Abstract
Testicular function was studied in 40 males treated in childhood for Hodgkin's disease at St Bartholomew's Hospital, and the Hospital for Sick Children, London, between 1971-1985. All patients were 16 years or over at evaluation, and off treatment more than 6 years. Basal FSH, LH and testosterone levels were measured. Testicular size was measured using a Prader orchidometer, and all patients were offered a seminal analysis. Twenty-eight patients were treated with chemotherapy, usually ChlVPP. Twenty-one also had radiotherapy, five below the diaphragm. Twelve patients were treated with radiotherapy alone (five below the diaphragm). Twenty-six of 28 patients treated with chemotherapy and three of five patients treated with radiotherapy alone below the diaphragm have elevated basal FSH levels, and 18 of these also have elevated basal LH levels. Median testicular volume is 11 ml (range 5-25 ml). Eleven of 13 patients investigated are azoospermic. All patients have normal testosterone levels, and normal secondary sexual characteristics. There is no biochemical evidence of healing of the damaged germinal epithelium with elevated FSH levels persisting up to 17 years from the end of therapy. These results indicate a high incidence of damage to the germinal epithelium in patients treated with ChlVPP chemotherapy and/or radiotherapy below the diaphragm. Appropriate counselling of these patients with regard to their reproductive capabilities is essential.
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- Brämswig J. H., Heimes U., Heiermann E., Schlegel W., Nieschlag E., Schellong G. The effects of different cumulative doses of chemotherapy on testicular function. Results in 75 patients treated for Hodgkin's disease during childhood or adolescence. Cancer. 1990 Mar 15;65(6):1298–1302. doi: 10.1002/1097-0142(19900315)65:6<1298::aid-cncr2820650607>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
- Green D. M., Brecher M. L., Lindsay A. N., Yakar D., Voorhess M. L., MacGillivray M. H., Freeman A. I. Gonadal function in pediatric patients following treatment for Hodgkin disease. Med Pediatr Oncol. 1981;9(3):235–244. doi: 10.1002/mpo.2950090306. [DOI] [PubMed] [Google Scholar]
- Ortin T. T., Shostak C. A., Donaldson S. S. Gonadal status and reproductive function following treatment for Hodgkin's disease in childhood: the Stanford experience. Int J Radiat Oncol Biol Phys. 1990 Oct;19(4):873–880. doi: 10.1016/0360-3016(90)90007-7. [DOI] [PubMed] [Google Scholar]
- Robinson B., Kingston J., Nogueira Costa R., Malpas J. S., Barrett A., McElwain T. J. Chemotherapy and irradiation in childhood Hodgkin's disease. Arch Dis Child. 1984 Dec;59(12):1162–1167. doi: 10.1136/adc.59.12.1162. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schwartz C. L. Creating life on the plateau: reproductive potential in survivors of childhood Hodgkin's disease. Int J Radiat Oncol Biol Phys. 1990 Oct;19(4):1099–1100. doi: 10.1016/0360-3016(90)90042-i. [DOI] [PubMed] [Google Scholar]
- Shalet S. M., Rosenstock J. D., Beardwell C. G., Pearson D., Jones P. H. Thyroid dysfunction following external irradiation to the neck for Hodgkin's disease in childhood. Clin Radiol. 1977 Sep;28(5):511–515. doi: 10.1016/s0009-9260(77)80066-4. [DOI] [PubMed] [Google Scholar]
- Sherins R. J., Olweny C. L., Ziegler J. L. Gynecomastia and gonadal dysfunction in adolescent boys treated with combination chemotherapy for Hodgkin's disease. N Engl J Med. 1978 Jul 6;299(1):12–16. doi: 10.1056/NEJM197807062990103. [DOI] [PubMed] [Google Scholar]
- Siimes M. A., Rautonen J. Small testicles with impaired production of sperm in adult male survivors of childhood malignancies. Cancer. 1990 Mar 15;65(6):1303–1306. doi: 10.1002/1097-0142(19900315)65:6<1303::aid-cncr2820650608>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
- Whitehead E., Shalet S. M., Blackledge G., Todd I., Crowther D., Beardwell C. G. The effects of Hodgkin's disease and combination chemotherapy on gonadal function in the adult male. Cancer. 1982 Feb 1;49(3):418–422. doi: 10.1002/1097-0142(19820201)49:3<418::aid-cncr2820490304>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
- Wilimas J., Thompson E., Smith K. L. Long-term results of treatment of children and adolescents with Hodgkin's disease. Cancer. 1980 Nov 15;46(10):2123–2125. doi: 10.1002/1097-0142(19801115)46:10<2123::aid-cncr2820461002>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
- Zachmann M., Prader A., Kind H. P., Häfliger H., Budliger H. Testicular volume during adolescence. Cross-sectional and longitudinal studies. Helv Paediatr Acta. 1974 Apr;29(1):61–72. [PubMed] [Google Scholar]