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Infertility QuickFact

Childhood cancer survivors can be at risk for the following gonadal late effects:

  • Precocious Puberty
  • Gonadatropin Deficiency
  • Testicular Deficiency
  • Ovarian Deficiency
  • Infertility
  • Uterine Vascular Insufficiency
  • Sexual Dysfunction

 

If your patient does not have a Survivor Healthcare Plan (SHP), please refer him/her to the appropriate survivor clinic.

Important factors in determining risk for gonadal late effects:

  • Age of patient at time of treatment
  • Total dose of alkylator therapy
  • Total dose of radiation
  • Time since treatment
  • Smoking
  • Gender

 

 

Chemotherapy

Table 1

 

Precocious Puberty

Gonadatropin Deficiency

Ovarian Dysfunction

Testicular Dysfunction

Infertility

Uterine Vascular Insufficiency

Sexual Dysfunction

Alkylating Agents                    

Busulfan

Carmustine

   BCNU   

Chlorambucil Cyclophosphamide

   Cytoxan

Ifosphamide

Lomustine

   CCNU

Mechlorethamine

Melphalan

Procarbazine

Thiotepa

 

Dacarbazine

    DTIC

Temozolomide

 

 

 

X

 

X

 

X

 

 

Heavy Metals

Carboplatin

Cisplatin

 

 

 

 

X

 

X

 

X

 

 

Antimetabolites

Cytarabine

   Ara-C

Mercaptopurine

   6MP

Thioguanine

   6TG

Methotrexate

 

 

 

 

 

 

 

 

 

Anthracycline antibiotics

Daunorubicin

Doxorubicin

   Adriamycin

Epirubicin

Idarubicin

Mitoxantrone

 

 

 

 

 

 

 

 

 

 

Chemotherapy

Table 2

 

Precocious Puberty

Gonadatropin Deficiency

Ovarian Dysfunction

Testicular Dysfunction

Infertility

Uterine Vascular Insufficiency

Sexual Dysfunction

Anti-tumor antibiotics

Bleomycin

Dactinomycin

 

 

 

 

 

 

 

 

Corticosteroids

Dexamethasone

   Decadron

Prednisone

 

 

 

 

 

 

 

 

Enzymes

Asparaginase

 

 

 

 

 

 

 

 

Plant alkaloids

Vincristine

Vinblastine

 

 

 

 

 

 

 

 

Epipodophyllotoxins

Etoposide

   VP16

Teniposide

   VM26

 

 

 

 

 

 

 

 

 

Radiation

Precocious Puberty

Gonadatropin Deficiency

Ovarian Dysfunction

Testicular Dysfunction

Infertility

Uterine Vascular Insufficiency

Sexual Dysfunction

All Radiation                  

 

 

 

 

 

 

 

TBI

 

 

X

X

X 

X

 

Head/Brain

X

 > 30 Gy

 

Include TBI in total dose calculation

 

 

 

 

 

Neck

 

 

 

 

 

 

 

Thorax

 

 

 

 

 

 

 

Abdomen

 

 

X

> 20 Gy 

  X

X

Vaginal fibrosis

Pelvis

 

 

X

> 20 Gy 

 X 

 

X

Vaginal fibrosis

Extremity

 

 

 

 

 

 

 

 

Hematopoietic

Stem Cell Transplant

Precocious Puberty

Gonadatropin Deficiency

Ovarian Dysfunction

Testicular Dysfunction

Infertility

Uterine Vascular Insufficiency

Sexual Dysfunction

Hematopoietic

Stem Cell Transplant

 

 

 

 

 

 

 

Hematopoietic Stem Cell Transplant with ANY history of chronic Graft vs. Host Disease (GVHD)

 

 

 

 

 

 

 

Vaginal fibrosis 

Surgery/Other

Precocious Puberty

Gonadatropin Deficiency

Ovarian Dysfunction

Testicular Dysfunction

Infertility

Uterine Vascular Insufficiency

Sexual Dysfunction

Oophoropexy             

 

 

 

 

X 

 

X

Cystectomy            

X

Oopherectomy    

X

 

X 

   

Orchiectomy

 

 

 

X

X 

 

 

Spinal Cord Surgery

 

 

 

 

 

 

X

Pelvic Surgery

 

 

 

 

 

 

X

Hysterectomy

 

 

 

 

 

 

X

For recommendations on how to screen for all potential late effects, please refer to The Children’s Oncology Group Long-Term Follow-Up Guidelines.

 

Health Links- Teaching Handouts from The Children's Oncology Group  

Visit www.survivorshipguidelines.org  to find many of the Health Links translated into other languages.  

References:

Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, and related Health Links Version 4.0. October, 2013. www.survivorshipguidelines.org.

Source: Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta
Last Updated: 1/30/2015 4:06:45 PM
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