化療與卵巢保護(hù)問題課件

NorthernJiangsuPeople’sHospitalDepartmentofThyroidandbreastsurgeryCaiFenglinProblemsofchemotherapyandovarianprotectioninpremenopausalbreastcancerpatients絕經(jīng)前乳腺癌患者化療與卵巢保護(hù)問題CASE(病例)Patient,female,

33yearsold,married,unpregnancy,女性，33歲，已婚，未孕Rightbreastmassintheupper-outerquadrant,2.5*2.0cm,Modifiedradicalmastectomy

右乳外上象限腫塊:2.5*2.0cm，改良根治術(shù)，CASE(病例)Postoperativepathology:Invasiveductalcarcinoma(IDC),histologicalgradeII,noaxillarylymphnodeswerefoundmetastasis(0/18)

浸潤(rùn)性導(dǎo)管癌II級(jí)，腋淋巴結(jié)未見癌轉(zhuǎn)移（0/18）Immunohistochemistry(IHC)：ER（+70%）；PR（+30%）；HER-2（+）；ki67：30%（+）；Nodistantmetastasis胸部CT及腹部彩超未見明顯轉(zhuǎn)移灶ECGandLeftventricularejectionfractionarenomalChemotherapy：FEC*6+TamoxifenFertility

？Amenorrhea?Prematureovarianfailure？Theseareoptionsforhavingababy

afteradiagnosisofbreastcancer

BUT…..

Itrequiresplanningbefore

chemotherapyAmericanSocietyofClinicalOncologyRecommendationsonFertilityPreservationinPeopleTreatedforCancerEligibleforprovenfertilitypreservationmethodMale:Female:spermcryopreservationembryocryopreservationconservativegynecologicsurgeryoophoropexy???Patientatriskfortreatment-inducedinfertility?PatientinterestedinfertilitypreservationoptionsRefertospecialistwithexpertiseinfertilitypreservationmethodsInvestigationalfertilitypreservationtechnique*?Cryopreservationoftesticularorovariantissue?Cryopreservationofoocytes?Ovariansuppression*ClinicaltrialparticipationencouragedEligibleforprovenfertilitypreservationmethodMale:Female:spermcryopreservationembryocryopreservationconservativegynecologicsurgeryoophoropexy?Assessmentofriskforinfertility?Communicationwithpatient?Patientatriskfortreatment-inducedinfertility?PatientinterestedinfertilitypreservationoptionsInvestigationalfertilitypreservationtechnique*?Cryopreservationoftesticularorovariantissue?Cryopreservationofoocytes?Ovariansuppression*Clinicaltrialparticipationencouraged

(Leeetal.,JClinOnc;2006)PreventionofEarlyMenopauseStudy<br/>(POEMS)-S0230<br/>PhaseIIItrialofLHRHanalogduringchemotherapytoreduceovarianfailureinearlystage,hormonereceptor-negativebreastcancer:aninternationalIntergrouptrialofSWOG,IBCSG,ECOG,andCALGB(Alliance)PresentedByHalleMooreat2014ASCOAnnualMeetingASCO2014：乳腺癌戈舍瑞林+標(biāo)準(zhǔn)化療保留生育力（S0230/POEMS研究）GoserelinAdministrationPresentedByHalleMooreat2014ASCOAnnualMeetingPOEMSOvarianFailurePresentedByHalleMooreat2014ASCOAnnualMeetingPOEMSDiseaseFreeSurvivalPresentedByHalleMooreat2014ASCOAnnualMeetingPOEMSOverallSurvivalPresentedByHalleMooreat2014ASCOAnnualMeetingConclusionsPresentedByHalleMooreat2014ASCOAnnualMeetingQuestions(問題）1.What’syourtreatmentplan?(您的治療方案是什么