Other malignant diseases

 

Detailed information and a list of references can be found in Chapter 2.9 of the FertiPROTEKT book, "Indications and fertility preservation methods for oncological and non-oncological disorders", which can be downloaded free of charge.

 

General information

The most common malignancies are presented separately on the website and in the book mentioned above. Less common diseases are described in the table below. Due to the wide variety of malignant diseases, it is not possible to list them all. Since many are accompanied by radiotherapy, the general effects of pelvic radiotherapy on the function of the gonads and the uterus are described first.  

 

Effects of radiotherapy on the ovaries and testes

The effect of radiotherapy on the ovaries and testes depends on the dose. Various doses and their effects are described below. 

+ Effects of different radiotherapy doses (measured in gray) on the ovaries


Effects Radiotherapy dose
No relevant effects 0,6 Gray
No relevant effects under the age of 40 years 1,5 Gray
Risk of a complete loss of ovarian function (infertility): about 60% between 15-40 years of age 2,5-5 Gray
Infertility with radiotherapy at the age of 10 years Ab 18 Gray
Infertility with radiotherapy at the age of 20 years Ab 16 Gray
Infertility with radiotherapy at the age of 30 years Ab 14 Gray
Infertility with radiotherapy at the age of 40 years Ab 7 Gray

+ Effects of different radiotherapy doses (measured in gray) on the testes

Effects Radiotherapy dose
Long-lasting infertility possible From 2 Gray
Permanent infertility possible From 4 Gray

 

Effects of radiotherapy on the function of the uterus (womb)

There are few studies available; however the following conclusions can be drawn:

  • Radiotherapy during childhood seems to have larger adverse effect on the uterus than radiotherapy during adulthood.
  • Radiotherapy to the uterus of an adult during total body irradiation with 12 Gray is associated with an increased risk of miscarriages, premature births and low birth weight.
  • Pregnancy should be strictly discouraged after radiotherapy to the uterus during childhood with more than 25 Gray and during adulthood with more than 45 Gray.

 

further malignant diseases

Ewing’s sarcoma (bone cancer)

Incidence

Incidence of limitation of ovarian function caused by the required treatment

Risk of metastasis to the ovaries

Fertility preservation methods

New cases 3/1,000,000 children < 15 years, 2.4/ 1,000,000 adolescents and young adults

Over 50%,

especially in combination with radiotherapy or bone marrow transplant;

Radiotherapy: see above

Possible in individual cases

GnRH agonists,

Cryopreservation of oocytes after stimulation and cryopreservation of ovarian tissue

Sperm cryopreservation; possibly cryopreservation of testicular tissue

 

Osteosarcoma (bone cancer)

Incidence

Incidence of limitation of ovarian function caused by the required treatment

Risk of metastasis to the ovaries

Fertility preservation methods

2-3 new cases / 1,000,000 persons

According to a study, 6 out of 90 young women have a complete loss of ovarian function after chemotherapy.

Possible in individual sarcoma cases

GnRH agonists,

Cryopreservation of oocytes after stimulation and cryopreservation of ovarian tissue

Sperm cryopreservation; possibly cryopreservation of testicular tissue

 

Colorectal cancer (colorectal and colon cancer)

Incidence

Incidence of limitation of ovarian function caused by the required treatment

Risk of metastasis to the ovaries

Fertility preservation methods

New cases 70/100,000 (30% colorectal, 70% colon)

Less with chemotherapy but high if pelvic radiotherapy is required and are the ovaries are in the field of radiation / scattered radiation.

Radiotherapy: see above

Low

Surgical relocation of the ovaries if radiotherapy is performed if the ovaries lay within the radiation field.

GnRH agonists if chemotherapy is given,

Cryopreservation of oocytes after stimulation and cryopreservation of ovarian tissue

Sperm cryopreservation; possibly cryopreservation of testicular tissue

 

Non-hodgkin’s lymphoma (lymphoma, especially so-called blastic and burkitt’s lymphoma)

Incidence

Incidence of limitation of ovarian function caused by the required treatment

Risk of metastasis to the ovaries

Fertility preservation methods

5-10 new cases / 100,000 persons; rather in higher age groups

High or very high, depending on treatment

High for blastic and Burkitt’s lymphoma,

Otherwise moderate

GnRH agonists if chemotherapy is given

Cryopreservation of oocytes after stimulation. No cryopreservation of ovarian tissue because of the possibility of tumour cell presence in the ovarian tissue.

Sperm cryopreservation; possibly cryopreservation of testicular tissue

 

Acute lymphocytic leukaemia (acute blood cancer)

Incidence

Incidence of limitation of ovarian function caused by the required treatment

Risk of metastasis to the ovaries

Fertility preservation methods

Incidence approximately 1.1 / 100,000 people, especially in young people

without bone marrow transplantation usually high,

very high with bone marrow transplantation

High

GnRH Agonists if chemotherapy is given

Cryopreservation of oocytes after stimulation usually not possible because time until chemotherapy is insufficient. Cryopreservation of ovarian tissue: experimental.

If cryopreservation of ovarian tissue should be carried out: after so-called induction chemotherapy and when in so-called complete remission, if there is sufficient ovarian reserve.

Sperm cryopreservation; possibly cryopreservation of testicular tissue

 

Acute myeloid leukaemia (acute blood cancer)

Incidence

Incidence of limitation of ovarian function caused by the required treatment

Risk of metastasis to the ovaries

Fertility preservation methods

New cases in ca. 3.5 / 100,000 persons, especially in older people

without bone marrow transplantation usually high,

very high with bone marrow transplantation

high

GnRH agonists if chemotherapy is given

Cryopreservation of oocytes after stimulation usually not possible because time until chemotherapy is insufficient. Cryopreservation of ovarian tissue: experimental.

If cryopreservation of ovarian tissue should be carried out: after so-called induction chemotherapy and when in so-called complete remission, if there is sufficient ovarian reserve.

Sperm cryopreservation; possibly cryopreservation of testicular tissue

 

Testicular cancer

Incidence

Incidence of limitation of testicular function caused by the required treatment

Fertility preservation methods

New cases in ca. 9/100.000 men

207 men tried to father a child after chemotherapy and / or radiotherapy: 77% successful, 5% after infertility treatment, 18% unsuccessful.

Cryopreservation of sperm or in individual cases of testicular tissue;

Possibly cryopreservation of testicular tissue in boys before puberty as a special experimental technique