Research Studies Conducted by Daniel M. Green, M.D.

Dr. Daniel M. Green is a member of the Department of Epidemiology & Cancer Control at St. Jude Children’s Research Hospital.  These studies pertain directly to the PORF research agenda.  Each research article presents findings relative to fertility preservation and/or offspring in pediatric cancer patients.  These are primary research studies, not opinion articles.  Therefore, they are important to an understanding of the research stream.

“Pregnancy Outcome After Treatment for Wilms Tumor:  A Report From the National Wilms Tumor Study Group.”

by Daniel M. Green, Eve M. Peabody, Nin Nan, Susan Peterson, John A Kalapurakal, and Norman E. Breslow.  Journal of Clinical Oncology, Vol 20, No 10 (May15, 2002:  pp 2506-2513.)

 

This research study focuses specifically on children treated for Wilms tumor.  The purpose of the study is to address pregnancy and offspring of those treated for Wilms tumor.  It does not specifically address fertility in the Wilms tumor survivor population.  Three study conclusions are important to PORF:

  • Female survivors who were treated with radiation to the flank for Wilm’s tumor are at increased risk for early, or threatened labor and fetal malposition.
  • Female survivors who were treated with radiation to the flank for Wilm’s tumor are more likely to experience premature births and offspring with low birthweight.
  • Female survivors who were treated with radiation to the flank for Wilm’s tumor may be at increased risk of bearing offspring with congenital malformations.  More study is required.

 

“Pregnancy Outcome of Partners of Male Survivors of Childhood Cancer:  A Report From the Childhood Cancer Survivor Study.”

by Daniel M. Green, John A Whitton, Marilyn Stovall, Ann C. Mertens, Sarah S. Donaldson, Frederick B. Ruymann, Thomas W. Pendergrass, and Leslie L. Robinson.  Journal of Clinical Oncology, Vol 21, No 4 (February 15, 2003:  pp 716-721.)

 

This research study focuses specifically on the offspring of male survivors of childhood cancer.  It does not address fertility in male survivors.  Two study conclusions are important to PORF:

  • Prior treatment of male pediatric adolescent cancer patients with chemotherapy does not adversely effect pregnancy outcomes of partners.
  • The possible effect of sex ratios of offspring requires further study.

 

“Ovarian Failure and Reproductive Outcomes After Childhood Cancer Treatment:  Results From the Childhood Cancer Survivor Study.”

by Daniel M. Green, Charles A Sklar, John d. Boice Jr, John J. Mulvihill, John A. Whitton, Marilyn Stovall, and Yutaka Yasui.  Journal of Clinical Oncology, Vol 27, No 14 (May 10, 2009:  pp 2374-2381)

 

This research study addresses acute ovarian failure (AOF) as well as offspring outcomes in children treated for cancer.  Five study conclusions are important to PORF:

  • Cancer treatment does not carry a large risk for genetic disease in the offspring of childhood cancer survivors.
  • Childhood cancer treatments, including direct ovarian radiation, or high doses of alkylating agents are at risk of causing acute ovarian failure (AOF).
  • Offspring of those treated with radiation to the uterus are at risk for premature delivery and small size.
  • Offspring of men who experienced cancer treatment as children are not impacted by that treatment.
  • The risk of AOF are greater for older children, age 13+.

 

“Fertility of Female Survivors of Childhood Cancer:  A Report From the Childhood Cancer Survivor Study.”

by Daniel M. Green, Toana Kawashima, Marilyn Stovall, Wendy Leisenring, Charles A. Sklar, Ann C. Mertens, Sarah S. Donaldson, Julianne Byrne, and Leslie L. Robison.  Journal of Clinical Oncology, Vol 27, No 16 (June 1, 2009:  pp 2677-2685)

 

This study addresses a number of issues related to fertility in children treated for cancer, including age at the time of treatment.  Three study conclusions are important to PORF:

  • Those children in the youngest group at diagnosis (ages 0-4 years) have an increased likelihood of pregnancy, which is possibly reflected in a greater number of ova present at the time of treatment.
  • A hypothalmic/pituitary radiation dose greater than 30 GY, or an ovarian/uterine radiation dose greater than 5 Gy was a significant risk factor for not having a pregnancy.
  • An alkylating agent dose (AAD) of 3-4 predicts a reduced chance for pregnancy.
    • Cumulative cyclophosphamide doses used in contemporary regimens for Hodgkin’s disease and rhabdomyosarcoma correspond to AAD scores of one to three.
    • Current regimens for Ewing sarcoma include cyclophosphamide and ifosfamide in combination, which results in an AAD score of six.