Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China.
Department for Women's Health, University Women's Hospital and Research Centre for Women's Health, University of Tuebingen, 72076, Tuebingen, Germany.
J Ovarian Res. 2021 Dec 12;14(1):176. doi: 10.1186/s13048-021-00929-3.
Fertility preservation using ovarian tissue cryopreservation (OTC) in patients with certain diseases, especially those needing chemo- or radiotherapy, is becoming routine in various Western countries. Our hospital is the first and until now the only centre in China to use this method. The question of whether treatment of breast cancer during pregnancy (PrBC) should be similar to non-pregnant young patients with breast cancer is controversial. To our knowledge, this is the first report worldwide to use OTC as fertility preservation for PrBC.
During the 29th week of pregnancy, a 24-year-old woman underwent needle aspiration cytology of a left breast tumour. Ultrasound and cytology revealed BI-RADS 4a grade. Oncologists recommended termination of the pregnancy. Caesarean section was performed at week 32, and ovarian tissue samples were collected for OTC to preserve fertility and ovarian endocrine function. Twenty-three ovarian cortex slices were cryopreserved. It is estimated that 13,000 follicles were cryopreserved. Breast nodules and sentinel lymph node biopsy suggested invasive micropapillary carcinoma. Neoadjuvant chemotherapy was started within 1 week after diagnosis. After six courses of neoadjuvant chemotherapy, targeted drug therapy and goserelin acetate, left mastectomy and left axillary lymph node dissection were performed. In total, 23 doses of radiotherapy, eight trastuzumab targeted therapy treatments, and 17 pertuzumab + trastuzumab double targeted therapy treatments were performed after breast cancer surgery. Until now, more than 2 years after delivery, the ovarian function still is good, and no signs of a negative impact of OTC have been observed. Goserelin acetate injections, administered every 28 days, are planned to last for the next 5 years. In addition, endocrine therapy with anastrozole was started after breast cancer surgery and also is scheduled for 5 years.
OTC for fertility preservation in patients with PrBC does not delay breast surgery, radiotherapy or chemotherapy, which is essential for effective treatment of breast cancer. We assess this method as a promising fertility preservation method which was used here for the first time worldwide in a patient who developed breast cancer during pregnancy.
在某些疾病患者中，特别是需要化疗或放疗的患者中，使用卵巢组织冷冻保存（OTC）进行生育力保存已在许多西方国家成为常规。我院是中国首家也是迄今为止唯一一家使用该方法的中心。关于妊娠期间乳腺癌（PrBC）的治疗是否应与非妊娠年轻乳腺癌患者相似的问题存在争议。据我们所知，这是全球首例使用 OTC 作为 PrBC 生育力保存的报告。
在妊娠 29 周时，一位 24 岁的女性接受了左乳房肿瘤的针吸细胞学检查。超声和细胞学检查显示 BI-RADS 4a 级。肿瘤学家建议终止妊娠。在第 32 周进行剖宫产，并采集卵巢组织样本进行 OTC 以保存生育力和卵巢内分泌功能。冷冻保存了 23 个卵巢皮质切片。估计冷冻保存了 13000 个卵泡。乳腺结节和前哨淋巴结活检提示浸润性微乳头状癌。诊断后 1 周内开始新辅助化疗。在完成 6 个疗程的新辅助化疗、靶向药物治疗和戈舍瑞林醋酸酯治疗后，进行了左侧乳房切除术和左侧腋窝淋巴结清扫术。乳腺癌手术后共进行了 23 次放疗、8 次曲妥珠单抗靶向治疗和 17 次帕妥珠单抗+曲妥珠单抗双靶向治疗。迄今为止，在分娩后超过 2 年的时间里，卵巢功能仍然良好，并且没有观察到 OTC 产生负面影响的迹象。预计戈舍瑞林醋酸酯注射将每 28 天进行一次，持续 5 年。此外，乳腺癌手术后开始使用阿那曲唑进行内分泌治疗，也计划进行 5 年。
在 PrBC 患者中进行 OTC 生育力保存不会延迟乳腺癌手术、放疗或化疗，这对有效治疗乳腺癌至关重要。我们评估这种方法是一种有前途的生育力保存方法，这是全球首例在妊娠期间发生乳腺癌的患者中使用。
