RESUMEN
Clinical situations requiring protections of ovaries are mainly paediatric irradiations and pre-menopausal pelvic irradiations. The main complication of ovarian irradiation is the induced castration. Ovaries are extremely radiosensitive organs with strong interpersonal variations. The castrative effect of irradiation depends mainly on two factors: patient's age and the dose delivered to ovaries. The surgical technique of ovarian transposition allows to minimize the dose received by ovaries by taking them away, out of irradiation fields; the aim is to exclude them from the volume receiving 5 Gy or more, and if possible from those receiving 2 Gy. This technique becomes integrated into a multidisciplinary approach of conservation of fertility for patients exposed to other cytotoxic treatments.
Asunto(s)
Ovario/efectos de la radiación , Tolerancia a Radiación , Radioterapia/efectos adversos , Adulto , Factores de Edad , Niño , Femenino , Fertilidad/efectos de la radiación , Humanos , Menopausia Prematura/efectos de la radiación , Ovariectomía , Ovario/anatomía & histología , Ovario/fisiología , Pelvis/anatomía & histología , Premenopausia/efectos de la radiación , Protección Radiológica/métodos , Radioterapia/métodos , Dosificación Radioterapéutica , Adulto JovenRESUMEN
BACKGROUND: As the incidence of breast-conserving therapy in women of childbearing years increases, patient concerns regarding subsequent pregnancies and lactation have become more prevalent. There is a paucity of data regarding lactation outcomes in women who have undergone breast-conserving therapy and then sustained full-term pregnancies. Our objective was to evaluate lactation outcomes in patients with early-stage breast cancer treated with breast-conserving therapy. METHODS: We reviewed a database of over 3,000 patients treated from 1965 to 2003 to identify our cohort of premenopausal women who underwent breast-conserving therapy and subsequently sustained full-term pregnancies. Lactation outcome parameters (breast swelling, ability to lactate, and volume of lactation in the treated and untreated breasts) were the main outcome measures. RESULTS: We identified 28 pregnancies in 21 patients. The median age at diagnosis was 32 years. One patient underwent bilateral breast treatment; therefore, a total of 22 breasts were irradiated. All patients interviewed reported little or no swelling of the treated breast during pregnancy. Of the patients studied, 4 (18.2%) elected pharmacological suppression of lactation. Of the remaining 18 breasts, lactation occurred in 10 (55.6%), did not occur in 7 (38.9%) and was unknown for 1 (5.5%). The volume was reported as significantly diminished in 80% of breasts treated. Lactation in the contralateral breast occurred in all patients who did not undergo pharmacological suppression. CONCLUSION: Patients can experience successful lactation in the contralateral, untreated breast after breast-conserving therapy. In the treated breast, functional lactation is possible but is significantly diminished in the majority of patients.
Asunto(s)
Neoplasias de la Mama/fisiopatología , Neoplasias de la Mama/cirugía , Lactancia , Mastectomía Segmentaria , Neoplasias Ductales, Lobulillares y Medulares/fisiopatología , Neoplasias Ductales, Lobulillares y Medulares/cirugía , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/patología , Femenino , Estudios de Seguimiento , Humanos , Lactancia/efectos de los fármacos , Lactancia/efectos de la radiación , Bienestar Materno , Estadificación de Neoplasias , Neoplasias Ductales, Lobulillares y Medulares/patología , Embarazo , Complicaciones Neoplásicas del Embarazo/patología , Complicaciones Neoplásicas del Embarazo/fisiopatología , Complicaciones Neoplásicas del Embarazo/cirugía , Premenopausia/efectos de los fármacos , Premenopausia/efectos de la radiación , Dosificación Radioterapéutica , Radioterapia Adyuvante , Resultado del TratamientoRESUMEN
Radioimmunoassay was employed to determine basal levels of LH, FSH, prolactin, total testosterone and 17 beta-estradiol in plasma from 52 pre- or postmenopausal women with prosopalgia consequent to cervical osteochondrosis. The measurements were made before and after laser treatment. Different from the control, basal levels of the hormones and the trends in their changes due to laser therapy depended on the patients' age and the disease stage.