Ovarian Dysfunction After Gonadotoxic Therapy in Childhood Cancer Survivors: A Cross-Sectional Study From a Resource-Limited Setting

Ovarian dysfunction is a life-altering late effect in female childhood cancer survivors (CCS), yet early identification of ovarian injury remains challenging. This study aimed to evaluate the burden and determinants of ovarian dysfunction in CCS, with a specific focus on treatment-related amenorrhea (TRA) persisting for ≥4 months. Demographic, clinical, and treatment exposure data were obtained from the hospital medical records. Menstrual and hormonal information was collected using a structured proforma. In this single-center cross-sectional study, 186 female CCS (mean age: 21±5 y) were evaluated after a mean follow-up of 10±5.6 years. Gonadotoxic exposures included chemotherapy (100%) with a mean cumulative cyclophosphamide equivalent dose (CED) of 5.1 g/m 2 , pelvic or craniospinal radiotherapy (6.45%), and hematopoietic stem cell transplantation (4.8%). Hypergonadotropic TRA was observed in 24% (45/186) of survivors, and 20% (9/45) of them progressed to acute ovarian failure (AOF). On multivariable analysis, independent predictors of TRA included postpubertal status at diagnosis (OR: 20.45; CI: 4-101.5), solid tumor diagnosis (OR: 5.98; CI: 1.7-8), and CED of ≥7.5 g/m 2 (OR: 4.56; CI: 1.4-14). Prevalence of AOF aligned with established risk categories. As an easily identifiable clinical feature, TRA may help identify survivors suitable for fertility preservation counselling and surveillance for premature ovarian failure.