI: https://doi.org/10.1007/s00432-013-1527-9

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