化疗前应用诺雷德预处理对乳腺癌患者月经复潮的影响

Effect of Zoladex Administered before Chemotherapy on Menstruation of Patients with Breast Cancer

目的:乳腺癌目前常规的化疗方案会导致大多数的绝经前患者提前永久性闭经,对进行术后辅助化疗并且有维持正常月经要求的女性,化疗前应用诺雷德,保护月经复潮。方法:2004年12月～2006年12月共63例入组,对确诊为乳腺癌并有维持正常月经要求的女性患者随机分成试验组(应用诺雷德组)31例和对照组(常规化疗组)32例,试验组:化疗前应用诺雷德3.6mg腹部皮下注射,待患者来月经一次再进行化疗,其后每28天腹部皮下注射诺雷德3.6mg,化疗方案为AC(环磷酰胺50mg/m2d1+阿霉素50mg/m2d1每2周1次,共4次),或AC-T(环磷酰胺50mg/m2d1+阿霉素50mg/m2d1每2周1次,共4次,序贯紫杉醇135mg/m2d1每2周1次,共4次);对照组:常规化疗,化疗方案为AC或AC-T,比较两组的化疗后的月经来潮情况。结果:63例均可完成治疗,化疗后月经周期紊乱。试验组、对照组复潮人数67.9%:46.9%、P=0.027<0.05,统计学有明显意义。结论:常规化疗会导致化疗患者提前永久性闭经,月经恢复与年龄相关,化疗前应用诺雷德,可以有效地保护其卵巢功能,保证了患者要求维持正常月经要求的可能。

Objective： Conventional chemotherapy for patients with breast cancer may lead to permanent amenorrhea in advance. In this trial, Zoladex was used to protect the ovarian function of the patients with breast cancer requiring for fertility or/and maintenance of the normal hormone level before chemotherapy. Methods： From December 2004 to December 2006, 63 patients with breast cancer requiring for fertility or/and maintenance of the normal hormone level were randomly divided into the test group （31 cases） and the. control group （32 cases）. The patients in the test group were treated with Zoladex 3.6 mg iH qd and then with chemotherapy after one menstrual cycle. Zoladex was used at 3.6 mg iH qd every month subsequently. The chemotherapy regimen was AC （cyclophosphamide 50mg/m^2 d1 ＋ adriamycin 50 mg/m^2 d1 once a week, x4） or AC-T （cyclophosphamide 50mg/m^2 d1 ＋ adriamycin 50 mg/m^2 d1 once a week, x4; follow paclitaxel 135 mg/m^2 d1 once a week, x4）. The patients in the control group were treated with conventional chemotherapy regimen of AC or AC-T. We compared the menstruation status after the chemotherapy between the two groups. Results- All of these 63 patients completed the treatment. The rates of the return of menstruation in the test group and the control group were 67.9% and 46.9%, respectively （P=-0.027）. Conclusion： Conventional chemotherapy may lead to permanent amenorrhea in advance and the recovery of menstruation is age-related. Zoladex administered before chemotherapy can effectively protect the ovarian function and can satisfy the patients with breast cancer requiring for fertility or/and maintenance of the normal hormone level.