Childhood cancer survivors can be at risk for developing the following gonadal late effects:
- Precocious Puberty
- Gonadatropin Deficiency
- Ovarian Dysfuction
- Testicular Dysfunction
- 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
- Smoking
|
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
|
|
Head/Brain
|
X
|
>30
Gy
Include TBI in total dose calculation
|
|
|
|
|
|
Neck
|
|
|
|
|
|
|
|
Thorax
|
|
|
|
|
|
|
|
Abdomen
|
|
|
X
|
X
|
|
X
|
Vaginal fibrosis
|
Pelvis
|
|
|
X
|
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)
|
|
|
|
|
|
|
X
|
Surgery/Other
|
Precocious Puberty
|
Gonadatropin Deficiency
|
Ovarian Dysfunction
|
Testicular Dysfunction
|
Infertility
|
Uterine Vascular Insufficiency
|
Sexual Dysfunction
|
Oophoropexy
|
|
|
|
|
X
|
|
X
|
Orchiectomy
|
|
|
|
X
|
X
|
|
|
Spinal Cord Surgery
|
|
|
|
|
|
|
X
|
Pelvic Surgery
|
|
|
|
|
|
|
X
|
Hysterectomy
|
|
|
|
|
|
|
X
|
|