Fertility outcomes following surgery and multiagent chemotherapy in malignant ovarian germ cell tumor survivors: a survey study

医学 依托泊苷 化疗 博莱霉素 生殖细胞肿瘤 生育率 不育 顺铂 环磷酰胺 保持生育能力 活产 长春新碱 外科 内科学 妇科 怀孕 人口 环境卫生 生物 遗传学
作者
Alice Bergamini,Ramya Ramaswami,Fieke E. M. Froeling,Panos Papanastasopoulos,Dee Short,Xianne Aguiar,Philip Savage,Naveed Sarwar,Baljeet Kaur,Srdjan Saso,Christina Fotopoulou,Anand Sharma,G. J. S. Rustin,Michael J. Seckl
出处
期刊:International Journal of Gynecological Cancer [BMJ]
卷期号:33 (11): 1750-1756
标识
DOI:10.1136/ijgc-2023-004699
摘要

To assess fertility outcomes in long-term survivors of malignant ovarian germ cell tumors treated with fertility-sparing surgery with or without additional chemotherapy.Women diagnosed and treated for malignant ovarian germ cell tumors at Charing Cross Hospital or Mount Vernon Cancer Centre between 1977 and 2015 were included. Questionnaires assessing fertility issues were sent to patients treated with fertility-sparing surgery. Fertility outcomes were evaluated according to the treatment received. The effect of the mean total dose of cyclophosphamide and cisplatin was assessed.A total of 146 patients were sent the questionnaire; 77 (56.5%) patients were included in the analysis. A total of 49 (64%) patients received platinum-based chemotherapy after surgery, 39 (79.6%) of these with cisplatin, vincristine, methotrexate, bleomycin, actinomycin D, cyclophosphamide, and etoposide, while 10 (20.4%) with bleomycin, etoposide, and cisplatin. After any treatment, 39/46 patients (85%) became pregnant: the conception rate was not different between those receiving surgery only and those receiving also chemotherapy (85.7% vs 84.4%, p=1.0). Live birth rate was 80.4% (37/46), with no statistically significant difference between the treatment groups (p=0.42). Median age of women achieving conception was 29 years (IQR 26-33). The probability of live birth at 5 years was 48% and 40% for patients in the surgery only and chemotherapy group, respectively (p=0.55). Infertility and miscarriage rates did not differ significantly between the two treatment groups (p=0.30 and p=0.32). The mean doses of cisplatin and cyclophosphamide received by patients failing and achieving conception were not different (p=0.10, p=0.47).Our results suggest that fertility may not be hampered in patients with malignant ovarian germ cell tumor treated with fertility-sparing surgery or receiving additional chemotherapy.
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