Pereyra Pacheco B, Méndez Ribas J M, Milone G, Fernández I, Kvicala R, Mila T, Di Noto A, Contreras Ortiz O, Pavlovsky S
Pediatric and Adolescent Gynecology Section, Hospital de Clinicas, Universidad de Buenos Aires, Argentina.
Gynecol Oncol. 2001 Jun;81(3):391-7. doi: 10.1006/gyno.2001.6181.
Recent success in polychemotherapy (PCT) in adolescent female cancer patients has become a source of concern for specialists who also strive to preserve fertility. We studied whether gonadotropin-releasing hormone (GnRH) analogs could prevent the early onset of ovarian insufficiency postchemotherapy and protect fertility.
The patients were divided into three groups: Control group 1 (Group A), premenarchal patients aged 3 to 7.5 years (n = 5), were not given GnRH analogs administered prior to PCT. Postmenarchal patients (Group B), aged 14.7 to 20 years (n = 12) with normal menstrual rhythm and ovulatory cycles, received treatment with GnRH analogs prior to PCT. Control group 2 (Group C), postmenarchal patients aged 15.9 to 20 years (n = 4), received PCT but no GnRH analog protection. All groups received the PCT regimens CAVPE, CVPP, ABVD, TAMO, ARA-C, and MTT. In group B, leuprolide acetate inhibition was obtained with a depot injection administered each month before and during treatment with PCT. To accelerate the timing of ovarian regression, a subcutaneous injection (0.2 mg) was administered simultaneously.
In Group A, patients had spontaneous menarche between the ages of 12 and 17.9 years, followed by normal menstruation and ovulatory cycles. Three patients became pregnant. After GnRH analog withdrawal, Group B patients continued with normal ovulatory cycles. Two patients became pregnant. Group C patients presented hypergonadotrophic hypoestrogenic amenorrhea.
GnRH analog treatment before and during PCT enhances ovarian function and preserves adolescent fertility. The results must be confirmed in a larger study.
青少年女性癌症患者多药化疗（PCT）最近取得的成功引起了那些也致力于保护生育能力的专家的关注。我们研究了促性腺激素释放激素（GnRH）类似物是否可以预防化疗后卵巢功能不全的早期发生并保护生育能力。
患者分为三组：对照组1（A组），3至7.5岁的青春期前患者（n = 5），在PCT之前未给予GnRH类似物。月经初潮后患者（B组），年龄14.7至20岁（n = 12），月经周期和排卵周期正常，在PCT之前接受GnRH类似物治疗。对照组2（C组），年龄15.9至20岁的月经初潮后患者（n = 4），接受PCT但未给予GnRH类似物保护。所有组均接受CAVPE、CVPP、ABVD、TAMO、ARA-C和MTT的PCT方案。在B组中，在PCT治疗前和治疗期间每月通过长效注射获得醋酸亮丙瑞林抑制作用。为了加速卵巢衰退的时间，同时给予皮下注射（0.2 mg）。
在A组中，患者在12至17.9岁之间自然月经初潮，随后月经和排卵周期正常。三名患者怀孕。停用GnRH类似物后，B组患者继续保持正常的排卵周期。两名患者怀孕。C组患者出现高促性腺激素性低雌激素性闭经。
PCT之前和期间的GnRH类似物治疗可增强卵巢功能并保护青少年的生育能力。结果必须在更大规模的研究中得到证实。
