Japan Society of Clinical Oncology Clinical Practice Guidelines 2017 for fertility preservation in childhood, adolescent, and young adult cancer patients: part 1

Abstract

In 2017, the Japan Society of Clinical Oncology (JSCO) published the JSCO Clinical Practice Guidelines 2017 for Fertility Preservation in Childhood, Adolescent, and Young Adult Cancer Patients. These were the first Japanese guidelines to address issues of oncofertility. In this field of medicine, sustained close cooperation between oncologists and reproductive specialists is essential from the diagnosis of cancer until many years after completion of cancer treatment. These JSCO guidelines were intended to guide multidisciplinary medical staff in considering the availability of fertility preservation options and to help them decide whether to provide fertility preservation to childhood, adolescent, and young adult cancer patients before treatment starts, with the ultimate goal of improving patient survivorship. The guidelines are presented as Parts 1 and 2. This article (Part 1) summarizes the goals of the guidelines and the methods used to develop them and provides an overview of fertility preservation across all oncology areas. It includes general remarks on the basic concepts surrounding fertility preservation and explanations of the impacts of cancer treatment on gonadal function by sex and treatment modality and of the options for protecting/preserving gonadal function and makes recommendations based on 4 clinical questions. Part 2 of these guidelines provides specific recommendations on fertility preservation in 8 types of cancer (gynecologic, breast, urologic, pediatric, hematologic, bone and soft tissue, brain, and digestive).

The possible effects of the Japan Society of Clinical Oncology Clinical Practice Guidelines 2017 on the practice of fertility preservation in female cancer patients in Japan

“…Compared with the previous survey (2011–2015), the range of diseases for which cryopreservation was performed has increased; the diseases that were not named as indications for cryopreservation in the previous survey (2011–2015) are marked with an asterisk. Pre, 2011–2015, i.e., before publication of the Japan Society of Clinical Oncology Clinical Practice Guidelines 2017 for Fertility Preservation in Childhood, Adolescent, and Young Adult Cancer Patients 8 , 9 ; post, 2016–2019, i.e., from shortly before to after publication of the guidelines…”

“… Note Pre, 2011–2015, i.e., before publication of the Japan Society of Clinical Oncology Clinical Practice Guidelines 2017 for Fertility Preservation in Childhood, Adolescent, and Young Adult Cancer Patients 8 , 9 ; post, 2016–2019, i.e., from shortly before to after publication of the guidelines. * p < 0.05 vs. the percentage during the period of the previous survey, i.e., 2011 to 2015 (pre).…”

“…Therefore, the Japan Society of Clinical Oncology (JSCO) developed and published the JSCO Clinical Practice Guidelines 2017 for Fertility Preservation in Childhood, Adolescent, and Young Adult Cancer Patients. 8,9 In 2019, our research group then published a manual, the "Clinical Practice Manual for Fertility Preservation in Cancer Patients," to assist reproductive specialists in complying with the guidelines. 10 The objective of the present study was to examine the possible effects of the JSCO 2017 guidelines on the practice of fertility preservation in female cancer patients in Japan.…”

“…The number of institutions that excluded diseases requiring hysterectomy from the permitted indications was almost the same as in the previous survey (11 vs. 10, Table3).Eight patients in six institutions underwent transplant of cryopreserved ovarian tissue (Table5). One institution reported that two TA B L E 3 Number of institutions that set age and indication limits for cryopreservation in childhood, adolescent, and young adult cancer patientsTA B L E 4Note: Pre, 2011-2015, i.e., before publication of the Japan Society of Clinical Oncology Clinical Practice Guidelines 2017 for Fertility Preservation in Childhood, Adolescent, and Young Adult Cancer Patients8,9 ; post, 2016-2019, i.e., from shortly before to after publication of the guidelines. *p < 0.05 vs. ratio during 2011-2015 (pre).Abbreviations: AI, aromatase inhibitor; COS, controlled ovarian stimulation.…”

“…8,9 ; post, 2016-2019, i.e., from shortly before to after publication of the guidelines TA B L E 2 Characteristics of cryopreservation for childhood, adolescent, and young adult patients with breast cancer and hematologic malignancy with hematologic malignancy, 100% (69/ 69) and 98.3% (59/60) of the institutions performed COS in embryo and oocyte cryopreservation, respectively. Among these institutions, 79.4% (54/ 68) and 91.5% (54/ 59) conducted random-start COS to shorten the time until oocyte collection could be performed.…”