Journal of Clinical Oncology, Vol 15, 239-245, Copyright © 1997 by American Society of Clinical Oncology
Fertility after chemotherapy for testicular germ cell cancers
H Lampe, A Horwich, A Norman, J Nicholls and DP Dearnaley
Urological Oncology Unit, Royal Marsden National Health Service Trust, Surrey, United Kingdom.
PURPOSE: To analyze the probability of recovery of spermatogenesis after
orchidectomy and cisplatin-based chemotherapy (CT) for testicular germ cell
cancer. PATIENTS AND METHODS: One hundred seventy-eight patients treated
between 1979 and 1991 were selected by the requirement of sperm count both
pre-CT and post-CT. Counts were classified as normospermic (NS) if more
than 10 x 10(6)/mL, oligospermic (OS) if 1 to 9 x 10(6)/mL, and azoospermic
(AS) if less than 1 x 10(6)/mL. The median follow-up time after CT before
sperm analysis was 30 months. RESULTS: Analysis of 170 patients whose
spermatogenesis was reassessed at least 1 year after CT showed that of 89
patients whose pre-CT counts were NS, the post-CT count was NS in 64%, OS
in 16%, and AS in 20%. There was clear evidence for continued recovery
beyond 1 year; the probability of spermatogenesis increased to 48% by 2
years and 80% by 5 years. There was a significantly higher probability of
recovery to OS and NS count levels in the 54 patients treated with
carboplatin-rather than cisplatin-based therapy. There was an independent
and similar effect of normal pre-CT count. There was a reduced probability
to recover to OS in the 26 patients treated with more than four cycles of
CT. A prognostic model identified three groups with 25%, 45%, and 82%
probabilities of recovering spermatogenesis by 2 years after CT.
CONCLUSION: Analysis of pre-CT sperm count together with details of planned
treatment can be used to predict recovery of spermatogenesis following germ
cell CT.
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