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2017 ; 6
(5
): 951-958
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Oncofertility in sarcoma patients
#MMPMID29184796
Lopategui DM
; Yechieli R
; Ramasamy R
Transl Androl Urol
2017[Oct]; 6
(5
): 951-958
PMID29184796
show ga
Treatment for sarcoma can significantly decrease fertility, both due to the
irradiation of gonads, and the impact of chemotherapy on gametogenesis.
Infertility in cancer survivors causes significant regret and decreased quality
of life in their adulthood. As this cancer mainly affects children and young
adults, fertility preservation is an essential part of survivorship care, however
it remains one of the least implemented services in adolescent and young adult
cancer patients. Success of fertility preservation is highly dependent on the
referral prior to oncologic treatment. Early patient counseling with possible
consult with oncofertility specialists should be offered to every oncologic
patient in reproductive age or younger. There are several options available and
in continuous evolution for fertility preservation. Cryopreservation of sperm and
oocytes constitutes nowadays the standard of care, and should be offered to all
patients. Other methods currently under development will potentially bring in the
future reliable options for fertility preservation in a wider range of patients,
such as those in pre-pubertal age at the time of diagnosis, or with an
insufficient sperm count for semen banking. These include testicular sperm
extraction (TESE), autologous ovarian tissue transplant, and in vitro maturation
of gametes. Novel therapies such as molecular-targeted agents offer a safer
toxicity profile regarding fertility, but further research is required to
evaluate their impact on the long term, both alone and in combination therapies.
Difficulties to access fertility preservation and its costs remain a significant
impediment for many patients in need. Warranting access to all sarcoma patients
should be a priority in all healthcare professionals involved in their care.
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