Effects Of Chemotherapy On The Ovarian Function Of Patients With GTN Of Childbearing Age

Background:Gestational trophoblastic neoplasia (GTN) comprises invasive mole (IM), choriocarcinoma (CC) and placental site trophoblastic tumor (PSTT). In clinical practice, since IM and CC are basically identical in terms of clinical manifestation, diagnosis and principle of management, generally, the two are collectively known as GTN. Currently, chemotherapy has already become the preferred and main method for the treatment of patients with GTN. It can not only kill cancer cells effectively, but will not change the anatomical structure of the female reproductive system, with cure rate reaching above 90% at present, highly appreciated by doctors and patients. Nevertheless, chemotherapeutic drugs will also damage the ovarian function at the same time of killing directly the tumor cells, giving rise to decreased ovarian function and infertility, etc., greatly affecting the living quality of young female patients. Therefore, gynecologists will pay attention to protecting the ovarian function of patients at the same time of treating diseases, as it is quite important for improving the living quality of young patients.Purpose:The paper is intended to discuss the impacts of a variety of chemotherapy regimens on the ovarian function of patients as well as the preventive strategies, through analyzing retrospectively the clinical data of patients with GTN of childbearing age.Data and Method:Choose 45 patients under 40 years old, who had received chemotherapy from January 2013 to June 2015 at the Department of Gynecology, the First Affiliated Hospital of Zhejiang University School of Medicine, due to suffering from GTN. Analyzed the impacts of chemotherapy on the menstruation, sex hormone levels and fertility。Result:Among the 45 patients with GTN,29 (4%) had abnormal menstruation, including 23 patients (51%) suffering from menolipsis, and 3 patients (6%) suffering from spanomenorrhea. After the chemotherapy, the menstruation of 22 patients in the 23 patients suffering from menolipsis had recovered; the recovery time of the menstruation is from 3 to 20 weeks after the chemotherapy, (6.7±4.5) week on average. Chemotherapy regimens adopted are as follows:regimen of MTX for 10 patients, regimen of 5-FU for 2 patients, regimen of ACTD for 14 patients, regimen of EMA-CO for 12 patients,regimen of FA for 4 patients and regimen of EP-EMA for 3 patients, the number of patients suffering from menolipsis is respectively 2,0,4,2,12 and 3. During the period of menolipsis, luteinizing hormone and follicle stimulating hormone of 14 patients of the menolipsis group had increased obviously, while estradiol had decreased obviously. After the recovery of the menstruation, their hormone level had returned to normal state. Upon comparison of the menolipsis rate of patients accepting different chemotherapy regimens, the menolipsis rate of the EMA-CO group is higher than other three single drug groups, the difference is statistically significant (P<0.05), while the difference from the comparison between high risk groups has no statistical significance(P>0.05).Conclusion:1. Chemotherapy of GTN has certain impacts on the ovarian function, mainly expressed by menolipsis or the reduction of menstruation, the elevated level of serum gonadotrophin and the lowered level of estrogen. However, for female of child-bearing ages, due to the good ovarian reserve function, menstruation changes caused by chemotherapy are temporary and reversible, and hormone level after the recovery of menstruation will return to the normal state.2. During the comparison of menopause rate in different chemotherapy schemes, the rate of EMA-CO group is higher than the single drug group, and there is statistical significance in the difference and there is no statistical significance in the comparative difference of high-risk group.3. For female with request in fertility, it is suggested to evaluate the ovarian reserve function before the chemotherapy. For female with descending reserve function and with risk of permanent menopause and premature ovarian failure, it is suggested to consider to protect the ovarian function and fertility before initiating the chemotherapy.