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Reproductive status in GTD treated with etoposide
1Department of Obstetrics and Gynecology, Faculty of Medicine, University of Chiba, Japan.
The Journal of Reproductive Medicine
|February 1, 1997
Summary
Etoposide treatment for gestational trophoblastic disease (GTD) can cause ovarian dysfunction in about 50% of patients, particularly those over 40. Age is a key factor, raising concerns about permanent anovulation in older women.
Area of Science:
- Reproductive Endocrinology
- Gynecologic Oncology
- Pharmacology
Background:
- Gestational trophoblastic disease (GTD) requires chemotherapy, with etoposide being a treatment option.
- Ovarian function is crucial for reproductive health, and its impairment can significantly impact patients.
- Understanding the long-term effects of chemotherapy on ovarian function is vital for patient management.
Purpose of the Study:
- To investigate the mechanism and extent of ovarian dysfunction in GTD patients treated with etoposide monotherapy.
- To evaluate the impact of etoposide on pituitary-ovarian axis function.
Main Methods:
- Forty-seven low-risk GTD patients received etoposide alone.
- Pituitary-ovarian function assessed via basal hormone levels (LH, FSH, estradiol, progesterone) and basal body temperature.
- Hormonal responses to gonadotropin-releasing hormone (GnRH) and thyrotropin-releasing hormone (TRH) were analyzed post-treatment.
Main Results:
- Elevated basal LH and FSH observed in ~50% of patients, more prevalent in those >40 years old.
- Exaggerated LH/FSH responses to GnRH in patients with high FSH; normal prolactin responses to TRH.
- Ovulation resumed within 121 days for patients <39 years; 5/9 patients >40 remained anovulatory.
Conclusions:
- Etoposide treatment impairs ovarian function in ~50% of GTD patients, though pituitary function remains intact.
- Ovarian dysfunction is age-dependent, not related to etoposide dosage.
- The risk of permanent anovulation must be considered for patients aged 40 and older receiving etoposide.