The role of hormonal ovarian ablation in adjuvant treatment of premenopausal breast cancer

• Published in: Srpski arhiv za celokupno lekarstvo Vol. 139; no. 5-6; pp. 339 - 346
• Main Authors: Murtezani, Zafir, Nešković-Konstantinović, Zora, Stanisavljević, Nataša, Kovčin, Vladimir
• Format: Journal Article
• Language: Serbian; English
• Published: Serbia Serbian Medical Society 01.05.2011
• Subjects: Adult; Antineoplastic Agents, Hormonal - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Chemotherapy, Adjuvant; Cyclophosphamide - therapeutic use; Disease-Free Survival; Doxorubicin - therapeutic use; Estrogen Antagonists - therapeutic use; Female; Fluorouracil - therapeutic use; Goserelin - therapeutic use; Humans; Middle Aged; ovarians; Premenopause; Survival Rate; Tamoxifen - therapeutic use
• ISSN: 0370-8179; 2406-0895
• DOI: 10.2298/SARH1106339M

Breast cancer is the most frequent malignant disease in women with about 25% compared to all malignant tumours. Chemotherapy, antiestrogen and ovarian ablation/ supression present effective adjuvant approach for premenopausal women diagnosed with hormonal depended, operable breast cancer. To evaluate benefits of combined chemo/hormonal therapy that is undutiful, but optimal application has not yet been clearly determined. Thirty-six women were divided into three therapy groups. The first group (13 women) was treated with six cycles of adjuvant FAC chemotherapy followed by regular check-ups; the second group (13 women) after six cycles of adjuvant FAC chemotherapy continued treatment with a two-year application of goserelin given by subcutaneous injections (FAC-Z); the third group (10 women), after six cycles of adjuvant FAC chemotherapy continued with once per month application of gorselin for two years and a daily application of 20 mg tamoxifen for five years (FAC-Z-T). The length of overall disease free period and survival were analyzed in all three groups. The benefit of LH-RH analogues in premenopausal women with hormone-dependent breast cancer was found to be low, and probably limited to smaller subgroups of patients, possibly such as those with either both steroid receptors positive (ER and PR) or those with an extremely high level of steroid receptors. In our paper, analyses of such subgroups could not been performed due to a small sample of patients. The effect of therapy is better in patients, who developed amenorrhoea, regardless of the type of later hormonal therapy. Ovarial ablation, whatever the method, should be probably applied as early as possible within the treatment of early breast cancer, especially in patients in whom chemotherapy induced amenorrhoea is not expected, i.e. in very young female patients.