Preservation of Fertility or Ovarian Function in Patients with Breast Cancer or Gynecologic and Internal Malignancies.

Abstract:

:Because of the efficacy of systemic therapies, neoplasias which occur in pediatric and adolescent patients and in young adults have high cure rates. This means that fulfilling their wish to have children has become a more pressing concern, particularly among young women with malignant tumors. Premature ovarian failure is also a not insignificant problem as it has a lasting detrimental effect on quality of life. Every oncology patient who may potentially wish to have children should be informed about their options for preserving fertility prior to starting treatment. The rates of patient who received detailed briefing on this point remain low. This review presents the effects of different chemotherapeutic drugs on gonadal function together with an overview of currently valid recommendations on fertility preservation. Risk groups are defined and the specific approaches for malignancies of various organ systems are described. Cryopreservation of oocytes, fertilized embryos and ovarian tissue are fertility-preserving options for girls/young women. The data on the benefits of administering GnRH analogs for ovarian protection prior to starting chemotherapy are not clear. In postpubertal boys or male cancer patients, the standard approach is to cryopreserve sperm before starting therapy. The cryopreservation of testicular tissue is possible for prepubertal boys, however in-vitro sperm maturation is still in its experimental stages. This review also presents existing drug options for the preservation of ovarian function in oncology patients prior to chemotherapy, particularly for patients with (hormone-sensitive) breast cancer, and looks at the special issues of fertility-preserving surgery and radiation therapy in patients with gynecologic malignancies. :Neoplasien des Kindes- und Jugendalters sowie junger Erwachsener gehen heute dank effektiver Systemtherapien mit einer hohen Heilungschance einher. Demzufolge rückt das Thema „Kinderwunsch“ insbesondere bei jungen Frauen mit Malignom zunehmend in den Vordergrund. Ein nicht unwesentliches Problem ist auch die vorzeitige Ovarialinsuffizienz mit ihren die Lebensqualität nachhaltig beeinträchtigenden Folgen. Jede(r) onkologische Patient(in) mit potenziellem Kinderwunsch sollte vor Therapiebeginn über die Möglichkeiten des Fertilitätserhaltes informiert werden. Die Aufklärungsrate ist diesbezüglich nach wie vor gering. In dieser Übersichtsarbeit wird der Effekt verschiedener Chemotherapeutika auf die Gonadenfunktion dargestellt sowie ein Überblick über die aktuell gültigen Empfehlungen zum Fertilitätserhalt gegeben. Dabei werden Risikokollektive definiert und das spezifische Vorgehen bei Malignomen der verschiedenen Organsysteme beschrieben. Bei Mädchen/jungen Frauen ist die Kryokonservierung von Eizellen, befruchteten Embryonen und Ovargewebe möglich. Zum Nutzen der GnRH-Analoga-Applikation zum Ovarschutz vor Chemotherapie ist die Studienlage uneinheitlich. Bei postpubertären Jungen bzw. männlichen Krebspatienten ist die Kryokonservierung von Spermien vor Therapiebeginn Standard. Bei Jungen im vorpubertären Alter ist die Kryokonservierung von Hodengewebe möglich, jedoch ist die In-vitro-Spermienreifung noch im experimentellen Stadium. Des Weiteren werden in der vorliegenden Arbeit medikamentöse Möglichkeiten des Erhaltes der Ovarfunktion bei onkologischen Patienten vor Chemotherapien, insbesondere bei (hormonabhängigem) Mammakarzinom sowie die speziellen Fragestellungen der Planung von fertilitätserhaltender Operation und Radiatio bei gynäkologischen Malignomen dargestellt.

authors

Stachs A,Hartmann S,Gerber B

doi

10.1055/s-0043-116222

subject

Has Abstract

pub_date

2017-08-01 00:00:00

pages

861-869

issue

8

eissn

0016-5751

issn

1438-8804

pii

3982158

journal_volume

77

pub_type

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