Skip to main content

Effet de la chimiothérapie sur la fonction testiculaire et ovarienne

Testicular and ovarian function after chemotherapy

Resume

Les progrés en cancérologie permettent des guérisons fréquentes chez l’enfant et l’adulte jeune. L’oligo azoospermie et les troubles fonctionnels du spermatozoïde chez l’homme, l’aménorrhée et la ménopause précoce chez la femme sont fréquents et préserver la fertilité des patients doit être un soucis du thérapeute. Les alkylants sont fortement gonadotoxiques suivant une relation de dose-dépendance. D’autres drogues comme le cisplatine, les anthracyclines, les vincaalcaloïdes et les épipodophyllotoxines sont modérément gonadotoxiques tandis que les antimétabolites ont une toxicité gonadique mineure. La fertilité est plus altérée chez l’homme que chez la femme et diminue d’autant plus chez la femme qu’elle est proche de la ménopause. L’ovaire prépubertaire est moins sensible aux effets des chimiothérapies mais n’est pas totalement protégé. Aucune tératogénicité n’a pu être formellement attribuée à la chimiothérapie. Néanmoins une grossesse pendant une exposition à des agents cytotoxiques est fortement déconseillée et un délai de deux ans semble pouvoir être recommandé avant une conception.

Abstract

Recent advances in the treatment of cancer now permits long-term remissions and can cure a large amount of young. It is now well established that infertility and premature menopause are common consequences of successeful treatment. Much is known about the fertility and sexual effects of chemotherapy and allow development of new strategies to reduce infertilty. Alkylating agents are among the most commonly used chemotherapy agents and are for the most part highly gonadotoxic. Other drugs like cisplatin, vinca alkaloids, epipodophyllotoxins and antibiotics have moderate intrinsic toxicity whereas antimetabolites exert little if any toxic effect. Nevertheless, drugs are often used in combinations which are more toxic than single agents. Gonadal toxicity is usually dose dependant. Infertility is more frequent in males than in females and prepubertal girls have better prognosis though prepubertal ovaries are profoundly affected by chemotherapy. The onset of chemotherapy-related ovarian failure is age related but the risk of premature menopause still exists in women who recover menstrual cycles after amenorrhea. Fertility is usually worse after Hodgkin’s disease and testes cancer than after other cancers. No teratognesis in the offspring was published so far after chemotherapy. Nevertheless, men and women should be expressly discouraged from being party to a conception while they are receiving cancer therapy. Adults surviving to cancer should wait at least two years after completion of therapy before attempting parenthood.

References

  1. BAKRI YN, GIVEN FT.: Normal pregnancy and delivery following conservative surgery and chemotherapy for ovarian endodermal sinus tumor. Gynecol Oncol 1984, 19: 222–225.

    Article  PubMed  CAS  Google Scholar 

  2. BLEYER WA.: The impact of childhood cancer in the United States and the world. CA Cancer J Clin 1990, 40: 355–367.

    Article  PubMed  CAS  Google Scholar 

  3. BONNADONNA G, SANTORO A, VIVIANI S, VALAGUSSA P.: Treatment strategies for Hodgkin’s disease. Seminar Hematol 1988, 25: 51–57.

    Google Scholar 

  4. BRENNER J, VUGRIN D, WHITMORE WF.: Effect of treatment on fertility and sexual function in males with metastatic nonseminomatous germcell tumors of testes. Am J Clin Oncol 1985, 8: 178–182.

    Article  PubMed  CAS  Google Scholar 

  5. BYRNE J, FEARS FR, GALL MG, PEE D, CONNELLY RR, AUSTIN DF.: Early menopause in long-term survivors of cancer during adolescence. Am J Obstet Gynecol 1992, 166: 788–793.

    PubMed  CAS  Google Scholar 

  6. BYRNE J, MULVIHILL JJ, MYERS MH, ET aL.: Effects of treatment on fertility in long-term survivors of childhood or adolescent cancer. N Engl J Med 1987, 317: 1315–1381.

    PubMed  CAS  Google Scholar 

  7. CADMANABHAN N, WANG DY, MOORE JW, RUBENS RD.: Ovarian function and adjuvant chemotherapy for early breast cancer. Eur J Cancer Clin Oncol 1987, 23: 745–748.

    Article  Google Scholar 

  8. CHAPMAN RM.: Gonadal toxicity and teratogenicity. In Perry MC ed. The chemotherapy source book. Williams and Wilkins. Baltimore. 1992, pp 710–753.

    Google Scholar 

  9. CURTIN JP, ADCOCK LL.: Pregnancy following treatment of endodermal sinus tumor of the ovary with combination chemotherapy including cis-platinium. Gynecol Oncol 1986, 24: 268–270.

    Article  PubMed  CAS  Google Scholar 

  10. DRASGA RE, EINHORN LH, WILLIAMS SD, PATEL DN, STEVENS EE.: Fertility after chemotherapy for testicular cancer. J Clin Oncol 1983, 1: 179–183.

    PubMed  CAS  Google Scholar 

  11. GREEN DM, HALL B, ZEVON MA.: Pregnancy outcome after treatment for acute lymphoblastic leukemia during childhood or adolescence. Cancer 1989, 64: 2335–2339.

    Article  PubMed  CAS  Google Scholar 

  12. HIMELSTEIN-BRAW R, PETERS H, FABER M.: Morphological study of the ovaries of leukaemic children. Br J Cancer 1978, 38: 82–87.

    PubMed  CAS  Google Scholar 

  13. HORNING SJ, HOPPE RT, HANCOCK SL, ROSENBERG SA.: Vinblastine, bleomycin, and methotrexate. An effective adjuvant in favorable Hodgkin’s disease. J Clin Oncol 1988, 6: 1822–1831.

    PubMed  CAS  Google Scholar 

  14. HORNING SJ, HOPPE RT, KAPLAN HS, ROSENBERG SA.: Female reproductive potential after treatment for Hodgkin’s disease. N Engl J Med 1981, 304: 1377–1382.

    PubMed  CAS  Google Scholar 

  15. LI FP, GIMBERE K, GELBER RD, ET aL.: Outcome of pregnancy in survivors of Wilm’s tumor. JAMA 1987, 257: 216–219.

    Article  PubMed  CAS  Google Scholar 

  16. LIPTON JH, DERZKO C, FYLES G, MEHARCHAND J, MESSNER HA.: Pregnancy after bone marrow transplantation: three case reports. Bone Marrow Transplantation 1993, 11: 415–418.

    PubMed  CAS  Google Scholar 

  17. MEISTRICH ML, CHAWLA SP, DA CUNHA MF, JOHNSON SL, PLAGER C, PAPADOPOULOS NE, LIPSCHULZ LP, BENJAMIN RS.: Recovery of sperm production after chemotherapy for osteosarcoma. Cancer 1989, 63: 2115–2123.

    Article  PubMed  CAS  Google Scholar 

  18. MULVIHILL JJ, MYERS MH, CONNELLY RR ET aL. Cancer in offspring of long-term survivors of childhood and adolescence cancers. Lancet 1987, ii: 813–817.

    Article  Google Scholar 

  19. NICHOLSON HS, BYRNE J.: Fertility and pregnancy after treatment for cancer during childhod or adolescence. Cancer 1993, 71: 3392–3399.

    Article  PubMed  CAS  Google Scholar 

  20. NICOSIA SV, MATUS-RIDLEY M, MEADOWS AT.: Gonadal effects of cancer therapy in girls. Cancer 1985, 55: 2364–2372.

    Article  PubMed  CAS  Google Scholar 

  21. ROTH BJ, GREIST A, KUBILIS PS, WILLIAMS SD, EINHORN LH.: Cisplatin-based combination chemotherapy for disseminated germ-cell tumors: long-term follow-up. J Clin Oncol 1988, 6: 1239–1247.

    PubMed  CAS  Google Scholar 

  22. SCHILSKY RL, YARBRO JW.: Pharmacology of antineoplastic drugs. In: Perry MC, Yarbro JW eds. Toxicity of chemotherapy. Grune and Straton. Orlando. 1984, pp 21–59.

    Google Scholar 

  23. SONG H, WU P, WANG Y, YANG X, DONG S.: Pregnancy outcomes after successful chemotherapy for choriocarcinoma and invasive mole: longterm follow-up. Am J Obstet Gynecol 1988, 158: 538–545.

    PubMed  CAS  Google Scholar 

  24. VILAR O.: Effect of cytostatic drugs on human testicular function. In: Mancini RE, Martini L eds. Male fertility and sterility. Academic Press. New York. 1974, pp 423–440.

    Google Scholar 

  25. WHITEHEAD E, SHALET SM, BLACKLEDGE G, TODD I, CROWTHER D, BEARDWELL CG.: The effect of Hodgkin’s disease and combination chemotherapy on gonadal function in the adult male. Cancer 1982, 49: 418–422.

    Article  PubMed  CAS  Google Scholar 

  26. WONG LC, CHOO YC, MA HK.: Primary oral etoposide therapy in gestational trophoblastic disease. Cancer 1986, 58: 14–17.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Note de la rédaction: Voir Andrologie, Vol. 5, no4, décembre 1995. Ce numéro est en grande partie consacré aux effets des traitements anti-cancéreux sur reproduction et sexualité.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Linassier, C., Colombat, P. Effet de la chimiothérapie sur la fonction testiculaire et ovarienne. Androl. 6, 293–300 (1996). https://doi.org/10.1007/BF03035284

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03035284

Mots clés

  • grossesse
  • fertilité
  • chimiothérapie
  • cancer
  • leucémie

Key words

  • Testes
  • ovary
  • fertility
  • chemotherapy
  • cancer
  • leukemia