Critical appraisal:Schmiegelow M, Lassen S, Poulsen HS, Schmiegelow K, Hertz H, Andersson AM, et al 2001 2

From Cancer Guidelines Wiki
Jutta's tick icon.png This appraisal has been completed.


Article
Schmiegelow M, Lassen S, Poulsen HS, Schmiegelow K, Hertz H, Andersson AM, et al. Gonadal status in male survivors following childhood brain tumors. J Clin Endocrinol Metab 2001 Jun;86(6):2446-52 Available from: http://www.ncbi.nlm.nih.gov/pubmed/11397837.
Assigned to
User:Property "Appraisal assigned to" (as page type) with input value "User:" contains invalid characters or is incomplete and therefore can cause unexpected results during a query or annotation process.
Topic area
Guidelines:COSA:Cancer fertility preservation guidelines/Impact of cancer on fertility
Clinical question
Form
Form:Critical appraisal


Section below only relevant for Cancer Council Project Officer

Edit appraisal assignment


Critical Appraisal

Article being appraised

Schmiegelow M, Lassen S, Poulsen HS, Schmiegelow K, Hertz H, Andersson AM, et al. Gonadal status in male survivors following childhood brain tumors. J Clin Endocrinol Metab 2001 Jun;86(6):2446-52 Available from: http://www.ncbi.nlm.nih.gov/pubmed/11397837.


Applicable clinical question

Key Facts

Study Design

case-control study

Study aims:

To assess the effect of radiation therapy and chemotherapy on gonadal function in a population-based follow-up study of males treated for a brain tumor in childhood

Number of Patients:

377

N=30 cases - of these N=13 radiotherapy and chemotherapy N=17 radiotherapy alone and 29/30 had surgery of some sort
N=347 controls
Reported outcome(s):

Inhibin B
Gonadotrophins
Testosterone
Total testicular volume

Results of outcome(s):

Inhibin B:
- significant inverse correlation between basal FSH and inhibin B (rs 􏰀 􏰄0.83; P 􏰂 0.0001) (data not shown) and peak FSH and inhibin B (rs 􏰀 􏰄0.84; P 􏰂 0.0001)
- in the group that had been treated with RT 􏰁 CT (n 􏰀 13), a median inhibin B of 86 pg/mL and a median peak FSH of 8.33 IU/L, and of the 13 patients, 6 had a serum inhibin B level 􏰂 80 pg/mL and a peak FSH 􏰒10 IU/L, which is why it is reasonable to assume a reduced sperm count in our study population. However, further studies are needed to determine a threshold level of inhibin B signifying permanent infertility.
Gonadotrophins: RT+CT LH no difference to control; RT only lower LH (2.45 vs. 3.44 IU/L; P 􏰀 0.0001)
Testosterone: both the RT 􏰁 CT group and the RT-only group had significantly lower testosterone lev- els, compared with our reference population (12.8 vs. 21.9 nmol/L; P 􏰀 0.001, and 14.7 vs. 21.9 nmol/L; P 􏰀 0.0003, respectively); no difference between groups
Total testicular volume: no significant difference

Comments on results:

Small sample size

Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-3

Risk of bias
High risk of bias Comments:
Result of appraisal

Jutta's tick icon.png Included



Comments

- radiotherapy can cause secondary hypogonadism
- chemotherapy can cause primary hypogonadism, authors propose an potentially important role for inhibin B measurement to detect this
- no semen analysis was done

Completed by

Dr Rita Upreti MBChB PhD FRACP