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The Influence of Endocrine Effects of Adjuvant Therapy on Quality of Life Outcomes in Younger Breast Cancer Survivors(七)

作者:来来来 整理:本网站论文网 录入时间:2011-12-13 23:15:34
gnized need to discuss fertility and options to preserve fertility before adjuvant chemotherapy for young women with breast cancer, yet women report that physicians described the side effects of therapy, but only one third to one half report that their concerns related to fertility were adequately discussed [82, 86]. In the U.S., there is a trend to marry later and to delay childbearing. If options to preserve fertility are not explored prior to treatment, the ovarian damage and subsequent premature menopause may prevent the possibility of a pregnancy after therapy. Potential options for fertility preservation include cryopreservation of oocytes, embryo cryopreservation with in-vitro fertilization (IVF), oocyte donation with IVF, ovarian tissue cryopreservation with IVF, and gonadotropin-releasing hormone (GnRH) agonists to protect ovarian function [87, 88].

  Cryopreservation of oocytes is not a viable option because of poor outcomes related to cryodamage of the oocyte in the process, and the exceptionally low pregnancy rate does not justify the use of this option for routine clinical practice [89]. In contrast, embryo cryopreservation with IVF is feasible, with established outcomes. For women with breast cancer, concerns and issues related to this option before the initiation of adjuvant therapy include the need for a partner or donor, compressed timing for decision making, potential risks of ovarian stimulation, and delay in initiating treatment because of the time required for ovarian stimulation and the IVF procedure [90]. Alternatives to standard ovarian stimulation have been investigated for women with hormonally dependent cancers. Tamoxifen with or without follicle-stimulating hormone [91, 92] and letrozole (Femara; Novartis Pharmaceuticals Corporation, East Hanover, NJ) combined with IVF have resulted in a good follicle yield, mature oocytes, and a sufficient number of embryos for cryopreservation [92]. These data should be considered preliminary, and further research is needed to verify the safety and efficacy of the approach. A second alternative, the use of a GnRH antagonist, was published as a case study of six women with cancer, four of whom were diagnosed with breast cancer [93]. The data suggest a potential role for the use of a GnRH antagonist for ovarian stimulation that reduces the duration of the fertility procedure and allows for earlier initiation of cancer therapy.

  Ovarian tissue cryopreservation with IVF is an experimental procedure that includes harvesting ovarian tissue and implantation of the ovarian tissue followed by IVF. The feasibility of harvesting ovarian tissue has been established [13, 94], and preliminary data suggest that implantation is feasible [88, 90], but more research is needed on cryopreservation protocols, cryoprotectants, and transplantation techniques [89]. In July 2005, a case report was published of a successful pregnancy and birth in a woman with a history of non-Hodgkin’s lymphoma

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