Bảo vệ buồng trứng và bảo tồn khả năng sinh sản trong điều trị ung thư phụ khoa ở những bệnh nhân muốn có con

Gynäkologische Endokrinologie - Tập 3 - Trang 107-114 - 2005
M. von Wolff1,2, S. Eisenhardt1, T. Strowitzki1
1Abteilung für Gynäkologische Endokrinologie und Fertilitätsstörungen der Universitäts-Frauenklinik Heidelberg
2Abteilung für Gynäkologische Endokrinologie und Fertilitätsstörungen der Universitäts-Frauenklinik Heidelberg, Heidelberg

Tóm tắt

Các kỹ thuật y học sinh sản mới và sự gia tăng nhận thức trong cộng đồng về khả năng thực hiện mong muốn có con sau khi mắc bệnh ung thư đã dẫn đến sự gia tăng áp dụng các biện pháp bảo tồn khả năng sinh sản trong khuôn khổ của các liệu pháp hóa trị liệu độc tế bào. Trong các khối u ác tính phụ khoa, ung thư vú là vấn đề có liên quan nhất, vì khoảng 2500 phụ nữ bị mắc bệnh này mỗi năm trước tuổi 35. Để bảo tồn khả năng sinh sản, có thể xem xét các điều trị IVF/ICSI, trưởng thành noãn trong ống nghiệm, đóng băng noãn, đóng băng mô buồng trứng và việc sử dụng các đồng phân GnRH. Tuy nhiên, xác suất mà bệnh nhân cuối cùng có thể hưởng lợi từ những liệu pháp này dưới góc độ sinh con là hạn chế. Vì vậy, các liệu pháp này chỉ nên được áp dụng sau khi đã cân nhắc kỹ lưỡng giữa rủi ro và lợi ích và sau khi đã có một cuộc tư vấn liên chuyên khoa đầy đủ cho bệnh nhân.

Từ khóa

#bảo tồn khả năng sinh sản #ung thư phụ khoa #ung thư vú #IVF #ICSI #GnRH #điều trị hóa trị liệu

Tài liệu tham khảo

Ataya K, Ramahi-Ataya A (1993) Reproductive performance of female rats treated with cyclophosphamide and/or LHRH agonist. Reprod Toxicol 7:229–235 Ataya K, Rao LV, Lawrence E, Kimmel R (1995) Luteinizing hormone-releasing hormone agonist inhibits cyclophosphamide-induced ovarian follicular depletion in rhesus monkeys. Biol Reprod 52:365–372 Ayhan A, Celik H, Taskiran C et al. (2003) Oncologic and reproductive outcome after fertility-saving surgery in ovarian cancer. Eur J Gynaecol Oncol 24:223–232 Baka SG, Toth TL, Veeck LL et al. (1995) Evaluation of the spindle apparatus of in-vitro matured human oocytes following cryopreservation. Hum Reprod 10:1816–1820 Bernardini M, Barrett J, Seaward G, Covens A (2003) Pregnancy outcomes in patients after radical trachelectomy. Am J Obstet Gynecol 189:1378–1382 Bines J, Oleske DM, Cobleigh MA (1996) Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer. J Clin Oncol 14:1718–1729 Blumenfeld Z, Dann E, Avivi I et al. (2002) Fertility after treatment for Hodgkin’s disease. Ann Oncol 13 [Suppl 1]:138–147 Bokser L, Szende B, Schally AV (1990) Protective effects of D-Trp6-luteinising hormone-releasing hormone microcapsules against cyclophosphamide-induced gonadotoxicity in female rats. Br J Cancer 61:861–865 Boring CC, Squires TS, Tong T, Montgomery S (1994) Cancer statistics, 1994. CA Cancer J Clin 44:7–26 Bukman A, Heineman MJ (2001) Ovarian reserve testing and the use of prognostic models in patients with subfertility. Hum Reprod Update 7:581–590 Byrne J, Rasmussen SA, Steinhorn SC et al. (1998) Genetic disease in offspring of long-term survivors of childhood and adolescent cancer. Am J Hum Genet 62:45–52 Cha KY, Han SY, Chung HM et al. (2000) Pregnancies and deliveries after in vitro maturation culture followed by in vitro fertilization and embryo transfer without stimulation in women with polycystic ovary syndrome. Fertil Steril 73:978–983 Chen C (1986) Pregnancy after human oocyte cryopreservation. Lancet 1:884–886 Chian RC, Buckett WM, Tulandi T, Tan SL (2000) Prospective randomized study of human chorionic gonadotrophin priming before immature oocyte retrieval from unstimulated women with polycystic ovarian syndrome. Hum Reprod 15:165–170 Covens A, Shaw P, Murphy J et al. (1999) Is radical trachelectomy a safe alternative to radical hysterectomy for patients with stage IA-B carcinoma of the cervix? Cancer 86:2273–2279 Donnez J, Dolmans MM, Demylle D et al. (2004) Livebirth after orthotopic transplantation of cryopreserved ovarian tissue. Lancet 364:1405–1410 Gook DA, Osborn SM, Bourne H, Johnston WI (1994) Fertilization of human oocytes following cryopreservation; normal karyotypes and absence of stray chromosomes. Hum Reprod 9:684–691 Gotlieb WH, Beiner ME, Shalmon B et al. (2003) Outcome of fertility-sparing treatment with progestins in young patients with endometrial cancer. Obstet Gynecol 102:718–725 Gruijters MJ, Visser JA, Durlinger AL, Themmen AP (2003) Anti-Mullerian hormone and its role in ovarian function. Mol Cell Endocrinol 211:85–90 Hawkins MM, Smith RA (1989) Pregnancy outcomes in childhood cancer survivors: probable effects of abdominal irradiation. Int J Cancer 43:399–402 Isachenko V, Montag M, Isachenko E et al. (2005) Aseptic technology of vitrification of human pronuclear oocytes using open-pulled straws. Hum Reprod 20:492–496 Jäger W, Bittl A, Rabenbauer B, Wildt L (1990) Chemotherapeutically induced amenorrhoea is associated with decreasing CA124 serum levels. In: Klapdor R (ed) Recent results in tumor diagnosis and therapy. Zuckschwerdt, München, pp 133–137 Johnson J, Canning J, Kaneko T et al. (2004) Germline stem cells and follicular renewal in the postnatal mammalian ovary. Nature 428:145–150 Kim SS, Soules MR, Battaglia DE (2002) Follicular development, ovulation, and corpus luteum formation in cryopreserved human ovarian tissue after xenotransplantation. Fertil Steril 78:77–82 Kimmig R, Strowitzki T, Muller-Hocker J et al. (1995) Conservative treatment of endometrial cancer permitting subsequent triplet pregnancy. Gynecol Oncol 58:255–257 Kroman N, Jensen MB, Melbye M et al. (1997) Should women be advised against pregnancy after breast-cancer treatment? Lancet 350:319–322 Levine MN, Bramwell VH, Pritchard KI et al. (1998) Randomized trial of intensive cyclophosphamide, epirubicin, and fluorouracil chemotherapy compared with cyclophosphamide, methotrexate, and fluorouracil in premenopausal women with node-positive breast cancer. National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 16:2651–2658 Mackie EJ, Radford M, Shalet SM (1996) Gonadal function following chemotherapy for childhood Hodgkin’s disease. Med Pediatr Oncol 27:74–78 McVie JG (1999) Cancer treatment: the last 25 years. Cancer Treat Rev 25:323–331 Meirow D, Fasouliotis SJ, Nugent D et al. (1999) A laparoscopic technique for obtaining ovarian cortical biopsy specimens for fertility conservation in patients with cancer. Fertil Steril 71:948–951 Meistrich ML, Byrne J (2002) Genetic disease in offspring of long-term survivors of childhood and adolescent cancer treated with potentially mutagenic therapies. Am J Hum Genet 70:1069–1071 Mikkelsen AL, Smith S, Lindenberg S (2000) Impact of oestradiol and inhibin A concentrations on pregnancy rate in in-vitro oocyte maturation. Hum Reprod 15:1685–1690 Mitwally MF, Casper RF (2003) Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 18:1588–1597 Morice P, Camatte S, El Hassan J et al. (2001) Clinical outcomes and fertility after conservative treatment of ovarian borderline tumors. Fertil Steril 75:92–96 Morita Y, Perez GI, Paris F et al. (2000) Oocyte apoptosis is suppressed by disruption of the acid sphingomyelinase gene or by sphingosine-1-phosphate therapy. Nat Med 6:1109–1114 Mueller BA, Simon MS, Deapen D et al. (2003) Childbearing and survival after breast carcinoma in young women. Cancer 98:1131–1140 Nabholtz JM, Cantin J, Chang J et al. (2002) Phase III trial comparing granulocyte colony-stimulating factor to leridistim in the prevention of neutropenic complications in breast cancer patients treated with docetaxel/doxorubicin/cyclophosphamide: results of the BCIRG 004 trial. Clin Breast Cancer 3:268–275 Oktay K, Buyuk E, Davis O et al. (2003) Fertility preservation in breast cancer patients: IVF and embryo cryopreservation after ovarian stimulation with tamoxifen. Hum Reprod 18:90–95 Oktay K, Buyuk E, Rosenwaks Z (2003) Novel use of an aromatase inhibitor for fertility preservation via embryo cryopreservation in endometrial cancer: a case report. Fertil Steril 80 [Suppl 3]:144 Oktay K, Buyuk E, Veeck L et al. (2004) Embryo development after heterotopic transplantation of cryopreserved ovarian tissue. Lancet 363:837–840 Paris F, Perez GI, Fuks Z et al. (2002) Sphingosine 1-phosphate preserves fertility in irradiated female mice without propagating genomic damage in offspring. Nat Med 8:901–902 Pereyra Pacheco B, Mendez Ribas JM, Milone G et al. (2001) Use of GnRH analogs for functional protection of the ovary and preservation of fertility during cancer treatment in adolescents: a preliminary report. Gynecol Oncol 81:391–397 Porcu E, Fabbri R, Maria Ciotti P et al. (2002) Oocytes or embryo storage? Fertil Steril 78 [Suppl 1]:O-38 Recchia F, Sica G, De Filippis S et al. (2002) Goserelin as ovarian protection in the adjuvant treatment of premenopausal breast cancer: a phase II pilot study. Anticancer Drugs 13:417–424 Reyno LM, Levine MN, Skingley P et al. (1992). Chemotherapy induced amenorrhoea in a randomised trial of adjuvant chemotherapy duration in breast cancer. Eur J Cancer 29A(1):21–23 Sankila R, Heinavaara S, Hakulinen T (1994) Survival of breast cancer patients after subsequent term pregnancy: „healthy mother effect“. Am J Obstet Gynecol 170:818–823 Scott RT, Opsahl MS, Leonardi MR et al. (1995) Life table analysis of pregnancy rates in a general infertility population relative to ovarian reserve and patient age. Hum Reprod 10:1706–1710 Velentgas P, Daling JR, Malone KE et al. (1999) Pregnancy after breast carcinoma: outcomes and influence on mortality. Cancer 85:2424–2432 Wang CB, Wang CJ, Huang HJ et al. (2002) Fertility-preserving treatment in young patients with endometrial adenocarcinoma. Cancer 94:2192–2198 Waxman JH, Ahmed R, Smith D et al. (1987) Failure to preserve fertility in patients with Hodgkin’s disease. Cancer Chemother Pharmacol 19:159–162 Welt CK (2002) The physiology and pathophysiology of inhibin, activin and follistatin in female reproduction. Curr Opin Obstet Gynecol 14:317–323 Yang D, Winslow KL, Blohm PL et al. (2002) Oocyte donation using cryopreserved donor oocytes. Fertil Steril 78 [Suppl 1]:O-37