Reproductive status in GTD treated with etoposide.
OBJECTIVE
To investigate the mechanism and degree of ovarian dysfunction in gestational trophoblastic disease (GTD) patients treated with etoposide alone.


METHODS
Forty-seven patients with low-risk GTD were treated with etoposide alone, and pituitary-ovarian function was evaluated by measuring basal serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol and progesterone and by recording basal body temperature. Moreover, the responses of LH and FSH to the administration of LH-releasing hormone (LHRH) and the responses of prolactin to thyrotropin-releasing hormone (TRH) were analyzed after the completion of etoposide treatment.


RESULTS
Increased basal LH and FSH levels were found in approximately 50% of patients, especially those over 40 years old. Although the LH and FSH responses to LHRH were exaggerated in patients with high basal FSH levels, the prolactin responses to TRH were normal. Ovulation resumed within 121 days after the cessation of chemotherapy in women under 39 years. However, five of nine patients over 40 years remained anovulatory during the follow-up period.


CONCLUSIONS
Ovarian function was impaired in approximately 50% of patients treated with etoposide at the time of LHRH study, though pituitary function was preserved. This complication is age related but not related to the amount of etoposide exposure. Therefore, we must consider the possibility of permanent anovulation when we treat patients 40 years old and older.
Matsui
H
H
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Chiba, Japan.
Seki
K
K
Sekiya
S
S
Takamizawa
H
H
D000328:Adult; D000375:Aging; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D005047:Etoposide / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D010053:Ovary / Q000503:physiopathology*; D010060:Ovulation; D011247:Pregnancy; D011388:Prolactin / Q000097:blood; D013973:Thyrotropin-Releasing Hormone; D014328:Trophoblastic Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000503:physiopathology
D000972:Antineoplastic Agents, Phytogenic; D007987:Gonadotropin-Releasing Hormone; D013973:Thyrotropin-Releasing Hormone; D005047:Etoposide; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone