接受放化疗年轻女性恶性肿瘤患者的生育能力保存
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摘要
放疗和化疗对恶性肿瘤的治疗至关重要,但会对年轻女性患者的生育功能造成负面影响,引起不孕。在放化疗前,可以为女性提供多种保留生育能力的选择,包括:卵巢移位、胚胎和卵母细胞冷冻保存、卵巢组织冷冻保存、药物保护性治疗等。将卵巢移位至结肠肝脾曲外侧,可以减少卵巢承受的放射量。卵母细胞和胚胎冷冻保存技术已经成熟,但也有其局限性。卵巢组织冷冻保存目前仍处于试验阶段,已有80多例成功妊娠的案例报道。在化疗期间使用促性腺激素释放激素类似物抑制卵巢功能治疗是一种有争议的保留生育能力的方法。肿瘤医生和生殖医生需要进行多学科合作,权衡保留生育能力与癌症相关的复发率和死亡率,制定个体化治疗方案。
Radiotherapy and chemotherapy are essential for the treatment of malignant tumors. However,chemoradiothery will have a negative impact on the reproductive function of young women, causing infertility.Before radiotherapy and chemotherapy, many fertility-preserving options can be provided, including ovarian transposition, embryo and oocyte cryopreservation, ovarian tissue cryopreservation, and drug-protective therapy.Transposition of the ovary to the outside of the hepatic flexure or splenic flexure of the colon can reduce the amount of radiation that the ovary bears. Oocyte and embryo cryopreservation is a mature technique, with its limitations. Cryopreservation of ovarian tissue is currently at clinical trial stage, with over 80 cases' reports.Inhibition of ovarian function with gonadotropin releasing hormone analogue during chemotherapy is a controversial method of preserving fertility. Oncologists and reproductive doctors need multidisciplinary collaboration to balance the fertility and the recurrence rate and mortality associated with cancer,so as to make the individualized treatment.
Radiotherapy and chemotherapy are essential for the treatment of malignant tumors. However,chemoradiothery will have a negative impact on the reproductive function of young women, causing infertility.Before radiotherapy and chemotherapy, many fertility-preserving options can be provided, including ovarian transposition, embryo and oocyte cryopreservation, ovarian tissue cryopreservation, and drug-protective therapy.Transposition of the ovary to the outside of the hepatic flexure or splenic flexure of the colon can reduce the amount of radiation that the ovary bears. Oocyte and embryo cryopreservation is a mature technique, with its limitations. Cryopreservation of ovarian tissue is currently at clinical trial stage, with over 80 cases' reports.Inhibition of ovarian function with gonadotropin releasing hormone analogue during chemotherapy is a controversial method of preserving fertility. Oncologists and reproductive doctors need multidisciplinary collaboration to balance the fertility and the recurrence rate and mortality associated with cancer,so as to make the individualized treatment.
引文
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[19]Elgindy E,Sibai H,Abdelghani A,et al.Protecting Ovaries During Chemotherapy Through Gonad Suppression:A Systematic Review and Meta-analysis[J].Obstet Gynecol,2015,126(1):187-195.
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[21]Li F,Turan V,Lierman S,et al.Sphingosine-1-phosphate prevents chemotherapy-induced human primordial follicle death[J].Hum Reprod,2014,29(1):107-113.
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[23]Kim SY,Lee JR.Fertility preservation option in young women with ovarian cancer[J].Future Oncol,2016,12(14):1695-1698.
[24]张娜,张聪,张辉,等.两种冷冻法对人卵巢组织冻存效果的分析[J].国际生殖健康/计划生育杂志,2018,37(4):285-287.
[25]Kim S,Lee Y,Lee S,et al.Ovarian tissue cryopreservation and transplantation in patients with cancer[J].Obstet Gynecol Sci,2018,61(4):431-442.
[26]Jensen AK,Macklon KT,Fedder J,et al.86 successful births and 9ongoing pregnancies worldwide in women transplanted with frozenthawed ovarian tissue:focus on birth and perinatal outcome in 40 of these children[J].J Assist Reprod Genet,2017,34(3):325-336.
[27]Demeestere I,Simon P,Dedeken L,et al.Live birth after autograft of ovarian tissue cryopreserved during childhood[J].Hum Reprod,2015,30(9):2107-2109.
[2]Oktay K,Harvey BE,Partridge AH,et al.Fertility Preservation in Patients With Cancer:ASCO Clinical Practice Guideline Update[J].J Clin Oncol,2018,36(19):1994-2001.
[3]Fleischer RT,Vollenhoven BJ,Weston GC.The effects of chemotherapy and radiotherapy on fertility in premenopausal women[J].Obstet Gynecol Surv,2011,66(4):248-254.
[4]Wallace WH,Thomson AB,Kelsey TW.The radiosensitivity of the human oocyte[J].Hum Reprod,2003,18(1):117-121.
[5]Ghadjar P,Budach V,Khler C,et al.Modern radiation therapy and potential fertility preservation strategies in patients with cervical cancer undergoing chemoradiation[J].Radiat Oncol,2015,10:50.
[6]Mahajan N.Fertility preservation in female cancer patients:An overview[J].J Hum Reprod Sci,2015,8(1):3-13.
[7]Kano M,Sosulski AE,Zhang L,et al.AMH/MIS as a contraceptive that protects the ovarian reserve during chemotherapy[J].Proc Natl Acad Sci U S A,2017,114(9):E1688-E1697.
[8]Bedoschi G,Navarro PA,Oktay K.Chemotherapy-induced damage to ovary:mechanisms and clinical impact[J].Future Oncol,2016,12(20):2333-2344.
[9]Winkler-Crepaz K,Ayuandari S,Ziehr SC,et al.Fertility preservation in cancer survivors[J].Minerva Endocrinol,2015,40(2):105-118.
[10]Oktem O,Oktay K.Quantitative assessment of the impact of chemotherapy on ovarian follicle reserve and stromal function[J].Cancer,2007,110(10):2222-2229.
[11]Anderson RA,Remedios R,Kirkwood AA,et al.Determinants of ovarian function after response-adapted therapy in patients with advanced Hodgkin's lymphoma(RATHL):a secondary analysis of a randomised phase 3 trial[J].Lancet Oncol,2018,19(10):1328-1337.
[12]高颖,李艳辉,黄佳语.妇科肿瘤与生育力保护及保存[J].生殖医学杂志,2018,27(4):293-298.
[13]Swift BE,Leung E,Vicus D,et al.Laparoscopic ovarian transposition prior to pelvic radiation for gynecologic cancer[J].Gynecol Oncol Rep,2018,24:78-82.
[14]Willows K,Lennox G,Covens A.Fertility-sparing management in cervical cancer:balancing oncologic outcomes with reproductive success[J].Gynecol Oncol Res Pract,2016,3:9.
[15]Gómez-Hidalgo NR,Darin MC,Dalton H,et al.Ovarian torsion after laparoscopic ovarian transposition in patients with gynecologic cancer:a report of two cases[J].J Minim Invasive Gynecol,2015,22(4):687-690.
[16]Kim SY,Kim SK,Lee JR,et al.Toward precision medicine for preserving fertility in cancer patients:existing and emerging fertility preservation options for women[J].J Gynecol Oncol,2016,27(2):e22.
[17]Song G,Gao H,Yuan Z.Effect of leuprolide acetate on ovarian function after cyclophosphamide-doxorubicin-based chemotherapy in premenopausal patients with breast cancer:results from a phase II randomized trial[J].Med Oncol,2013,30(3):667.
[18]Moore HC,Unger JM,Phillips KA,et al.Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy[J].N Engl J Med,2015,372(10):923-932.
[19]Elgindy E,Sibai H,Abdelghani A,et al.Protecting Ovaries During Chemotherapy Through Gonad Suppression:A Systematic Review and Meta-analysis[J].Obstet Gynecol,2015,126(1):187-195.
[20]Iwase A,Nakamura T,Nakahara T,et al.Anti-Müllerian hormone and assessment of ovarian reserve after ovarian toxic treatment:a systematic narrative review[J].Reprod Sci,2015,22(5):519-526.
[21]Li F,Turan V,Lierman S,et al.Sphingosine-1-phosphate prevents chemotherapy-induced human primordial follicle death[J].Hum Reprod,2014,29(1):107-113.
[22]Wang A,Santistevan A,Hunter Cohn K,et al.Freeze-only versus fresh embryo transfer in a multicenter matched cohort study:contribution of progesterone and maternal age to success rates[J].Fertil Steril,2017,108(2):254-261.
[23]Kim SY,Lee JR.Fertility preservation option in young women with ovarian cancer[J].Future Oncol,2016,12(14):1695-1698.
[24]张娜,张聪,张辉,等.两种冷冻法对人卵巢组织冻存效果的分析[J].国际生殖健康/计划生育杂志,2018,37(4):285-287.
[25]Kim S,Lee Y,Lee S,et al.Ovarian tissue cryopreservation and transplantation in patients with cancer[J].Obstet Gynecol Sci,2018,61(4):431-442.
[26]Jensen AK,Macklon KT,Fedder J,et al.86 successful births and 9ongoing pregnancies worldwide in women transplanted with frozenthawed ovarian tissue:focus on birth and perinatal outcome in 40 of these children[J].J Assist Reprod Genet,2017,34(3):325-336.
[27]Demeestere I,Simon P,Dedeken L,et al.Live birth after autograft of ovarian tissue cryopreserved during childhood[J].Hum Reprod,2015,30(9):2107-2109.