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. 2022 Sep 15;151(6):843-858.
doi: 10.1002/ijc.34006. Epub 2022 May 11.

White paper: Oncofertility in pediatric patients with Wilms tumor

M E Madeleine van der Perk  1 , Nicholas G Cost  2 , Annelies M E Bos  3 , Robert Brannigan  4 , Tanzina Chowdhury  5 , Andrew M Davidoff  6 , Najat C Daw  7 , Jeffrey S Dome  8 , Peter Ehrlich  9 , Norbert Graf  10 , James Geller  11 , John Kalapurakal  12 , Kathleen Kieran  13   14 , Marcus Malek  15 , Mary F McAleer  16 , Elizabeth Mullen  17 , Luke Pater  18 , Angela Polanco  19 , Rodrigo Romao  20 , Amanda F Saltzman  21 , Amy L Walz  22 , Andrew D Woods  23 , Marry M van den Heuvel-Eibrink  1 , Conrad V Fernandez  24
Affiliations

White paper: Oncofertility in pediatric patients with Wilms tumor

M E Madeleine van der Perk et al. Int J Cancer. .

Abstract

The survival of childhood Wilms tumor is currently around 90%, with many survivors reaching reproductive age. Chemotherapy and radiotherapy are established risk factors for gonadal damage and are used in both COG and SIOP Wilms tumor treatment protocols. The risk of infertility in Wilms tumor patients is low but increases with intensification of treatment including the use of alkylating agents, whole abdominal radiation or radiotherapy to the pelvis. Both COG and SIOP protocols aim to limit the use of gonadotoxic treatment, but unfortunately this cannot be avoided in all patients. Infertility is considered one of the most important late effects of childhood cancer treatment by patients and their families. Thus, timely discussion of gonadal damage risk and fertility preservation options is important. Additionally, irrespective of the choice for preservation, consultation with a fertility preservation (FP) team is associated with decreased patient and family regret and better quality of life. Current guidelines recommend early discussion of the impact of therapy on potential fertility. Since most patients with Wilms tumors are prepubertal, potential FP methods for this group are still considered experimental. There are no proven methods for FP for prepubertal males (testicular biopsy for cryopreservation is experimental), and there is just a single option for prepubertal females (ovarian tissue cryopreservation), posing both technical and ethical challenges. Identification of genetic markers of susceptibility to gonadotoxic therapy may help to stratify patient risk of gonadal damage and identify patients most likely to benefit from FP methods.

Keywords: Wilms tumor; fertility preservation; gonadal damage; pediatric cancer.

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Conflict of interest statement

The authors declare no potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Male fertility preservation options
FIGURE 2
FIGURE 2
Female fertility preservation options. †Only in selected cases receiving abdominal radiotherapy (RT) with an ovary in the RT field. *In rare cases, older patients with a partner may want to opt for embryo cryopreservation. However, for most Wilms tumor patients this will not be an option. ^Currently, no strong evidence exists that hormonal suppression has a protective effect on gonadal damage in children. However, it can be used in addition to other fertility preservation methods
See this image and copyright information in PMC

References

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