Fertility preservation counselling for childhood cancer survivors
Menée à partir de données portant sur 5 886 patientes ayant survécu à un cancer durant l'enfance puis validée à partir de données portant sur 875 patientes supplémentaires (durée médiane de suivi : 23,9 ans), cette étude évalue la précision d'un modèle prédictif, basé notamment sur le recours à une greffe de cellules souches hématopoïétiques et la dose cumulée de médicaments alkylants, pour identifier les patientes présentant un risque de perte permanente de la fonction ovarienne dans les 5 ans qui suivent le diagnostic de cancer
Guidelines recommend that appropriate information about the effects of cancer treatment on ovarian function and future fertility should be provided to all paediatric patients and their families. Although fertility counselling in children and adolescents is more complex than in adults, the risk of acute ovarian failure, defined as permanent discontinuation of menstruation within 5 years of diagnosis or primary amenorrhoea, is a major concern in this population because it affects long-term quality of life. The evaluation of this risk is often difficult in young patients and prospective studies are scarce. The Childhood Cancer Survivor Study (CCSS) provided important data leading to estimates that the overall prevalence of acute ovarian failure in survivors of childhood cancer is 6%. The occurrence of this side-effect varies greatly according to the type and dose of treatment, the disease, and the age of the child at diagnosis. Children and adolescents treated with high doses of alkylating drugs, haematopoietic stem-cell transplantation, or pelvic irradiation are considered to be at high risk (>80%) of future poor fertility. Although risk factors have been previously identified, access to accurate and easy-to-use models for predicting future risk of acute ovarian failure remains an unmet need, affecting the decision of whether or not to offer fertility preservation procedures to children and adolescents with cancer.
The Lancet Oncology , commentaire en libre accès, 2019