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The Influence of Endocrine Effects of Adjuvant Therapy on Quality of Life Outcomes in Younger Breast Cancer Survivors(三)

作者:来来来 整理:本网站论文网 录入时间:2011-12-13 23:15:34
ated with ovarian toxicity of adjuvant chemotherapy for breast cancer (Table 1) [14, 1628]. Age is a strong discriminating factor for ovarian failure [25]. In women <40 years of age who receive a three-drug combination of cyclophosphamide and fluorouracil with either methotrexate (CMF) or an anthracycline (CAF, FAC) for six to nine cycles, the incidence of amenorrhea ranges from 31%38%, and for women >40 years of age, the incidence of amenorrhea is dramatically higher. The time to develop amenorrhea also corresponds with age. Younger women (<40 years of age) develop amenorrhea in 48 months, compared with women who are older (>40 years of age) who can develop amenorrhea in 24 months on adjuvant chemotherapy. Based on the fact that higher cumulative doses and longer durations of therapy are associated with a greater risk for amenorrhea, the two-drug combination of doxorubicin and cyclophosphamide (AC) for four cycles was expected to result in less damage to the ovary. There are three studies (Table 1) [2628] that have explored the incidence of amenorrhea with four cycles of AC regimens with or without a taxane. The incidence of amenorrhea at 12 months was 14% in women <30 years of age and 33% in women aged 3040 years [27]. In another study, for women <40 years of age, the incidence of amenorrhea at 1 year was 15% [28]. Despite the fact that only one study collected prospective data [27], the findings of these studies suggest that four cycles of AC adjuvant chemotherapy with or without a taxane result in a slightly lower incidence of amenorrhea in younger women than six cycles of CMF. However, women >45 years of age who receive AC with or without a taxane have a >70% risk of becoming menopausal [26, 27, 29].

  The return of menses following 12 months of amenorrhea after treatment in young women is not well documented [22, 23]. A recent prospective study suggests that there can be a return of menses after prolonged amenorrhea (>12 months), which raises issues about the appropriateness of a gynecologic workup to assess uterine pathology for unexplained vaginal bleeding [30].

  SIDE EFFECTS OF ADJUVANT ENDOCRINE THERAPY

  

  Young and young midlife women with hormonally sensitive breast cancer may receive endocrine therapy alone or following chemotherapy [31]. In addition to symptoms associated with the hormonal changes of induced menopause, endocrine therapy is also associated with a variety of other symptoms. Adjuvant therapy with tamoxifen (Nolvadex; AstraZeneca Pharmaceuticals, Wilmington, DE) has a symptom profile that includes vasomotor symptoms, vaginal complaints (dryness, itching, discharge), amenorrhea, insomnia, and mood disturbances [6, 27, 28, 3235]. Endocrine therapy with aromatase inhibitors is not recommended for women who become amenorrheic following chemotherapy because the amenorrhea may not be permanent and not reflect a true menopause [36]. However, there are clinical trials with aromatase inhibitors c

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