Davidson N E
Johns Hopkins Oncology Center, Baltimore, MD 21231.
J Natl Cancer Inst Monogr. 1994(16):95-9.
Ovarian ablation has been used for breast cancer treatment for nearly 100 years. Available methods of causing ovarian failure include surgical or radiotherapeutic ablation and LH-RH agonists that effect a reversible "medical oophorectomy." In addition, administration of certain types of chemotherapy to susceptible hosts may also result in permanent amenorrhea. The response rate to ovarian ablation in premenopausal women with metastatic breast cancer is about 35%. It is more effective in women over 35 years of age or with estrogen receptor-positive tumors. Oophorectomy, ovarian radiation, and luteinizing hormone-releasing hormone agonists are probably equally effective in this setting, although rigorous comparative trials have not been completed. Individual trials of ovarian ablation as adjuvant therapy show a trend toward increased relapse-free survival, but rarely show a survival advantage. However, an overview analysis of randomized trials of adjuvant ovarian ablation, which includes about 1800 women under 50 years of age, suggests that this modality reduces the annual rates of recurrence and death by about 25%, an effect similar to that seen with adjuvant chemotherapy by indirect comparison. Therefore, a number of clinical trials designed to elucidate the role of ovarian ablation alone or in conjunction with other adjuvant approaches are in progress. The routine use of ovarian ablation as an adjuvant therapy should await the establishment of its efficacy in these trials.
卵巢去势用于乳腺癌治疗已有近100年历史。导致卵巢功能衰竭的现有方法包括手术或放射治疗去势以及能产生可逆性“药物性卵巢切除”的促性腺激素释放激素（LH-RH）激动剂。此外，对易感宿主给予某些类型的化疗也可能导致永久性闭经。绝经前转移性乳腺癌女性对卵巢去势的反应率约为35%。在35岁以上女性或雌激素受体阳性肿瘤患者中更有效。在这种情况下，卵巢切除术、卵巢放疗和促黄体生成素释放激素激动剂可能同样有效，尽管尚未完成严格的对比试验。作为辅助治疗的卵巢去势的个别试验显示出无复发生存期增加的趋势，但很少显示出生存优势。然而，一项对辅助性卵巢去势随机试验的综述分析（纳入了约1800名50岁以下女性）表明，这种方法可使年复发率和死亡率降低约25%，通过间接比较，这一效果与辅助化疗相似。因此，一些旨在阐明单独使用卵巢去势或与其他辅助方法联合使用的作用的临床试验正在进行中。卵巢去势作为辅助治疗的常规应用应等待这些试验确定其疗效。
