medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2010, Número 02

<< Anterior Siguiente >>

Ginecol Obstet Mex 2010; 78 (02)


Cáncer de mama y embarazo subsiguiente. Infertilidad, riesgo de muerte y supervivencia

Ramírez-Torres N, Robles-Robles AG, Villafaña-Vázquez VH, Hernández-Valencia M

Idioma: Español
Referencias bibliográficas: 75
Paginas: 85-93
Archivo PDF: 316.84 Kb.


RESUMEN

Antecedentes: los esquemas de quimioterapia indicados para el tratamiento del cáncer suelen afectar la fertilidad y ocasionar insuficiencia ovárica prematura. En consecuencia, el embarazo subsiguiente al cáncer de mama no es habitual.
Objetivo: identificar los efectos de la quimioterapia en la reproducción femenina, evaluar la frecuencia de mujeres con embarazo posterior al tratamiento del cáncer de mama y los efectos del embarazo subsiguiente al cáncer.
Material y método: estudio retrospectivo efectuado de marzo de 1994 a junio de 2008 en 14 pacientes con cáncer de mama, con embarazo subsiguiente. Se identificaron variables demográficas, presentación clínica, datos histopatológicos, procedimientos diagnósticos, tratamientos y resultados del embarazo.
Resultados: la edad media de las mujeres embarazadas fue de 31.5 ± 5.2 años; 83.3% de ellas recibieron quimioterapia coadyuvante con antraciclinas; las pacientes con enfermedad regional (› 4 N+) y enfermedad avanzada tuvieron un pronóstico adverso. La recidiva sistémica y la progresión se manifestaron en 42.8% de los casos. En 50% de los casos el embarazo llegó a término en los primeros dos años y en una tercera parte luego de dos años de finalizado el tratamiento oncológico. En 14 pacientes con cáncer de mama se registraron 16 embarazos: 9 fueron de término, 3 de pretérmino y 4 abortos.
Conclusiones: los hallazgos del estudio se basan en una serie de casos que no sugieren que el embarazo después del diagnóstico y tratamiento del cáncer de mama tenga algún efecto adverso en la supervivencia, por lo que las pacientes pueden concebir después del tratamiento oncológico. Sin embargo, en este estudio se observó que el efecto de la etapa avanzada y los ganglios axilares positivos (más de 4) influyen en las recidivas.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Hortobagy GN, Buzdar AU, Marcus CE, Smith TL. Immediate and long term toxicity of adjuvant chemotherapy regimens containing doxorubicin in trials of MD Anderson Hospital and Tumor Institute. NCI Monogr 1986;1:105-109.

  2. Bines J, Oleske DM, Cobleigh MA. Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer. J Clin Oncol 1996;14:1718-1729.

  3. Del Mastro L, Venturini M, Sertoli MR, Rosso R. Amenorrhea induced by adjuvant chemotherapy in early breast cancer patients: prognostic role and clinical implications. Breast Cancer Res Treat 1997;43(2):183-190.

  4. Levine MN, Bramwell VH, Pritchard KI, et al. Randomized trial of intensive cyclophosphamide, epirubicin and fluorouracil che motherapy compared with cyclophosphamide, methotrexate and fluorouracil in premenopausal women with node-positive breast cancer. National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1998;16(8):2651-2658.

  5. Fornier MN, Modi S, Panageas KS, et al. Incidence of chemotherapy induced, long-term amenorrhea in patients with breast carcinoma age 40 years and younger after adjuvant anthracycline and taxane. Cancer 2005;104(8):1575-1579.

  6. Thewes B, Meiser B, Taylor A, et al. Fertility and menopause related information needs of younger women with a diagnosis of early breast cancer. J Clin Oncol 2005;23(22):5155-5165.

  7. Mueller BA, Simen MS, Deapen D, et al. Childbearing and survival after breast carcinoma in young women. Cancer 2003;98:1131-1140.

  8. Ganz PA, Greendale GA, Petersen L, et al. Breast cancer in younger women: Reproductive and late health effects of treatment. J Clin Oncol 2003;21:4181-4193.

  9. Blakely LI, Buzdar AU, Lozada JA, et al. Effects of pregnancy after treatment for breast carcinoma on survival and risk of recurrence. Cancer 2004;100(3):465-469.

  10. Goodwin PJ, Ennis M, Pritchard KI, et al. Risk of menopause during the first year after breast cancer diagnosis. J Clin Oncol 1999;17:2365-2370.

  11. Del Mastro L, Catzeddu T, Venturini M. Infertility and pregnancy after breast cancer: Current knowledge and future perspectives. Cancer Treat Rev 2006;32:417-422.

  12. Byrne J, Fears TR, Gail MH, et al. Early menopause in longterm survivors of cancer during adolescence. Am J Obstet Gynecol 1992;166(3):788-793.

  13. Early Breast Cancer Trialists’ Collaborative Group: ovarian ablation: in early breast cancer: an overview of the randomized trials. Lancet 1996;348:1189.

  14. Bath LE, Wallace WH, Shaw MP, et al. Depletion of ovarian reserve in young women after treatment for cancer in childhood: detection by anti-Müllerian hormone, inhibin B and ovarian ultrasound. Hum Reprod 2003;18(11):2368-2374.

  15. Guinea VF, Olson H, Moller T, et al. Effect of pregnancy on prognosis for young women with breast cancer. Lancet 1994;343:1587-1589.

  16. Anderson BO, Petrek JA, Byrd DR, et al. Pregnancy influences breast cancer stage at diagnosis in women 30 years of age and younger. Ann Surg Oncol 1996;3:204-211.

  17. Saphner T, Tormey DC, Gray R. Annual hazard rates of recurrence for breast cancer after primary therapy. J Clin Oncol 1996;14:2738-2746.

  18. Kroman N, Wohlfahrt J, Andersen KW, et al. Parity, age at first childbirth and the prognosis of primary breast cancer. Br J Cancer 1998;78:1529-1533.

  19. Harvey JC, Rosen PP, Ashikari R, et al. The effect of pregnancy on the prognosis of carcinoma of the breast following radical mastectomy. Surg Gynecol Obstet 1981;153(5):723-725.

  20. Von Schoultz E, Johansson H, Wilking N, Rutquist LE. Influence of prior and subsequent pregnancy on breast cancer prognosis. J Clin Oncol 1995;13:430-434.

  21. Kroman N, Wohlfahrt J, Andersen KW, et al. Time since childbirth and prognosis in primary breast cancer: population based study. BMJ 1997;315:851-855.

  22. Velentgas P, Daling JR, Malone KE, et al. Pregnancy after breast carcinoma: outcomes and influence on mortality. Cancer 1999;85:2424-2432.

  23. Gelber S, Coates AS, Goldhirsch A, et al. International Breast Cancer Study Group. Effect of pregnancy on overall survival after diagnosis of early-stage breast cancer. J Clin Oncol 2001;19:1671-1675.

  24. Ives A, Saunders C, Bulsara M, Semmens J. Pregnancy after breast cancer: population based study. BMJ 2007;334:194-198.

  25. Bonadonna G, Valagussa P. Adjuvant systemic therapy for resectable breast cancer: J Clin Oncol 1985;3:259-275.

  26. Shalet SM. Effects of cancer chemotherapy on gonadal function of patients. Cancer Treat Rev 1980;7:141-152.

  27. Bonadonna G, Valagussa P, Brambilla C, et al. Primary chemotherapy in operable breast cancer: eight-year experience at the Milan Cancer Institute. J Clin Oncol 1998;16:93-100.

  28. Larsen EC, Muller J, Schmiegelow K, et al. Reduced ovarian function in long-term survivors of radiation and chemotherapy treated in childhood cancer. J Clin Endocrinol Metab 2003;88:5307-5314.

  29. Sonmezer M, Oktay K. Fertility preservation in young women undergoing breast cancer therapy. The Oncologist 2006;11:422-434.

  30. Warne GL, Fairley KE, Hobbs JB, Martin FIR. Cyclophosphamide-induced ovarian failure. N Engl J Med 1973;289:1159-1162.

  31. Kayama H, Wada T, Nishizawa Y, Aoki Y. Cyclophosphamideinduced ovarian failure and its therapeutic significance in patients with breast cancer. Cancer 1977;39:1403-1409.

  32. Meirow D, Epstein M, Lewis H, et al. Administration of ciclophosphamide at different stages of follicular maturation in mice: effects on reproductive performance and fetal malformations. Hum Reprod 2001;16:632-637.

  33. Goldhirsch A, Gelber RD, Castiglione M. The magnitude of endocrine effects of adjuvant chemotherapy for premenopausal breast cancer patients. The International Breast Cancer Study Group. Ann Oncol 1990;1:183-188.

  34. Di Cosimo S, Alimonti A, Ferretti G, et al. Incidence of chemotherapy-induced amenorrhea depending on the timing of treatment by menstrual cycle phase in women with early breast cancer. Ann Oncol 2004;15:1065-1071.

  35. Schmidt KLT, Andersen Y, Loft, A, et al. Follow-up of ovarian function post-chemotherapy following on ovarian cryopreservation and transplantation. Human Reprod 2005;20:3539-3546.

  36. Sutton R, Buzdar AU, Hortobagy GN. Pregnancy and offspring after adjuvant chemotherapy in breast cancer patients. Cancer 1990;65:847-850.

  37. Hensley ML, Reichman BS. Fertility and pregnancy after adjuvant chemotherapy for breast cancer. Crit Rev Oncol Hematol 1998;28:121-128.

  38. Levine M, Eisen A. Anthracycline adjuvant chemotherapy: how much is enough? J Clin Oncol 2001;19:599-560.

  39. Nabholtz JM, Pienkowski T, Mackey J, et al. Phase III trial comparing TAC (docetaxel, doxorubicin, cyclophosphamide) with FAC (5-fluorouracil, doxorubicin, cyclophosphamide) in the adjuvant treatment of node positive breast cancer patients: interim analysis of the BCIRG 001 study. Proc Am Soc Clin Oncol 2002;44:21-36.

  40. Venturini M, Del Mastro L, Aitini E, et al. Dose-dense adjuvant chemotherapy in early breast cancer patients: results from randomized trial. J Natl Cancer Inst 2005;97:1724-1733.

  41. Martin M, Pienkowski T, Mackey J, et al. Adjuvant docetaxel for node-positive breast cancer. N Engl J Med 2005;352:2302-2313.

  42. Oktay K, Libertella B, Oktem O, et al. The impact of paclitaxel on menstrual function. Breast Cancer Res Treat 2005;94:27-29.

  43. Oktay K, Buyuk E, Davis O, et al. Fertility preservation in breast cancer patients: IVF and embryo cryopreservation after ovarian stimulation with tamoxifen. Hum Reprod 2003;18:90-95.

  44. Goodwin PJ, Okay KH, Lobo RA. Options for preservation of fertility in women. N Engl J Med 2005;353(13):1418-1420.

  45. Jonat W, Kaufmann M, Sauerbrei W, et al. Goserelin versus cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy in premenopausal patients with node-positive breast cancer: The Zoladex Early Breast Cancer Research Association Study. J Clin Oncol 2002;20:4628-4635.

  46. Oktay K, Buyuk E, Libertella N, et al. Fertility preservation in breast cancer patients: a prospective controlled comparison of ovarian stimulation with tamoxifen and letrozole for embryo cryopreservation. J Clin Oncol 2005;23:4347-4353.

  47. Del Mastro L, Catzeddu T, Boni L, et al. Prevention of chemotherapy- induced menopause by temporary ovarian suppression with goserelin in young, early breast cancer patients. Ann Oncol 2006;17:74-78.

  48. Vanhuyse M, Fournier C, Bonneterre J. Chemotherapy-induced amenorrhea: influence on disease-free survival and overall survival in receptor-positive premenopausal early breast cancer patients. Ann Oncol 2005;16:1283-1288.

  49. Arriagada R, Le MG, Spielmann M, et al. Randomized trial of adjuvant ovarian suppression in 926 premenopausal patients with early breast cancer treated with adjuvant chemotherapy. Ann Oncol 2005;16:389-396.

  50. Thewes B, Meiser B, Duric V, et al. What survival benefits do premenopausal patients with early breast cancer need to make endocrine therapy worthwhile? Lancet Oncology 2005;6:581-588.

  51. Andrieu JM, Ochoa-Molina ME. Menstrual cycle, pregnancies and offspring before and after MOPP therapy for Hodgking’s disease. Cancer 1983;52:435-438.

  52. Doll DC, Ringenberg QS, Yarbo JW. Antineoplastic agents and pregnancy. Semin Oncol 1989;16:337-346.

  53. Garber JE. Long-term follow-up of children exposed in utero to antineoplastic agents. Semin Oncol 1989;16:427-429.

  54. Lentz RD, Bergstein J, Steffes MW, et al. Postpuberal evaluation of gonadal function following cyclophosphamide therapy before and during puberty. J Pediatr 1977;91:385-394.

  55. Sankila R, Heinävaara S, Hakulinen T. Survival of breast cancer patients after subsequent term pregnancy: “Healthy mother effect”. Am J Obstet Gynecol 1994;170:818-823.

  56. Dow KH. Having children after breast cancer. Cancer Pract 1994;2:407-413.

  57. Burstein HJ, Winer EP. Primary care for survivors of breast cancer. N Eng J Med 2000;343:1086-1094.

  58. Cooper DR, Butterfield J. Pregnancy subsequent to mastectomy for cancer of the breast. Ann Surg 1970;171:429-433.

  59. Donegan WL. Breast cancer and pregnancy. Obstet Gynecol 1977;50:244-252.

  60. Ariel IM, Kempner R. The prognosis of patients who become pregnant after mastectomy for breast cancer. Int Surg 1989;74:185-187.

  61. Mignot L, Morvan F, Berdah J, et al. Pregnancy after treated breast cancer. Results of a case-control study. Presse Med 1986;15:1961-1964.

  62. Clark RM, Chua T. Breast cancer and pregnancy: the ultimate challenge. Clin Oncol 1989;1:11-18.

  63. Danforth DN. How subsequent pregnancy affects outcome in women with a prior breast cancer. Oncology 1991;5:23-30.

  64. Petrek JA. Pregnancy safety after breast cancer. Cancer 1994;74:528-531.

  65. Malamos NA, Stathopoulos GP, Keramopoulos A, et al. Pregnancy and offspring after the appearance of breast cancer. Oncology 1996;53:471-475.

  66. Kroman N, Jensen MB, Wohlfahrt J, et al. Factors influencing the effect of age on prognosis in breast cancer: population based study. BMJ 2000;320:474-479.

  67. Woo JC, Yu T, Hurd TC. Breast cancer in pregnancy: a literature review. Arch Surg 2003;138:91-98.

  68. Gwyn K, Theriault R. Breast cancer during pregnancy. Oncology 2001;15:39-46.

  69. Royal Collage of Obstetricians and Gynaecologists. Pregnancy and breast cancer. Guideline No. 12; Jan 2004 .

  70. Averette HE, Mirhashemi R, Moffert FL. Pregnancy after breast carcinoma: the ultimate medical challenge. Cancer 1999;85:2301-2304.

  71. Wright J, Dúchesne C, Sabourin S, et al. Psychosocial distress and infertility: Men and women respond differently. Fertil Steril 1991;55:100-108.

  72. Litt MD, Tennen H, Affleck G, Klock S. Coping and cognitive factors of fertility issues in vitro fertilization failure. J Behav Med 1992;15:171-187.

  73. Avis NE, Crawford S, Manuel J. Psychosocial problems among younger women with breast cancer. Psycho-oncology 2004;13:295-308.

  74. Partridge AH, Winer EP. Fertility after breast cancer: Questions abound. J Clin Oncol 2005;23:4259-4261.

  75. Partridge AH, Gelber S, Peppercorn J, et al. Fertility and menopausal outcomes in young breast cancer survivors. Clinical Breast Cancer 2008;8:65-69.




2020     |     www.medigraphic.com