PREMATURE OVARIAN FAILURE IN BREAST CANCER PATIENTS

辅助化疗可降低乳腺癌患者的死亡率 癌症。因为许多乳腺癌患者的生存期较长 在辅助治疗后，与以下相关的长期健康影响 辅助化疗是重要的评价指标。卵巢早熟 失败(绝经)发生在大约70%的绝经前乳房 接受辅助化疗的癌症患者。由此产生的 乳腺癌患者雌激素缺乏与绝经提前的关系 可能会导致加速的骨丢失，以及后续的风险 骨骼骨折(骨质疏松)。为了调查乳腺癌是否 出现化疗所致卵巢早衰的患者 体验加速的骨质流失，在特定的目标#1中，我们将 前瞻性检测骨密度和生化指标 绝经前乳腺癌患者的骨骼内环境平衡 化疗导致的卵巢早衰。在具体目标#2中，我们 将测试鼻腔喷雾降钙素，一种骨骼抑制物 吸收，防止这些女性的骨质流失。绝经前乳房 有0-3个腋窝淋巴结转移的癌症患者将被招募到 参与本次研究性学习。一百名这样的妇女将接受 月经状况、卵泡刺激素的基线评估 卵泡刺激素(FSH)、雌二醇(E_2)、孕酮(P)、生殖史 问卷、活动问卷、抑郁自评 问卷调查，3天膳食评估，定量测量 腰椎和股骨近端的骨密度，以及 骨骼动态平衡生化指标(血清离子钙、 甲状旁腺激素和骨钙素)。(DEXA)方法。紧随其后的是 将实施基线评估辅助化疗。这个 然后在6个月、12个月和24个月时重复基线测量。在… 化疗所致卵巢功能衰竭患者的12个月评估 (约70%的参与者)将随机分配到 一年鼻腔喷雾降钙素(200IU/天)，外加1500毫克口服 每日钙摄入量或鼻腔喷雾安慰剂，外加每日1500毫克口服 钙摄入量的双盲安慰剂对照试验。他莫昔芬可能 还可防止骨质流失，抑制骨吸收。在具体目标3中 我们将测试他莫昔芬是否能预防乳腺癌患者的骨丢失 化疗导致卵巢衰竭的患者。在这 42例绝经前乳腺癌患者年龄0~3岁的观察研究 接受辅助化疗和三苯氧胺治疗的腋窝淋巴结转移 将在6点、12点和12点进行基线评估和研究评估 24个月。这些针对绝经前乳房妇女的前瞻性研究 癌症将提供对化疗自然历史的洞察- 诱发卵巢功能衰竭和骨质丢失以及鼻腔喷雾的影响 降钙素和三苯氧胺预防这些动物的加速骨丢失 女人。

Adjuvant chemotherapy reduces mortality rates in women with breast cancer. Because many breast cancer patients have prolonged survival after adjuvant treatment the long term health effects associated with adjuvant chemotherapy are important to evaluate. Premature ovarian failure (menopause) occurs in approximately 70% of premenopausal breast cancer patients who receive adjuvant chemotherapy. The resulting estrogen deficiency and premature menopause in women with breast cancer may result in accelerated loss of bone, and the risk for subsequent skeletal fractures (osteoporosis). To investigate whether breast cancer patients who develop chemotherapy-induced premature ovarian failure experience accelerated bone loss, in Specific Aim #1 we will prospectively examine bone mineral density and biochemical indices of skeletal homeostasis in premenopausal breast cancer patients who develop chemotherapy-induced premature ovarian failure. In Specific Aim #2 we will test whether nasal spray calcitonin, an inhibitor of bone resorption, prevents bone loss in these women. Premenopausal breast cancer patients with 0-3 axillary nodal metastases will be recruited to participate in this research study. One-hundred such women will undergo baseline evaluations of menstrual status, follicle-stimulating hormone (FSH), estradiol (E2), and progesterone, (P), reproductive history questionnaire, activity questionnaire, self-rating depression questionnaire, 3-day dietary evaluation, quantitative measurements of bone mineral density of the lumbar spine and proximal femur, and biochemical indices of skeletal homeostasis (serum ionized calcium, parathyroid hormone, and osteocalcin). (DEXA) method. Following the baseline evaluation adjuvant chemotherapy will be administered. The baseline measurements will then be repeated at 6, 12, and 24 months. At the 12 month evaluation women with chemotherapy-induced ovarian failure (approximately 70% of participants) will be randomly allocated to either one year of nasal spray calcitonin (200 IU/day) plus 1500 mg of oral daily calcium intake or nasal spray placebo plus 1500 mg of oral daily calcium intake in a double-blind placebo-controlled trial. Tamoxifen may also prevent bone loss and inhibit bone resorption. In Specific Aim #3 we will test whether tamoxifen prevents bone loss in breast cancer patients with chemotherapy-induced ovarian failure. In this observational study 42 premenopausal breast cancer patients with 0-3 axillary nodal metastases who receive adjuvant chemotherapy and tamoxifen will undergo the baseline evaluation and study evaluations at 6, 12, and 24 months. These prospective studies in premenopausal women with breast cancer will provide insights into the natural history of chemotherapy- induced ovarian failure and bone loss, and the effects of nasal spray calcitonin and tamoxifen in preventing the accelerated bone loss in these women.