Avaliação da disfunção gonadal em pacientes do sexo masculino, submetidos a tratamento oncológico na infância / Evaluation of the male gonadal function submitted to treatment in the childhood cancer

RESUMO

INTRODUÇÃO: À medida que aumenta o número de adultos que sobrevivem ao tratamento do câncer infantil, observa-se a presença de efeitos tardios decorrentes do tratamento. ... OBJETIVO: Avaliar a função gonadal nos pacientes submetidos a diferentes esquemas de tratamento na infância e identificar os fatores de risco para disfunção gonadal neste grupo. CASUÍSTICA E MÉTODOS: Foram avaliados 151 pacientes, que fazem parte do GEPETTO (Grupo de Estudos Pediátricos dos Efeitos Tardios do Tratamento Oncológico) fora de tratamento há mais de 8 anos, que deram entrada no Hospital A.C. Camargo entre 1966 a 1994. ... RESULTADOS: Azoospermia foi observada em 43 pacientes. As dosagens séricas mostraram 36 pacientes com FSH alterada, 26 pacientes com testosterona total anormal e 18 pacientes com LH alterado. ... O estudo da regressão logística observou que a procarbazina (OR=7,7 para o grupo B e 10,3 para o grupo A), etoposide (OR=3,9 para o grupo A), doxorrubicina (OR=1,9 para o grupo C) e a Rxt testicular (OR=38 para o grupo C), tiveram impacto na disfunção gonadal. CONCLUSÕES: Os pacientes tratados na infância com regimes combinados de quimioterapia e/ou radioterapia apresentaram evidências de dano gonadal, com a presença de FSH alterado e/ou azoospermia e/ou volume testicular diminuído, sugerindo importante dano ao epitélio germinativo...

ABSTRACT

INTRODUCTION: As far as a majority of children with malignant diseases are cured, the late effects of the treatment are of major importance. The gonadal dysfunction is one of the undesirable late effects due to the treatment. OBJECTIVES: To evaluate the male gonadal function, submitted to treatment in the childhood and to identify the risk factors for gonadal dysfunction in this group. PATIENTS AND METHODS: Semen quality, hormonal status and testicular volume were evaluated in 151 patients treated from 1966 to 1994 in the A.C. Camargo Hospital. The age at diagnosis varied from 0.3 to 18.6 years old, with medium age 6.9 years; 114 (75.50%) patients were prepubertal (< 10 years) and 37 (24.50%) were pubertal. They were revaluated after a long period off (median of 14 years). The patients were separed in groups group A (alterations at least in a variable FSH, LH, testosterone, testicular volume and azoospermia), group B (increased FSH values and/or azoospermia) and group C (increased LH and/or testosterone values). RESULTS: Azoospermia was observed in 43 patients. Serum levels showed 36 patients with increased FSH values, 26 patients with abnormal total testosterone and 18 patient with increased LH values The testicular radiation was significant in three groups when compared the normal patients results versus abnormal ones (p<0.001). Nitrogen mustard and especially procarbazine were highly significant in group A and B (p<0.001),and daunorubicin (p<0.001) in group C. Logistic regression was observed that procarbazina showed the OR=7.7 for group B and OR= 10.3 for group A), etoposide (OR=3.9 for group A), doxorrubicina (OR=1.9 for group C), and testicular radiation (OR=38 for group C), were associated with impact in the gonadal dysfunction. CONCLUSIONS: The patients treated in the childhood with combined chemotherapy and/or radiotherapy presented evidences of gonadal, damage with increased FSH and/or azoospermia and/or reduction of testicular size, suggesting important damage to the germinal epithelium.