Pre-chemotherapy preservation of fertility in male patients with high-grade malignant bone and soft tissue tumors

Abstract

Abstract. Only a limited number of orthopedic oncologists make arrangements for pre-chemotherapy fertility preservation, such as sperm cryopreservation, for their patients. The purpose of this study was to offer fertility preservation to male patients with high-grade malignant bone and soft tissue tumors and assess the outcomes. The study included 14 male patients, aged <45 years, with high-grade bone and soft tissue tumors. The median age at diagnosis was 23.0±12.0 years (range, 8-42 years). Following pathological confirmation of high-grade malignant tumor, we informed all the patients and/or their guardians on the issue of chemotherapy-related male infertility. If the patients were interested in preserving fertility, they were referred to a team of reproductive specialists. We documented the patients' clinical characteristics and techniques used for fertility preservation. The majority of unmarried and childless patients were interested in fertility preservation. Four patients (28.5%) selected sperm cryopreservation and 1 patient (7.1%) selected hemi-testicular preservation, as he had developed erectile dysfunction following previous surgery for colon cancer. Married patients and those with children did not wish to preserve fertility. In conclusion, infertility following chemotherapy raises serious concerns for young male patients with high-grade bone and soft tissue tumors. Prior to initiating chemotherapy, the potential risks of chemotherapy should be explained, counseling should be provided and informed consent should be obtained from the patients, ideally without delaying commencement of cancer treatment. Prior to administering cancer chemotherapy, orthopedic oncologists are encouraged to offer sperm banking to young male patients at risk of infertility.

Semen cryopreservation in adolescent and adult men undergoing fertility compromising cancer treatment: A systematic review

“…Reasons for exclusion are depicted in Figure . A total of 42 studies could be included in this review (Achille et al, ; Armuand et al, ; Babb et al, ; Bann et al, ; Boltezar et al, ; Branvall et al, ; Brydøy et al, ; Chang, Chen, Chen, & Hsieh, ; Crha et al, ; Fitoussi et al, ; Gilfillan et al, ; Girasole et al, ; Greaves et al, ; Grover, Deal, Wood, & Mersereau, ; Harrison, Welch, Matook, & Schwartz, ; Hoshi et al, ; van der Kaaij et al, ; Kamimura, Matsumoto, Zhou, Moriyama, & Saijo, ; Kelvin et al, ; Klosky, Anderson, et al, ; Klosky, Flynn, et al, ; Klosky et al, ; Klosky, Wang, et al, ; Kumar, Merali, Pond, & Zbuk, ; Latif & Ali, ; Naccache et al, ; Neal et al, ; Noetzli et al, ; Pacey et al, ; Ping, Gu, Li, Huang, & Li, ; Ramstein et al, ; Richter, Mehnert, & Geue, ; Rieker, Fitzgerald, & Kalish, ; Rooney et al, ; Rotker et al, ; Schover et al, ; Schover, Rybicki, Martin, & Bringelsen, ; Sheth et al, ; Shnorhavorian et al, ; Sonnenburg, Brames, Case‐Eads, & Einhorn, ; Wang, Chen, Ruan, & Cheung, ; Xu et al, ). No additional study could be identified by checking the references of included papers, and we did not receive any additional relevant studies by contacting the corresponding authors of included trials.…”

“…Most studies followed a retrospective approach (38/42). Only four trials were executed prospectively: Hoshi et al () (Japan): 11 patients; Klosky, Flynn, et al () (USA and Canada): 146 patients; Klosky, Wang, et al () (USA and Canada): 99 patients; and Klosky, Flynn, et al () (USA and Canada): 122 patients. Three studies comprise more than one cohort (Kelvin et al, ; Klosky, Wang, et al, ; Rotker et al, ).…”

“…For 16 studies reporting on both genders, we included male patients only. In one study, we excluded four pre‐pubertal boys from the age of 8–11 years (Hoshi et al, ).…”

“…In all but one case, semen was obtained by masturbation within the target population. In Hoshi et al (), one patient underwent testicular preservation under general anaesthesia.…”

“…Main differences between the studies were factors such as investigated countries. While some countries like France and Japan reported a rate of 100% (Fitoussi et al, ; Hoshi et al, ), other countries consistently reported lower rates. Little information on the healthcare coverage at the time of analysis was given for each study.…”