Role of ovarian sleep with gnrh analogs during chemotherapy for fertility preservation inyoung patient (up to 40 years) with breast cancer(study of 54 patients in ostad alinasabhospital and oure clinic in tabriz) .

Breast cancer is the commonest malignant disease in women and up to 20% of this cases in west world (Near to 50% Iran ) have less than 50years old ( Pre menopause ). Premature ovarian failure (POF) is a common toxicity of chemotherapy. For reproductive age women, a large number of whom have either not contemplated or not completed their families, the diagnosis of breast cancer poses fertility concerns. Advances in breast cancer care , including early diagnosis and aggressive chemotherapy ,have improved the life expectancy for young women ;and have necessitated an increased emphasis on issues of survivorship, including family planning. The reported incidence of amenorrhea after systemic therapy for breast cancer varies widely, and is related to age , type, and cumulative dose of administered chemotherapy, and reserve of ovaries and probably time of cycles during chemotherapy. The incidence of permanent amenorrhea following systemic therapy for breast cancer ranges from 33% to76%.Methods: Premenopausal patients with age up to 40 years with stage I-III ER/PR_ breast carcinoma to be treated with chemotherapy (CA OR TEC) with or without GnRH analogs started 10 day prior to the first chemotherapy dose(q28day up to 2weeks after later course of chemotherapy). The primary endpoint is2/5 years POF defined as amenorrhea for the prior 6months and post –menopausal FSH level . .RESULTS: 54patients with mean age 35years (19-40) , 28 patient in group I ( Cytoxan +Adriamycin orCA +GnRHa) and 26 patient in group II (TAXENS+EPIRUBICINE+CYCLOPHOFAMID or TEC + GnRHa ) are studied, After 6month of last course of chemotherapy normal FSH and menses were seen in 46% and 35% ,and after 12 month in 76% and62% , and after 18month in86% and 73% and after 24 month in 93% and 85%and after 30 month in96/5% an92%.In control group of patient (54cases)normal FSH and menses seen in 31%, 61%,72% 80%, and 84%.After 2/5 years ,premature menopause were seen in 3/5% in CA- GnRHa ,7/5%Iin TEC-GnRHa , 16% in control groups. CONCLlUSION : Administration of GnRHa analog with chemotherapy was associated with less POF and premature menopause, and we recommended this form of adjuvant therapy in young patients with breast carcinoma.