Prowell Tatiana M, Davidson Nancy E
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans Street, Room 409, Baltimore, Maryland 21231-1000, USA.
Oncologist. 2004;9(5):507-17. doi: 10.1634/theoncologist.9-5-507.
Ovarian ablation has been used for more than a century in the treatment of breast cancer. Methods of irreversible ovarian ablation include surgical oophorectomy and ovarian irradiation. Potentially reversible castration can be accomplished medically using luteinizing hormone releasing hormone (LHRH) analogues. In addition, cytotoxic chemotherapy unpredictably produces amenorrhea and primary ovarian failure in 10%-95% of premenopausal women as a function of patient age, cumulative dose, and the specific agents used. In the metastatic setting, ovarian ablation and tamoxifen monotherapies produce comparable outcomes and may be more effective when used together. While many early adjuvant trials of ovarian ablation were methodologically flawed, a more recent meta-analysis by the Early Breast Cancer Trialists' Collaborative Group of 12 properly designed randomized trials found significantly greater disease-free and overall survival rates for women under the age of 50, regardless of nodal status, receiving ovarian ablation as a single adjuvant therapy. Several important issues regarding the role of ovarian ablation in the treatment of breast cancer remain unresolved. Data suggest that ovarian ablation followed by some years of tamoxifen produces similar results to those seen with adjuvant chemotherapy in women with hormone-receptor positive breast cancer; however, the value of combining these modalities is still unclear. Other areas of ongoing investigation include the appropriate duration of therapy with LHRH analogues in the adjuvant setting, the long-term sequelae of ovarian suppression among young breast cancer survivors, and refinement of the population most likely to benefit from ovarian ablation or suppression.
卵巢去势用于治疗乳腺癌已有一个多世纪。不可逆卵巢去势的方法包括手术切除卵巢和卵巢放疗。使用促黄体生成素释放激素（LHRH）类似物可实现药物性潜在可逆性去势。此外，细胞毒性化疗会不可预测地使10%-95%的绝经前女性出现闭经和原发性卵巢功能衰竭，这取决于患者年龄、累积剂量和所用的具体药物。在转移性乳腺癌的情况下，卵巢去势和他莫昔芬单药治疗效果相当，联合使用可能更有效。虽然许多早期卵巢去势辅助治疗试验在方法上存在缺陷，但早期乳腺癌试验者协作组对12项设计合理的随机试验进行的一项最新荟萃分析发现，无论淋巴结状态如何，50岁以下接受卵巢去势作为单一辅助治疗的女性，其无病生存率和总生存率显著更高。关于卵巢去势在乳腺癌治疗中的作用，仍有几个重要问题尚未解决。数据表明，对于激素受体阳性乳腺癌女性，卵巢去势后使用数年他莫昔芬与辅助化疗产生的结果相似；然而，联合这些治疗方式的价值仍不清楚。正在进行研究的其他领域包括辅助治疗中使用LHRH类似物的适当疗程、年轻乳腺癌幸存者卵巢抑制的长期后遗症，以及确定最可能从卵巢去势或抑制中获益的人群。
