Board Preparation: Survivorship, Fertility Preservation

Feb 22, 2016

Test your knowledge to assist your preparations for Board examinations with questions on palliative care and central nervous system tumors from two courses on ASCO University®—Focus Under Forty: Survivorship and Focus Under Forty: Fertility Preservation. Visit university.asco.org for information about these and other available self-assessment courses.

Correct answers, rationales, and suggested reading are listed at the bottom of the page.

1. Assuming no differences in comorbid health conditions, family history, or lifestyle behaviors, which of the following individuals will have the highest risk of a myocardial infarction by age 40?

  1. A 5-year-old boy diagnosed with pre–B-cell acute lymphoblastic leukemia and treated with dexamethasone, intrathecal and oral methotrexate, intrathecal and intravenous cytarabine, pegaspargase, vincristine, mercaptopurine, and doxorubicin (cumulative dose, 150 mg/m2).
  2. A 20-year-old woman diagnosed with Hodgkin lymphoma and treated with combined-modality therapy, including involved-field radiation (30 Gy to the mediastinum and the infraclavicular and supraclavicular nodes) and chemotherapy (cyclophosphamide, doxorubicin [cumulative dose, 150 mg/m2], mechlorethamine, vincristine, bleomycin [cumulative dose, 30 U/m2], etoposide, and prednisone).
  3. A 25-year-old man diagnosed with diffuse large B-cell lymphoma and treated with six cycles of rituximab, cyclophosphamide, doxorubicin (cumulative dose, 300 mg/m2), vincristine, and prednisone.
  4. A 20-year-old man diagnosed with T-cell acute lymphoblastic leukemia and treated with 18 Gy of cranial irradiation and chemotherapy.

2. Which of the following statements represents a myth in counseling men about fertility and cancer?

  1. There are no options for men who did not cryopreserve sperm prior to chemotherapy and who are azoospermic after chemotherapy.
  2.  For post-pubertal men with infertility due to retrograde ejaculation, sperm may be retrieved using electro-ejaculation.
  3. The retrieval of only a few viable sperm is sufficient to allow for future reproduction options.
  4.  Azoospermia may be only temporary after chemotherapy.

 

Rationales

1: B

Mediastinal irradiation is the treatment exposure associated with the highest risk of coronary artery disease. There does not appear to be a difference in risk by sex. Anthracycline chemotherapy is associated with left ventricular dysfunction and arrhythmias but not coronary artery disease. Cranial irradiation can lead to metabolic syndrome when used to treat young children, but is uncommon following therapy of young adults.

Suggested reading

Aleman BM, van den Belt-Dusebout AW, De Bruin ML, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood. 2007;109:1878-86.

Mulrooney DA, Yeazel MW, Kawashima T, et al. Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the Childhood Cancer Survivor Study cohort. BMJ. 2009;339:b4606.

2: A

It is a myth that men who did not cryopreserve sperm prior to chemotherapy, and who are azoospermic after chemotherapy, have no further options. Microdissection testicular sperm extraction (TESE) with intracytoplasmic sperm injection (ICSI) has been shown to successfully retrieve spermatozoa and lead to pregnancies and live births for such patients. Answers B, C, and D are not myths, but represent facts for men facing fertility issues associated with cancer.

Suggested reading

Hsiao W, Stahl PJ, Osterberg EC, et al. Successful treatment of postchemotherapy azoospermia with microsurgical testicular sperm extraction: the Weill Cornell experience. J Clin Oncol. 2011;29:1607-11.

Howell SJ, Shalet SM. Spermatogenesis after cancer treatment: damage and recovery. J Natl Cancer Inst Monogr. 2005;34:12-7.

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