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Gonadal effects of cancer therapy in girls
Abstract:
The gonadal histology of 21 prepubertal, intrapubertal, and postpubertal girls who died 1 day to 2 months after cessation of therapy for extragonadal solid tumors was reviewed. In addition to focal or diffuse cortical fibrosis, a reduction in follicle numbers and impaired follicular maturation were observed in cancer patients independent of their pubertal age. These changes appeared to be more severe in malnourished patients and in girls who received multiple agent chemotherapy, with or without irradiation. Both before and after the age of 10 years, most cancer patients had a total number of follicles similar to that of age- and nutrition-matched controls. However, the majority of these girls displayed impaired follicular maturation as demonstrated by reduced numbers of growing and antral follicles compared to controls. Histologic evidence of ovarian damage suggests that the future reproductive performance may be impaired in some female cancer patients treated even before puberty.
Insights
Cancer therapies can harm the ovaries of young girls, even before puberty. Studies show reduced follicle numbers and impaired maturation, potentially affecting future fertility in female cancer survivors.
Area of Science:
- Reproductive Endocrinology
- Pediatric Oncology
- Gynecologic Pathology
Background:
- Childhood cancer survivors face long-term health challenges, including potential reproductive dysfunction.
- Ovarian toxicity from cancer treatments is a significant concern for prepubertal and pubertal females.
- Understanding the impact of therapy on immature gonads is crucial for fertility preservation strategies.
Purpose of the Study:
- To evaluate the gonadal histology in prepubertal, intrapubertal, and postpubertal girls treated for extragonadal solid tumors.
- To assess the relationship between cancer therapy, pubertal status, nutritional status, and ovarian damage.
- To determine the potential long-term impact on reproductive capacity in young female cancer patients.
Main Methods:
- Histological review of ovarian tissue from 21 deceased girls (prepubertal, intrapubertal, postpubertal) treated for extragonadal solid tumors.
- Comparison of follicle numbers and maturation stages with age- and nutrition-matched controls.
- Analysis of factors including chemotherapy regimens, irradiation, and nutritional status.
Main Results:
- Ovarian damage, including cortical fibrosis, reduced follicle numbers, and impaired follicular maturation, was observed in cancer patients irrespective of pubertal age.
- These ovarian changes were more pronounced in malnourished patients and those receiving multi-agent chemotherapy, with or without irradiation.
- While total follicle counts were similar to controls, a majority of cancer patients showed reduced numbers of growing and antral follicles, indicating impaired maturation.
Conclusions:
- Histological evidence indicates significant ovarian damage in female cancer patients treated prior to puberty.
- Impaired follicular maturation suggests a potential risk of compromised future reproductive performance in these young survivors.
- Early cancer therapies, even before puberty, can have lasting adverse effects on ovarian function and fertility potential.