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Severe gonadotoxic insult manifests early in young girls treated for Ewing sarcoma

Mörse, Helena LU ; Elfving, Maria LU ; Turkiewicz, Aleksandra LU ; Andersen, Claus Yding and Øra, Ingrid LU (2016) In Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries 95(33).
Abstract

We prospectively investigated anti-Müllerian hormone (AMH) as a measure of ovarian insult in young females during and after treatment for Wilms tumor (WT), osteosarcoma (OS), and Ewing sarcoma (ES). Twenty-one female childhood cancer patients, with a mean age of 7.9 years (range 0.6-17), entered the study. Levels of AMH, follicle-stimulating hormone (FSH), and luteinizing hormone were monitored at diagnosis and every 3 to 4 months during, and regularly for a mean of 2.6 years after treatment. A profound decline in AMH was seen in the majority of the 21 study patients 3 to 4 months after the beginning of treatment, the exception being patients with WT, of whom 60% showed no such decline. During the remaining treatment, all patients... (More)

We prospectively investigated anti-Müllerian hormone (AMH) as a measure of ovarian insult in young females during and after treatment for Wilms tumor (WT), osteosarcoma (OS), and Ewing sarcoma (ES). Twenty-one female childhood cancer patients, with a mean age of 7.9 years (range 0.6-17), entered the study. Levels of AMH, follicle-stimulating hormone (FSH), and luteinizing hormone were monitored at diagnosis and every 3 to 4 months during, and regularly for a mean of 2.6 years after treatment. A profound decline in AMH was seen in the majority of the 21 study patients 3 to 4 months after the beginning of treatment, the exception being patients with WT, of whom 60% showed no such decline. During the remaining treatment, all patients except those with WT not treated with whole abdominal radiotherapy or stem cell transplantation (SCT) had AMH below detection limit. After completion of treatment, patients with OS and WT (without whole abdominal radiotherapy and SCT) recovered in AMH and had FSH in the normal range. In contrast, ES patients showed no AMH recovery and highly fluctuating FSH in the first years of follow-up, except for the 2 youngest patients, who had a late, slow AMH recovery. In conclusion, young female ES patients already showed signs of severe ovarian dysfunction during the first years after cancer treatment similar to patients treated with SCT and abdominal radiotherapy, in contrast to females with WT and OS. Fertility counseling and information concerning fertility preservation procedures should be considered before starting to treat young females with ES.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
anti-Müllerian hormone, Ewing sarcoma, female fertility, osteosarcoma, ovarian reserve, Wilms tumor
in
Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries
volume
95
issue
33
publisher
Lippincott Williams & Wilkins
external identifiers
  • Scopus:84983483129
ISSN
0025-7974
DOI
10.1097/MD.0000000000004512
language
English
LU publication?
yes
id
ff33a1fd-a05c-4b9a-9b38-23a82aa12e97
date added to LUP
2016-10-04 08:23:44
date last changed
2016-11-14 12:48:23
@misc{ff33a1fd-a05c-4b9a-9b38-23a82aa12e97,
  abstract     = {<p>We prospectively investigated anti-Müllerian hormone (AMH) as a measure of ovarian insult in young females during and after treatment for Wilms tumor (WT), osteosarcoma (OS), and Ewing sarcoma (ES). Twenty-one female childhood cancer patients, with a mean age of 7.9 years (range 0.6-17), entered the study. Levels of AMH, follicle-stimulating hormone (FSH), and luteinizing hormone were monitored at diagnosis and every 3 to 4 months during, and regularly for a mean of 2.6 years after treatment. A profound decline in AMH was seen in the majority of the 21 study patients 3 to 4 months after the beginning of treatment, the exception being patients with WT, of whom 60% showed no such decline. During the remaining treatment, all patients except those with WT not treated with whole abdominal radiotherapy or stem cell transplantation (SCT) had AMH below detection limit. After completion of treatment, patients with OS and WT (without whole abdominal radiotherapy and SCT) recovered in AMH and had FSH in the normal range. In contrast, ES patients showed no AMH recovery and highly fluctuating FSH in the first years of follow-up, except for the 2 youngest patients, who had a late, slow AMH recovery. In conclusion, young female ES patients already showed signs of severe ovarian dysfunction during the first years after cancer treatment similar to patients treated with SCT and abdominal radiotherapy, in contrast to females with WT and OS. Fertility counseling and information concerning fertility preservation procedures should be considered before starting to treat young females with ES.</p>},
  author       = {Mörse, Helena and Elfving, Maria and Turkiewicz, Aleksandra and Andersen, Claus Yding and Øra, Ingrid},
  issn         = {0025-7974},
  keyword      = {anti-Müllerian hormone,Ewing sarcoma,female fertility,osteosarcoma,ovarian reserve,Wilms tumor},
  language     = {eng},
  month        = {08},
  number       = {33},
  publisher    = {ARRAY(0x7a384e8)},
  series       = {Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries},
  title        = {Severe gonadotoxic insult manifests early in young girls treated for Ewing sarcoma},
  url          = {http://dx.doi.org/10.1097/MD.0000000000004512},
  volume       = {95},
  year         = {2016},
}