tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncoweb10.18027/2224-5057-2017-2-47-53tumors-342Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL REPORTSРепродуктивная функция пациенток со злокачественными герминогенными опухолями яичниковReproductive function in patients with malignant ovarian germ cell tumoursЧекиниД. А.ChekiniD. A.

врач отделения клинической фармакологии и химиотерапии

MD, Clinical Pharmacology and Chemotherapy Department

jenneta@inbox.ruТрякинА. А.TryakinA. A.

д.м.н., старший научный сотрудник отделения химиотерапии и комбинированного лечения злокачественных опухолей

MD, PhD, Сhemotherapy and Combined Treatment Department

atryakin@mail.ruФедянинМ. Ю.FedyaninM. Y.

к.м.н., старший научный сотрудник отделения клинической фармакологии и химиотерапии

MD PhD, Clinical Pharmacology and Chemotherapy Department

fedianinmu@mail.ruЖорданиаК. И.ZhordaniaK. I.

профессор, ведущий научный сотрудник гинекологического отделения

MD, PhD, Gynecology Department

k.zhordania@osors.comПокатаевИ. А.PokataevI. A.

к.м.н., старший научный сотрудник отделения клинической фармакологии и химиотерапии

MD, PhD, Clinical Pharmacology and Chemotherapy Department

pokia@mail.ruБулановА. А.BulanovA. A.

к.м.н., старший научный сотрудник отделения клинической фармакологии и химиотерапии

MD, PhD, Clinical Pharmacology and Chemotherapy Department

maknun@mail.ruЗахароваТ. И.ZakharovaT. I.

к.м.н., старший научный сотрудник отдела патологической анатомии опухолей человека

MD, PhD, Pathology Department

zakharova@mail.ruТюляндинС. А.TjulandinS. A.

профессор, заведующий отделением клинической фармакологии и химиотерапии

MD, PhD, Clinical Pharmacology and Chemotherapy Department

stjulandin@mail.ruНИИ клинической онкологии ФГБУ «РОНЦ им. Н. Н. Блохина», МоскваРоссияN. N. Blokhin Russian Cancer Research Center, MoscowRussian Federation201720072017024753Copyright © Чекини Д.А., Трякин А.А., Федянин М.Ю., Жорданиа К.И., Покатаев И.А., Буланов А.А., Захарова Т.И., Тюляндин С.А., 20172017Чекини Д.А., Трякин А.А., Федянин М.Ю., Жорданиа К.И., Покатаев И.А., Буланов А.А., Захарова Т.И., Тюляндин С.А.Chekini D.A., Tryakin A.A., Fedyanin M.Y., Zhordania K.I., Pokataev I.A., Bulanov A.A., Zakharova T.I., Tjulandin S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/342

Злокачественные герминогенные опухоли яичников (ЗГОЯ) чаще встречаются у молодых женщин. Оптимальным объемом хирургического лечения в настоящее время признана односторонняя аднексэктомия. Химиотерапия (ХТ) по схеме ВЕР является наиболее эффективным режимом лекарственного лечения. Поскольку данным заболеванием страдают преимущественно девочки-подростки и молодые женщины репродуктивного возраста, одним из важнейших приоритетов у данной категории пациенток является сохранение детородной функции.

Цель

Цель. Изучение овариальной и репродуктивной функции у больных ЗГОЯ после ранее проведенного комбинированного лечения, включавшего органосохранное лечение и ХТ.

Материалы и методы

Материалы и методы. Критериями включения в настоящее рестроспективное исследование были: 1) морфологически верифицированная ЗГОЯ; 2) органосохраняющее хирургическое лечение (односторонняя аднексэктомия тубоовариэктомия); 3) проведение ХТ первой линии на основе цисплатина; 4) возраст 16–49 лет на момент начала ХТ; 5) наличие менструаций до начала лечения; 6) срок не менее 12 месяцев после завершения ХТ; 7) согласие пациентки. С целью оценки овариальной и репродуктивной функций яичников проведено исследование гормонального статуса: определение уровня фолликулостимулирующего гормона (ФСГ), лютеинизирующего гормона (ЛГ), эстрадиола, антимюллерова гормона (AMГ), ингибина Б.

Malignant ovarian germ cell tumors (MOGCT) generally affect young women. The optimal volume of surgical treatment is unilateral adnexectomy. BEP-regimen chemotherapy (ChT) is the most effective regimen of treatment. Since this disease affects mainly adolescents and young women of reproductive age, one of the most important priorities concerning this category of patients is the fertility preservation.

The aim of this study was analysis of long-term effects of ChT on reproductive function in a large population of young women treated for MOGCT in our center.

Materials and methods

Materials and methods. Inclusion criteria in our study were MOGCT, fertility-sparing surgery, cisplatin- and etoposide-based induction ChT (BEP/EP regimen), age 16-49 years. Presence of menstruation before treatment; no relapse following ChT at least 1 year. Blood tests were taken for hormones of ovarian function (follicle-stimulating hormone, luteinizing hormone, estradiol, anti-Mullerian hormone (AMH), inhibin B) to assess their menstrual, reproductive function, post therapeutic status of pregnancy or delivery.

Results

Results. The median time from the end of ChT until the date of filling out the questionnaire was 90 months (12–228 months). 58 (93.5%) of the 62 patients received BEP/EP regimen as a first line treatment, 4 (6.5%) treated with other regimens. During the ChT 42 (71.2%) patients developed amenorrhea due to the toxic effect of ChT. Among 47 women with regular menstruation after completion of ChT 23/47 (49%) patients attempted conception, 18/23 (78.3%) women conceived, 20 live birth deliveries were received. Correspondingly there were 2/18 (11%) miscarriages and 6/18 (33.3%) terminations. Four women were pregnant at the moment of the analysis. Inhibin B level was normal in all 15 evaluated pts (median 74,4 pg/ml, range 10–120). Median of AMH level was 0,97 ng/ml (range 0.08-6). In 10 (52.6%) of 19 pts AMH level was < 1 ng/ml, that was considered a decrease of ovarian reserve. 

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The authors declare that there are no conflicts of interest present.