11 aug. 2008 THERAPEUTIC APPROACH OF OVARIAN CYSTS WITH A Gn-RH ANALOGUE (GOSERELIN) IN TAMOXIFEN-TREATED POSTMENOPAUSAL BREAST CANCER PATIENTS
S. Zervoudis ***, D. Koukouras****, A. Keramopoulos****
* Dept of Gynecologic Oncology Division, Patras University, Rion, Greece
**Dept of Obstetrics and Gynecology Kalamata General Hospital, Kalamata, Greece
***Department of Surgery Patras University, Rion, Greece
****Breast Unit, “Iaso” and “Lito” Maternities, Athens, Greece
Chistul ovarian care este un efect secundar frecvent al tratamentului cu tamoxifen la femeile cu cancer de sân, poate fi tratat cu success cu analogi de GnRH, care poate duce la regresia chistului, permițând astfel continuarea tratamentului cu Tamoxifen.
We performed transvaginal ultrasound in 549 tamoxifen-treated breast cancer postmenopausal patients and detected ovarian cysts in 64 women (11.7%). In six cases the cyst’s individual sonographic patterns were strongly suggestive of malignancy and the patients underwent surgery. The remainder 58 patients presenting with cysts of benign –appearing sonographic depiction were treated either with Goserelin (3.6mg injection) for a period ranking from3 to 9 months (Group A, n=27 patients), or underwent sonographically-assisted evacuation of the cyst (Group B, n=19 patients). The control group (Group C, n=12 patients) consisted of patients who did not undergo any medical intervention. Distribution of patients was based upon physician’s decision and patient’s desire, and no randomization was performed. Patients were studied prospectively, with sequential transvaginal sonograms and monthly serum CA-125 assays. Additionaly, Group A patients underwent monthly 17-beta estradiol measurements.
In the group of goserelin-treated patients, after a treatment periond ranging from 3 to 9 months, all but one ovarian cyst disappeared (cure rate that corresponds to 96.3%). On follow up 12 months after discontinuation of treatment, and despite that another goserelin-treated patient redeveloped ovarian cysts, sonograohic ovarian cyst detection rate favored the gosereline-treated group of patients (ovarian cyst prevalence 7.4% versus 22.2% and 27.3% for groups B and C, respectively).
In conclusion, ovarian cysts that are relatively common side-effect of tamoxifen in postmenopausal breast cancer patients can be effectively treated with GnRH analogue administration, that causes regression of the ovarian cysts and therefore permits continuation of the adjuvant tamoxifen treatment.