High prevalence of gonadal dysfunction in pediatric sarcoma survivors: insights from hormonal and clinical markers

A critical proportion of childhood bone and soft tissue sarcoma survivors experience some form of reproductive impairment. These findings underscore the increasing need for a comprehensive evaluation of gonadal function in this patient population. This study aimed to evaluate gonadal function in survivors of childhood bone and soft tissue sarcomas and to identify treatment-related risk factors.

This retrospective cohort study included survivors aged 17 years or older at evaluation who had received curative-intent treatment for bone or soft tissue sarcomas diagnosed between January 2009 and February 2022. Demographics, clinical history, hormonal assays [follicle-stimulating hormone (FSH), luteinizing hormone, anti-Müllerian hormone (AMH), inhibin B, estradiol, testosterone], pelvic ultrasonography (females), and semen analysis (males) were recorded.

The cohort comprised 38 participants (median age 18.75 years); 17 males (44.74%) and 21 females (55.26%). Gonadal dysfunction was observed in 18 participants (47.4%), including low ovarian reserve or diminished AMH as the most common finding in females and azoospermia as the most frequent abnormality in males. Normal gonadal function was preserved in 20 participants (52.6%). FSH levels were significantly higher in the gonadal dysfunction group in both females (p = 0.004) and males (p = 0.007).

Childhood sarcoma survivors have a high prevalence of gonadal dysfunction, with notable impairments in ovarian reserve and spermatogenesis, marked by elevated FSH in both sexes. Routine surveillance, patient education on gonadotoxicity and infertility risks, and pre-treatment fertility preservation counseling are essential.