Ovarian Effection With Goserelin During Adjuvant Chemotherapy For Pre-menopausal Women With Breast Cancer

Breast cancer is one of the most common malignancy in women. Raise the level of diagnosis and treatment of early breast cancer diagnosis rate has gradually improved, its fatality rate decreased survival time gradually extended. Adjuvant chemotherapy has significantly improved the outlook in early breast cancer (EBC), particularly in younger women. This benefit has however been accompanied by short-term and long-term toxicities which become increasingly important as prognosis improves. One of these long-term side effects is failure of ovarian function with associated infertility in young pre-menopausal women.However, breast cancer patients benefit from chemotherapy in the same time increasingly important as prognosis improves. Which also undermines their ovarian function induced ovarian dysfunction and lead to premature amenorrhea and infertility.Normal ovarian blood supply depends largely on the functional status of each side of the ovary varies with the menstrual cycle. Preovulatory ovarian stromal blood flow than the follicular phase of a richer, more blood vessels are usually around the dominant follicle, systolic and diastolic flow velocity increased, while the latter increased more significantly, the formation of low-resistance-type blood spectrum. Chemotherapy-induced premature ovarian failure patients, E2levels decreased, reduced vasomotor dysfunction and ovarian stromal, vascular network formation, causing the fibrous hyperplasia of the interstitial portion of the blood vessels become thin and wall compliance decreased, the peak velocity to reduce increased vascular resistance and effective hypoperfusion, resulting in thinning of the cortex,the imbalance of the cortex and medulla, cortex echogenic, ovarian atrophy, to the detriment of the patient’s ovarian reserve capacity.Ovarian reserve refers to the follicular growth and development of ovarian cortex to form the ability of the fertilized oocytes,reproductive potential decreased with the decline in ovarian reserve.Goserelin is generate a luteinizing hormone releasing hormone analogues, long-term use can suppress the pituitary luteinizing hormone synthesis, so that the serum estrogen levels decline, and remained in post-menopausal levels.ObjectiveTo assess the protective effect of goserelin on the ovarian function of the patients during chemotherapy for breast cancer.MethodsThe clinical data of the premenopausal patients with breast cancer over during a two-year period were retrospectively analyzed. The patients were divided into the study group (treated with Goserelin+conventional chemotherapy) and the control group (treated with conventional chemotherapy) with40cases.The menstrual status and the hormone levels during chemotherapy and first year follow-up after chemotherapy between the two groups were observed.Uterus and ovary size, antral follicle count, ovarian stromal blood flow were measured by color Doppler at the same time.ResultsAll the80patients finished their chemotherapy treatment and all of them developed menstrual disorders.The menstrual recovery rate of the observation group and the control group were85%and55%,respectively, and the difference between the two groups had statistical significance (P=0.007).Of the observation group, the serum oestradiol (E2)decreased to postmenopausal levels, and the serum levels of luteinising hormone(LH) and follicle stimulating hormone (FSH) were also significantly decreased during combination treatment (goserelin plus conventional chemotherapy).Of the control group, E2levels decreased gradually while FSH and LH level increased significantly during chemotherapy. Of the observation group, the size of the uterus, ovarian volume, AFC,ovarian stromal artery peak velocity less than the control group, while the RI higher than the control;Of the control group, PSV and E2was positively correlated with FSH was negatively correlated.One year follow-up after the end of treatment, the treatment group the size of the uterus, ovarian volume, AFC, ovarian stromal artery peak velocity gradually returned to normal.No significant changes in the control group.ConclusionGoserelin administered during chemotherapy can effectively prevent the ovarian function injury caused by chemotherapy, and can help maintain normal menstruation and fertility for those young and middle-aged patients.