scholarly journals Specific protocols of controlled ovarian stimulation for oocyte cryopreservation in breast cancer patients

2018 ◽  
Vol 25 (6) ◽  
Author(s):  
F. Cavagna ◽  
A. Pontes ◽  
M. Cavagna ◽  
A. Dzik ◽  
N. F. Donadio ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Total Dose ◽  
Cancer Patients ◽  
Ovarian Stimulation ◽  
Estradiol Level ◽  
Controlled Ovarian Stimulation ◽  
Oocyte Cryopreservation ◽  
Breast Cancer Patients ◽  
Specific Protocol ◽  
The Mean

Background Fertility preservation is an important concern in breast cancer patients. In the present investigation, we set out to create a specific protocol of controlled ovarian stimulation (cos) for oocyte cryopreservation in breast cancer patients.Methods From November 2014 to December 2016, 109 patients were studied. The patients were assigned to a specific random-start ovarian stimulation protocol for oocyte cryopreservation. The endpoints were the numbers of oocytes retrieved and of mature oocytes cryopreserved, the total number of days of ovarian stimulation, the total dose of gonadotropin administered, and the estradiol level on the day of the trigger.Results Mean age in this cohort was 31.27 ± 4.23 years. The average duration of cos was 10.0 ± 1.39 days. The mean number of oocytes collected was 11.62 ± 7.96 and the mean number of vitrified oocytes was 9.60 ± 6.87. The mean estradiol concentration on triggering day was 706.30 ± 450.48 pg/mL, and the mean dose of gonadotropins administered was 2610.00 ± 716.51 IU. When comparing outcomes by phase of the cycle in which cos was commenced, we observed no significant differences in the numbers of oocytes collected and vitrified, the length of ovarian stimulation, and the estradiol level on trigger day. The total dose of follicle-stimulating hormone and human menopausal gonadotropin administered was statistically greater in the group starting cos in the luteal phase than in the group starting in the late follicular phase.Conclusions Our results suggest that using a specific protocol with random-start ovarian stimulation for oocyte cryopreservation in breast cancer patients is effective and could be offered to young women undergoing oncologic treatment.

Methods of controlled ovarian stimulation for embryo/oocyte cryopreservation in breast cancer patients

2016 ◽  
Vol 2 (1) ◽  
pp. 47-59 ◽  
Author(s):  
Matteo Lambertini ◽  
Maria Carolina Pescio ◽  
Giulia Viglietti ◽  
Oranite Goldrat ◽  
Lucia Del Mastro ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Ovarian Stimulation ◽  
Controlled Ovarian Stimulation ◽  
Oocyte Cryopreservation ◽  
Breast Cancer Patients

scholarly journals Relative Potencies of Anastrozole and Letrozole to Suppress Estradiol in Breast Cancer Patients Undergoing Ovarian Stimulation before in Vitro Fertilization

2007 ◽  
Vol 92 (6) ◽  
pp. 2197-2200 ◽  
Author(s):  
Amr A. Azim ◽  
Maria Costantini-Ferrando ◽  
K. Lostritto ◽  
Kutluk Oktay
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Ovarian Stimulation ◽  
Area Under The Curve ◽  
Oocyte Retrieval ◽  
Embryo Cryopreservation ◽  
Breast Cancer Patients ◽  
Vitro Fertilization ◽  
The Mean

Abstract Context: Breast cancer patients undergoing controlled ovarian hyperstimulation (COH) for embryo or oocyte cryopreservation should be induced by the method that leads to the least increase in estradiol (E2) levels. Objective: The aim of the study was to determine the potency of anastrozole to suppress serum E2 levels in breast cancer patients undergoing COH. Design and Setting: A prospective sequential cohort study was conducted in an academic center for reproductive medicine between May 2003 and November 2005 for letrozole and between December 2005 and April 2006 for anastrozole. Patients: Breast cancer patients presenting for fertility preservation participated in the study. Intervention: COH using FSH and letrozole (n = 47) or anastrozole (n = 7) was followed by oocyte retrieval and embryo cryopreservation. Main Outcome Measures: Serum E2 levels, area under the curve for E2, and outcomes of COH cycles were measured. Results: There were no significant differences between the two groups regarding length of stimulation, total gonadotropin dose, number of follicles larger than 17 mm, and the lead follicle size on human chorionic gonadotropin (hCG) day and number of embryos cryopreserved. The mean E2 levels on the day of hCG and post-hCG days were higher in the anastrozole group compared to the letrozole group (1325.89 ± 833.17 and 2515.07 ± 1368.52 vs. 427.78 ± 278.24 and 714.38 ± 440.83 pg·d/ml; P ≤ 0.01), respectively, even when anastrozole dose was increased up to 10 mg/d. The mean area under the curve was significantly higher in the anastrozole group compared to the letrozole group (4402.93 ± 1526.7 vs. 1287.48 ± 732.17 pg·d/ml; P <0.004). Conclusions: Breast cancer patients who underwent ovarian stimulation with anastrozole had a significantly higher exposure to E2 than those who were stimulated with letrozole.

scholarly journals Prospective superficial EPR in-vivo dosimetry study during hypofractionated radiotherapy of breast cancer patients treated with helical tomotherapy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sebastian Höfel ◽  
Matteo Gandalini ◽  
Michael K. Fix ◽  
Malte Drescher ◽  
Felix Zwicker
Keyword(s):  
Breast Cancer ◽  
Total Dose ◽  
Cancer Patients ◽  
Helical Tomotherapy ◽  
Planning System ◽  
In Vivo Dosimetry ◽  
Breast Cancer Patients ◽  
Displacement Vectors ◽  
The Mean

Abstract Background In-vivo dosimetry (IVD) is a patient specific measure of quality control and safety during radiotherapy. With regard to current reporting thresholds for significant occurrences in radiotherapy defined by German regulatory authorities, the present study examines the clinical feasibility of superficial electron paramagnetic resonance (EPR) IVD of cumulative total doses applied to breast cancer patients treated with helical intensity-modulated radiotherapy (tomotherapy). Methods In total, 10 female patients with left- or right-sided breast cancer were enrolled in this prospective IVD study. Each patient received a hypofractionated whole breast irradiation. A total median dose of 42.4 Gy in 16 fractions (5 fractions per week) was prescribed to the planning target volume. The treatments were completely delivered using helical tomotherapy and daily image guidance via megavoltage CT (MVCT). For each patient, three EPR dosimeters were prepared and placed at distinct locations on the patient’s skin during the delivery of all fractions. Two dosimeters were placed next to the ipsilateral and contralateral mammilla and one dosimeter was placed ventrally to the thyroid (out-of-primary-beam). The total doses delivered to the dosimeters were readout after all fractions had been administered. The measured total dose values were compared to the planned dose values derived from the treatment planning system (TPS). Daily positional variations (displacement vectors) of the ipsilateral mammilla and of the respective dosimeter were analyzed with respect to the planned positions using the daily registered MVCT image. Results Averaged over all patients, the mean absolute dose differences between measured and planned total dose values (± standard deviation (SD)) were: 0.49 ± 0.85 Gy for the ipsilateral dosimeter, 0.17 ± 0.49 Gy for the contralateral dosimeter and -0.12 ± 0.30 Gy for the thyroid dosimeter. The mean lengths of the ipsilateral displacement vectors (± SD) averaged over all patients and fractions were: 10 ± 7 mm for the dosimeter and 8 ± 4 mm for the mammilla. Conclusion Superficial EPR IVD is suitable as additional safeguard for dose delivery during helical tomotherapy of breast cancer. Despite positional uncertainties in clinical routine, the observed dose deviations at the ipsilateral breast were on average small compared to national reporting thresholds for total dose deviations (i.e. 10%/4 Gy). EPR IVD may allow for the detection of critical dose errors during whole breast irradiations.

scholarly journals Effects of controlled ovarian stimulation on toxicity of TAC chemotherapy in early breast cancer patients

2018 ◽  
Vol Volume 10 ◽  
pp. 3931-3935 ◽  
Author(s):  
Stefanie de Groot ◽  
Leoni A Louwé ◽  
Ashna IE Ramautar ◽  
Johanneke EA Portielje ◽  
Aernout C Ogilvie ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Early Breast Cancer ◽  
Ovarian Stimulation ◽  
Controlled Ovarian Stimulation ◽  
Breast Cancer Patients ◽  
Tac Chemotherapy

scholarly journals Letrozole Reduces Estrogen and Gonadotropin Exposure in Women with Breast Cancer Undergoing Ovarian Stimulation before Chemotherapy

2006 ◽  
Vol 91 (10) ◽  
pp. 3885-3890 ◽  
Author(s):  
Kutluk Oktay ◽  
Ariel Hourvitz ◽  
Gulnaz Sahin ◽  
Ozgur Oktem ◽  
Bradley Safro ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Ovarian Stimulation ◽  
Cost Effective ◽  
Oocyte Cryopreservation ◽  
Breast Cancer Patients ◽  
Vitro Fertilization ◽  
Estrogen Exposure ◽  
Estradiol Levels

Abstract Context: Women with breast cancer are not typically offered embryo or oocyte cryopreservation to preserve their fertility before chemotherapy because of the potential risks associated with high estrogen levels arising from ovarian stimulation. Objective: We aimed to determine whether the combination of an aromatase inhibitor with gonadotropin treatment in breast cancer patients produces comparable results to standard in vitro fertilization (IVF), without a significant increase in estradiol levels and delay in the initiation of chemotherapy. Patients and Methods: Stages I-IIIA breast cancer patients (n = 47) received 5 mg/d letrozole and 150–300 IU FSH to cryopreserve embryos or oocytes. Age-matched retrospective controls (n = 56) were selected from women who underwent IVF for tubal disease. Results: Whereas letrozole and FSH stimulation resulted in significantly lower peak estradiol levels (mean ± sd 483.4 ± 278.9 vs. 1464.6 ± 644.9 pg/ml; P < 0.001) and 44% reduction in gonadotropin requirement, compared with controls, the length of stimulation, number of embryos obtained, and fertilization rates were similar. The human chorionic gonadotropin administration criteria had to be adjusted to 20 mm after letrozole stimulation, compared with 17–18 mm in the controls. The mean delay from surgery to cryopreservation was 38.6 d, with 81% of all patients completing their IVF cycles within 8 wk of surgery. Conclusion: Ovarian stimulation with letrozole and FSH appears to be a cost-effective alternative for fertility preservation in breast cancer patients with reduced estrogen exposure, compared with standard IVF. If patients are referred promptly, they may undergo embryo or oocyte cryopreservation without a delay in chemotherapy.

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