ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This single centre cross-sectional study used a self-reported questionnaire to evaluate ovarian function in 1333 female young adult childhood cancer survivors (CCS).

The authors used two different indicators of primary ovarian insufficiency (POI): induced puberty, reported in 5.3% and estrogen replacement therapy (ERT) at assessment, reported in 9.3%. Induced puberty was correlated with more aggressive cancer treatments, in particular the use of abdominal irradiation. A cut-off of 36 Gy showed 100% sensitivity in predicting the need for puberty induction, while a dose of 24 Gy had 100% specificity. ERT was more common in patients who had undergone hematopoietic stem cell transplantation (HSCT) or abdominal irradiation. ERT in the context of multiple hormone deficiencies was more common in patients with high-grade CNS neoplasms (9.9%), patients receiving CNS radiotherapy (15.7%) or HSCT (8.3%).

One of the major detrimental late effects of cancer treatment in women is impaired ovarian function. Premature ovarian insufficiency (POI) includes acute ovarian failure (AOF), as absence of menarche or cessation of menstruation, and premature menopause. The frequency of POI in CCS is estimated to be 11-13%, with a consequently reduced incidence of pregnancy (28-31%), compared to the general population. This study confirms that HSCT is the strongest predictor of POI, need of fertility treatments and reduced chance of pregnancy; chemotherapy and pelvic or CNS irradiation are also risk factors. The importance of psychological and social factors is also highlighted. The use of a self-reported questionnaire is the main limitation of this study. More detailed assessments using laboratory data to diagnose POI are needed to provide more precise information to clinicians and patients.

References: 1. Chemaitilly W, Li Z, Krasin MJ, et al. Premature ovarian insufficiency in childhood cancer survivors: a report from the St. Jude lifetime cohort. J Clin Endocrinol Metab. 2017;102(7):2242-2250.2. Netterlid A, Mörse H, Giwercman A, et al. Premature ovarian failure after childhood cancer and risk of metabolic syndrome: a crosssectional analysis. Eur J Endocrinol. 2021;185(1):67-75.