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عنوان فارسی مقاله:
اختلال باروری در رادیوتراپی
عنوان انگلیسی مقاله:
Fertility impairment in radiotherapy
سال انتشار : 2016
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بخشی از مقاله انگلیسی:
Effect of radiotherapy on female and male fertility
Adverse events of radiation therapy associated with fertility impairment affect patients treated with radiation to the area of the head and neck, pelvis and spine. Head and neck radiotherapy can damage the central nervous system, including the hypothalamus and/or pituitary, leading to hyperprolactinemia, gonadotropin deficiency and precocious puberty, causing directly or indirectly impairment of ovarian function. Radiotherapy of pelvis, spine or testicles shows a direct effect on the gonads, resulting in infertility and steroid hormone production disorders [4]. The biological response to radiation varies depending on the organ and tissue type; both the total and the single dose given to the patient are important. An example of this is radiotherapy to the scrotum where a single radiation dose damages germinal epithelium to a lesser extent than the same dose divided into a few fractions. In the setting of the ovaries there is a reverse effect. It is also significant if there was a tissue injury before radiation exposure, e.g. during surgery, as in this situation tissues are dose-depen-dent, which means fertility depends on a given radiation dose [4]. Testicle The testicle is one of the most radiosensitive tissues, with the lowest dose leading to its dysfunction – a dose of 0.15 Gy leads to a significant decrease in semen volume, and 0.3–0.5 Gy causes temporary oligospermia [5]. Such doses can be received not only during radiation therapy, but also as a result of radiologic imaging. Testicular tissue can be irradiated for prophylaxis radiotherapy of the pelvis and/or abdomen. It is estimated that low doses received per year due to radiation exposure do not have such an unfavorable effect as single high exposure, e.g. due to a nuclear accident, which leads to a long-term decrease in semen volume. As a result of radiotherapy, loss of proliferation in Leydig and Sertoli cells is observed. A dividing spermatogonium is very radiosensitive – a dose below 1 Gy leads to a substantial reduction in the number of spermatogonia and daughter cells. Doses causing death of spermatocytes are higher than in the case of spermatogonia (2–3 Gy); spermatids are not damaged by that dose, but after receiving a 4–6 Gy dose a noticeable decrease in the sperm count can be observed. The spermatocyte and spermatid lifetime is approximately 46 days, and the time needed for a spermatozoon to reach the ejaculate from a seminiferous tubule through the system of efferent ducts is 4 to 12 days. Therefore, during the first 50-60 days the sperm count is reduced to 50% (at a 1.5–2 Gy dose), and after that period of time it is dramatically reduced, leading even to azoospermia [4, 6]. The most severe postradiation sperm cell damage occurs between 4 and 6 months after radiotherapy completion [5]. Higher radiation doses lead much faster to extended or permanent oligo- and azoospermia. Return of fertility is a result of proliferation and regeneration of stem cells which have survived. After a single exposure dose, the time to return of normal semen volume and sperm count is 9–18 months for a dose below 1 Gy, 30 months for a dose of 2–3 Gy and 5 or more years for a dose of 4–6 Gy. Daily low fractional doses, which are used nowadays in radiotherapy, lead to protection of cells from late side effects [1, 4, 5, 7, 8].
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کلمات کلیدی:
Oncofertility: Fertility Preservation for Cancer Survivors https://books.google.com/books?isbn=0387722939 Teresa K. Woodruff, Karrie Ann Snyder - 2007 - Medical Conversely, antimetabolite therapy, such as methotrexate and mercaptopurine, does not have an adverse impact on male fertility. Cisplatin-based regimens including velban, bleomycin, and etoposide result in temporary impairment of spermatogenesis in all patients but with recovery in a significant percentage [91]. Female Genital Diseases: Advances in Research and Treatment: 2011 ... https://books.google.com/books?isbn=1464936749 2012 - Medical Infertility Charite University Hospital and School of Medicine, Berlin: Hormone and Sperm Analyses after Chemo- and Radiotherapy in Childhood and Adolescence Researchers detail in 'Hormone and Sperm Analyses ... Paediatric oncological therapy seems to have led to fertility impairment in about 1/3 of the participants. Sexual dysfunction and infertility as late effects of cancer treatment ... www.sciencedirect.com/science/article/pii/S1359634914000068 by LR Schover - 2014 - Cited by 55 - Related articles The risk of permanent ovarian failure increases with the woman's age, especially for women over age 35, and with alkylating drugs and higher total doses of chemotherapy. As in men, any pelvic radiation therapy contributes strongly to the risk of sexual dysfunction, from a combination of ovarian failure and direct tissue ...
