Tumors of female reproductive systemTumors of female reproductive systemОпухоли женской репродуктивной системы1994-40981999-8627Publishing House ABV Press44610.17650/1994-4098-2015-11-3-35-42MAMMOLOGY. TREATMENTМАММОЛОГИЯ. ЛЕЧЕНИЕOvarian function suppression: To what extent is it necessary for premenopausal patients with operable hormone-sensitive breast cancer?Супрессия функции яичников: насколько она необходима у пременопаузальных пациенток, страдающих операбельным гормоночувствительным раком молочной железы?KoposovP. V.КопосовП. В.
Russian Federation
pkoposov@emcmos.ruEuropean Medical Cancer Research CenterЗАО «Европейский медицинский центр»35 Shchepkin St., Moscow, 129090, RussiaРоссия, 129090, Москва, ул. Щепкина, 35EMC Medical SchoolЧУ ДПО «Медицинская школа ЕМС»3А Oktyabrskaya St., Moscow, 119027, RussiaРоссия, 119027, Москва, ул. Октябрьская, 3А1609201511335421509201515092015https://ojrs.abvpress.ru/ojrs/article/view/446

The use of tamoxifen is conventional adjuvant hormone therapy in premenopausal patients with receptor-positive breast cancer. Clinical trials demonstrating the benefits of ovarian function suppression as adjuvant treatment had an ambiguous interpretation. There is no scientific evidence favoring the empiric use of ovarian suppression for these patients. The members of the American Society of Clinical Oncology consider that ovarian ablation or suppression should be used during adjuvant hormone therapy only in certain cases. Irreversible ovarian function ablation may improve time to relapse, by simultaneously deteriorating the quality of life in patients. Irreversible fertility loss in the patients who have experienced breast cancer may become a leading stressful factor for these patients. Many investigators believe that chemotherapy-induced amenorrhea reduces the risk of recurrence. The paper discusses the usage of gonadotropin-releasing hormone agonists in combination with tamoxifen and aromatase inhibitors during adjuvant hormone therapy for early breast cancer. Whether ovarian suppression is needed during hormone therapy is considered, it is the reversible ovarian function suppression that must be standard treatment in premenopausal patients. 

Общепринятым методом адъювантной гормонотерапии у пременопаузальных пациенток, страдающих рецептор-положительным раком молочной железы, является применение тамоксифена. Клинические исследования, демонстрирующие преимущества супрессии функции яичников в адъювантном лечении, имели неоднозначную трактовку. Эмпирическое назначение овариальной супрессии для таких пациенток не имело научно обоснованных доказательств. Члены Американского общества клинических онкологов считают, что овариальная абляция или супрессия должны использоваться при адъювантной гормонотерапии только в определенных случаях. Необратимая абляция функции яичников может улучшить показатели времени до наступления рецидива, вместе с тем ухудшая качество жизни пациенток. Необратимая потеря фертильности пациентками, перенесшими рак молочной железы, может стать ведущим психотравмирующим фактором для них. Аменорея, индуцированная химиотерапией, как считают многие исследователи, снижает риск развития рецидива заболевания. В статье дискутируются вопросы применения агонистов гонадотропин-рилизинг-гормона с тамоксифеном и ингибиторами ароматазы при адъювантной гормонотерапии раннего рака молочной железы. При рассмотрении вопроса о необходимости овариальной супрессии при адъювантной гормонотерапии именно обратимая супрессия функции яичников должна стать стандартом лечения пременопаузальных пациенток. 

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