Ovarian ablation is the oldest form of systemic treatment of breast cancer and consists of removal of the main source of estrogen biosynthesis in premenopausal women. Over the last century several different means of stopping ovarian function have been studied: surgical oophorectomy, ovarian irradiation, and more recently, chemical castration by gonadotropin-releasing hormone analog therapy. In unselected patients the response rate to ovarian ablation is of about 35% but the likelihood of response is considerably higher for patients with hormonal receptor-positive tumors, the therapy being most effective in women who are actively menstruating. In spite of this evidence, the role of ovarian ablation in the management of early-stage breast cancer still remains controversial. Here we review current evidence supporting the value of this ablative procedure as an adjuvant and update ongoing clinical research to refine our knowledge about its use.
BajettaE., ZilemboN., BuzzoniR., CelioL., ZampinoM.G., ColleoniM., OrianaS., AttiliA., SacchiniV., MartinettiA.: Goserelin in premenopausal advanced breast cancer: clinical and endocrine evaluation of responsive patients.Oncology,51: 262–269, 1994.
2.
BinesJ., OleskeD.M., CobleighM.A.: Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer.J. Clin. Oncol., 14: 1718–1729, 1996.
3.
BoccardoF., RubagottiA., AmorosoD., MesitiM., RomeoD., AldrighettiD., GentaP., GiaiM., IrtelliL., DonatiD., FarrisA., SchieppatiG.: CMF vs tamoxifen plus ovarian suppression as adjuvant treatment of ER positive pre-perimenopausal breast cancer patients.Breast Cancer Res. Treat.,57: 47, 1999.
4.
BurgerC.W., PrinssenH.M., KenemansP.: LHRH agonist treatment of breast cancer and gynecological malignancies: a review.Eur. J. Obstet. Gynecol. Reprod. Biol., 97: 27–33, 1996.
5.
BuzdarA.U., HortobagyiG.N.: Recent advances in adjuvant therapy of breast cancer.Semin. Oncol., 26: 21–27, 1999.
6.
BuzzoniR., BiganzoliL., BajettaE., CelioL., FornasieroA., MarianiL., ZilemboN., Di BartolomeoM., Di LeoA., ArcangeliG., AitiniE., FarinaG., SchieppatiG., GalluzzoD., MartinettiA.: Combination goserelin and tamoxifen therapy in premenopausal advanced breast cancer: a multicentre study by the ITMO group.Br. J. Cancer, 71: 1111–1114, 1995.
7.
ColleoniM., CoatesA., PaganiO., GoldhirshA.: Combined chemo-endocrine adjuvant therapy for patients with operable breast cancer: still a question?Cancer Treat. Rev., 24: 15–26, 1998.
8.
DavidsonN.E.: Ovarian ablation as treatment for young women with breast cancer.Monogr. Natl. Cancer Inst., 16: 95–99, 1994.
9.
DavidsonN., O'NeillA., VukovA., OsborneC.K., MartinoS., WhiteD., AbeloffM.D.: Effect of chemohormonal therapy in premenopausal, node (+), receptor (+) breast cancer: an Eastern Cooperative Oncology group phase III intergroup trial.Proc. Am. Soc. Clin. Oncol.,18: 67a, 1999.
10.
Early Breast Cancer Trialists’ Collaborative Group.Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy: 133 randomised trials involving 31000 recurrences and 24000 deaths among 75000 women.Lancet, 339: 1–15, 71–85, 1992.
11.
Early Breast Cancer Trialists’ Collaborative Group. Ovarian ablation for early breast cancer:overview of the randomised trials.Lancet, 348: 1189–1196, 1996.
12.
EjlertsenB., DombernowskyP., MouridsenH.T., KambyC., KjaerM., RoseC., AndersenK.W., JensenM.B., BengtssonN.O., BerghJ.: Comparable effect of ovarian ablation and CMF chemotherapy in premenopausal hormone receptor positive breast cancer patients.Proc. Am. Soc. Clin. Oncol.,18: 66a, 1999.
13.
GoldhirshA., GlickJ.H., GelberR.D., SennH.J.: Meeting highlights: international consensus panel on the treatment of primary breast cancer.J. Natl. Cancer Inst., 90: 1601–1608, 1998.
14.
JakeszR., HausmaningerH., SamoniggH., KubistaE., DepischD., FridrikM., StiererM., GnantM., StegerG., KolbR., JatzkoG., HofbauerF., ReinerG., Luschin-EbengreuthG.: Comparison of adjuvant therapy with tamoxifen and goserelin vs CMF in premenopausal stage I and II hormone-responsive breast cancer patients: four-year results of Austrian breast cancer study group trial 5.Proc. Am. Soc. Clin. Oncol.,18: 67a, 1999.
15.
KaufmannM.: Luteinizing hormone-releasing hormone analogues in early breast cancer: updated status of ongoing clinical trials.Br. J. Cancer, 78: 9–11, 1998.
16.
RutqvistL.E.: Zoladex and tamoxifen as adjuvant therapy in premenopausal breast cancer: a randomised trial by the Cancer Research Campaign Breast Cancer Trials Group, the Stockholm Breast Cancer Study Group, the South-East Sweden Breast Cancer Group and the Gruppo Interdisciplinare Valutazione Interventi in Oncologia.Proc. Am. Soc. Clin. Oncol.,18: 67a, 1999.
17.
SalvadoriB., CelioL., OrianaR., BajettaE.: Adjuvant oophorectomy versus CMF in premenopausal node-positive breast cancer: long-term results of an experience at the Milan Cancer Institute.Tumori, 86: 259–260, 2000.
18.
Scottish Cancer Trials Breast Group and ICRF Breast Unit:Adjuvant ovarian ablation versus CMF chemotherapy in premenopausal women with pathological stage II breast carcinoma.Lancet, 341: 1293–1298, 1993.
