A common chemotherapy treatment for bone and muscle cancers in boys can cause infertility when they reach adulthood, confirms new research.

Previously, doctors had surmised that the drugs, which are known to cause infertility in men, might not affect boys' reproductive ability since they were pre-pubescent when the doses were given, says lead researcher Dr Lisa Kenney of Boston's Dana Farber Cancer Institute.

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But that's false, she says.

"The prior literature made some suggestion that boys would be protected for gonadial activity [because they had not yet matured]," Kenney says, "but they all had abnormal sperm counts."

Dr Anna Meadows, senior oncologist at the Children's Hospital of Philadelphia, says the study actually confirms what's been known for a while. "About 20 years ago it was thought that boys weren't as affected by chemotherapy," she says, "but we've known [that wasn't true] for a long time."

All other aspects of male sexual development, like the development of physical characteristics and sexual functioning, however, are not affected by chemotherapy, both doctors say.

The latest study followed 17 men who had been treated for bone or muscle cancer at the Farber Institute and Boston Children's Hospital from 1960 to 1992. At the onset of their disease, 10 of the participants were pre-pubescent.

All the participants had been given chemotherapy drugs known as alkylating agents, a common treatment for the disease that works by destroying fast-dividing cells in the body. Cancer cells fall into this category, as do hair cells, cells in the digestive tract and cells in the testicles that produce sperm.

Of the 17 participants followed to adulthood, 10 - or all the men who had been pre-pubescent when treated - had no sperm production, five had reduced sperm production and two had normal sperm counts, Kenney says. The two with normal counts had received the least amount of chemotherapy, she says.

But such sober results need not be wholly discouraging, she says.

"The bad news is these men are at high risk for infertility, but the good news is that they can still father children with assistance," Kenney says. Today, she says, people can bank sperm before treatment if they're old enough, and they can take advantage of new technologies in reproductive techniques, like in vitro fertilisation, and sperm injections.

Meadows points out that newer drugs now are being used to treat these kinds of cancer, and those drugs may turn out to be effective in reducing the problem of infertility as a side effect of treating cancer.

"There are other drugs that are not as harmful," she says. "What we haven't done is to follow patients with the new drugs to see what their fertility is like."

 

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