Evaluation of the effect of GnRH agonist on menstrual reverse in breast cancer cases treated with cyclophosphamide

Twenty-five percent of breast cancer cases are detected during premenopausal period and the number of young women suffering from breast cancer is increasing in the world, especially in Iran. Preservation of fertility and ovarian function leads to improved quality of life of these patients. The aim of this study was to evaluate the effect of gonadotropin releasing hormone (GnRH) agonist on menstrual reverse in breast cancer cases treated with cyclophosphamide regimen.

MATERIALS AND METHODS

This randomized clinical trial (RCT) was conducted on 42 adenocarcinoma cases. Mean age of patients was 37 +/- 5 years (range 25 to 45). Primary stages to Stage II (T2N1M0) whose histology reports were negative ER/PR were enrolled in this study. All the enrolled patients were candidates for cyclophosphamide (600 mg/m2), adriamycin (60 mg/m2), and taxoter (75 mg/m2) chemotherapy regimens.

RESULTS

Spontaneous menstrual reverse occurred in 90.5% of patients receiving diphereline at three to six months after treatment which occurred in 33.3% of control cases. In control group, 14.3% (three cases) had oligomenorrhea and hypomenorrhea during chemotherapy and 19%(four cases) had spontaneous menstrual reverse at three to six months. It should be noted that there was a significant difference between controls and cases (p < 0.001). This difference was insignificant in cases younger than 35 years (p < 0.594). In 100% of patients older than 35 years who received diphereline, spontaneous menstrual reverse occurred during six months after chemotherapy, but this occurred in only 20% of controls (p < 0.001). Mean serum level of follicle stimulating hormone (FSH) and luteinizing hormone (LH) during and at three months after therapy was significantly lower in cases in comparison with controls, but serum level of estradiol was significantly more in cases three months after chemotherapy (p < 0.001).

CONCLUSION

GnRH agonists significantly improve ovarian function andfertility. They also lead to spontaneous menstrual reverse in negative ER/PR breast cancer cases.

Cancer in pregnancy: a 10-year experience in shahid sadoughi hospital, yazd, iran

INTRODUCTION

Although occurrence of cancer during pregnancy is rare, it leads to high morbidity and mortality in both mother and fetus. Recent trends in prolongation of child-bearing age have made cancer-associated pregnancies more frequent than past. As yet there are few documents concerning cancer and its related treatment outcomes during pregnancy. This study aimed at describing clinical characteristics of pregnant women with cancer in the Shahid Sadoughi hospital in Yazd, Iran.

MATERIALS AND METHODS

Case series were reviewed retrospectively, which included 19 pregnant women diagnosed with cancer in Shahid Sadoughi hospital from 2002 to 2012. Data collected comprised demographics, pregnancy characteristics and outcomes, type of cancer, clinical stage, treatment and oncological.

RESULTS

From 17 pregnant women with cancer, 4 women had gynecologic cancers and 13 had non-gynecologic cancers. The Following tumors were observed: breast [6], acute myeloblastic leukemia [3], uterine cervix carcinoma [3], ovary [1], chronic myelogenous leukemia [1], lymphoma [1], papillary carcinoma of thyroid [1], and pseudopapillary carcinoma of pancreas [1]. The mean age of patients was 30.6 years, and the mean gestational age at diagnosis was 21.1 weeks. Surgical treatment was performed in 3 patients, 6 patients were treated by chemotherapy, and in 3 by both.

DISCUSSION

Although cancer during pregnancy is uncommon, it is considered an important problem due to unsuitable maternal and fetal outcomes and lack of standard management guidelines. Our cases represent examples of feasible or justifiable managements for them.

A comparison of the effect of levonorgestrel IUD with oral medroxyprogesterone acetate on abnormal uterine bleeding with simple endometrial hyperplasia and fertility preservation

OBJECTIVE

Endometrial hyperplasia is clinically important, because it can lead to abnormal uterine bleeding (AUB) which itself can precede endometrial cancer. Endometrial carcinoma is the most common malignancy of the female genital tract, occurring in about 75%-85% younger, perimenopausal women as endometrial hyperplasia. The treatment is hysterectomy or hormone therapy with progesterone. The aim of this study was, therefore, to compare the effect of levonorgestrel intrauterine device (LNG-IUD) with medroxyprogesterone acetate (MPA) on simple endometrial hyperplasia for fertility preservation.

MATERIALS AND METHODS

Forty women in reproductive age (22-47 years) with AUB with endometrial biopsies confirming simple hyperplasia, were enrolled in this study and then randomly divided into two groups. All patients presented with designed special checklist which was filled with satisfaction. Complete history and physical examination especially blood pressure (BP), body mass index (BMI), breast examination, bimanual vaginal examination, and transvaginal sonography (to measure the thickness of endometrial and exclude the other pathologic lesions) were performed. In the first group, treatment was performed with MPA (20 mg/daily) for ten days and in other group with LNG-IUD was prescribed. After three months, transvaginal sonography and biopsy of endometrium were done. The status of AUB and side-effects of two methods,along with the rate of satisfactory were evaluated.

RESULT

The findings showed the significant differences in the treatment of simple hyperplasia between two groups (LNG-IUD group vs. MPA group) (p < 0.047). Recovery of AUB in the group LNG was enhanced (p < 0.047). Endometrial thickness was reduced in both groups (p < 0.001), but further reduction in LNG group was seen. Also, LNG was tolerated more than MPA. Side-effects of MPA were more and reached significance (p < 0.003). The rate of satisfaction with LNG was higher than MPA and reached significance (p < 0.048).

CONCLUSION

The results of this study show that LNG-IUD is more effective than MPA in treatment of simple endometrial hyperplasia and can be helpful in young women who want to preserve their fertilities.

Comparing letrozole with medroxyprogesterone acetate (MPA) as hormonal therapy for simple endometrial hyperplasia without atypia in adult and middle-aged women

BACKGROUND

The aim of this survey was to compare the effect of letrozole with medroxyprogesterone acetate (MPA) in treatment of simple endometrial hyperplasia to preserve fertility in young women.

MATERIALS AND METHODS

Forty-five patients referred to Shahid Sadoughi gynecology clinics from 2009 until 2011 who suffered from abnormal vaginal bleeding or endometrial thickness, that underwent curettage with diagnosis of simple endometrial hyperplasia without atypia were enrolled. The patients were divided randomly into two groups. First group including 22 women receive ten mg MPA, for ten days during a month for three months. All cases were followed by interview, endometrial curetage, and vaginal sonography. Serum level of estradiol was checked before and after treatment. At the end of the study, biopsy was retaken in 41 patients. All the patients were under observation by two gynecologists.

RESULTS

Age range of patients was 20 to 42 years. Mean body mass index (BMI) in the MPA and letrozole groups was 29.13 +/- 4.8 and 25.42 +/- 4.2, respectively. Fifty and 34.8 percent of cases had history of obesity or polycystic ovarian syndrome (PCOS) in MPA and letrozole groups, respectively. Forty-one selected cases (20 of the MPA and 21 of the letrozole groups) continued the treatment for three months. The endometrial thicknesses decreased in both groups. Serum estradiol level also decreased in both groups. The most common complication in the MPA and letrozole groups was headache (27.3%) and flashing and dizziness, respectively. The side-effects were reported less in the letrozole group and the most common ones in this group were dizziness and flashing.

DISCUSSION

In women suffering from simple endometrial hyperplasia without atypia, letrozole can lead to decrease of serum estradiol level and endometrial thickness like MPA. In both groups, there was no simple hyperplasia report in curettage report following treatment. It should be noted that there was an incomplete response to treat case with pathology of disordered proliferative type.

CONCLUSION

Letrozole is a good therapeutic option in simple endometrial hyperplasia without atypia: cases candidate for medical treatment. To confirm the effect and safety of letrozole, more studies with larger samples are recommended.