Oophorectomy/adrenalectomy.

Oophorectomy is indicated for premenopausal women who have disseminated breast cancer and who are estrogen receptor positive. Adrenalectomy is indicated in women who have advanced disseminated breast cancer and who have hormonally dependent tumors as evidenced by estrogen receptors in the tumor tissue, or by virtue of regression from previous oophorectomy, anti-estrogens, or medical adrenalectomy. Endocrine ablation should be performed early in the course of the disease. For perimenopausal women or for those who are immediately postmenopausal, combined oophorectomy/adrenalectomy are performed. Adrenalectomy is contraindicated in those women with fulminant recurrent disease with a short interval from mastectomy to time of recurrence. It is also contraindicated in those with advanced liver metastasis, extensive pulmonary metastasis, especially of the lymphangitic type, or symptomatic brain metastasis. Clinical assessment together with estrogen receptor assay wil permit more careful patient selection so that ablative procedures will be performed only in those patients most likely to have a good response.