Testicular function following the treatment of Hodgkin's disease in childhood

Br J Cancer. 1993 Dec;68(6):1199-204. doi: 10.1038/bjc.1993.504.

Abstract

Testicular function was studied in 40 males treated in childhood for Hodgkin's disease at St Bartholomew's Hospital, and the Hospital for Sick Children, London, between 1971-1985. All patients were 16 years or over at evaluation, and off treatment more than 6 years. Basal FSH, LH and testosterone levels were measured. Testicular size was measured using a Prader orchidometer, and all patients were offered a seminal analysis. Twenty-eight patients were treated with chemotherapy, usually ChlVPP. Twenty-one also had radiotherapy, five below the diaphragm. Twelve patients were treated with radiotherapy alone (five below the diaphragm). Twenty-six of 28 patients treated with chemotherapy and three of five patients treated with radiotherapy alone below the diaphragm have elevated basal FSH levels, and 18 of these also have elevated basal LH levels. Median testicular volume is 11 ml (range 5-25 ml). Eleven of 13 patients investigated are azoospermic. All patients have normal testosterone levels, and normal secondary sexual characteristics. There is no biochemical evidence of healing of the damaged germinal epithelium with elevated FSH levels persisting up to 17 years from the end of therapy. These results indicate a high incidence of damage to the germinal epithelium in patients treated with ChlVPP chemotherapy and/or radiotherapy below the diaphragm. Appropriate counselling of these patients with regard to their reproductive capabilities is essential.

MeSH terms

  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Chlorambucil / administration & dosage
  • Chlorambucil / adverse effects
  • Combined Modality Therapy / adverse effects
  • Follicle Stimulating Hormone / blood
  • Hodgkin Disease* / drug therapy
  • Hodgkin Disease* / radiotherapy
  • Humans
  • Infertility, Male / chemically induced
  • Infertility, Male / etiology*
  • Luteinizing Hormone / blood
  • Male
  • Oligospermia / chemically induced
  • Oligospermia / etiology
  • Prednisolone / administration & dosage
  • Prednisolone / adverse effects
  • Procarbazine / administration & dosage
  • Procarbazine / adverse effects
  • Radiotherapy, High-Energy / adverse effects*
  • Spermatogenesis / drug effects
  • Spermatogenesis / radiation effects
  • Testis / drug effects
  • Testis / physiopathology*
  • Testis / radiation effects
  • Testosterone / blood
  • Vinblastine / administration & dosage
  • Vinblastine / adverse effects

Substances

  • Chlorambucil
  • Procarbazine
  • Testosterone
  • Vinblastine
  • Luteinizing Hormone
  • Follicle Stimulating Hormone
  • Prednisolone

Supplementary concepts

  • ChlVPP protocol