Fertilitypreservationincancerpatient如何保留癌症病患的生育能力.PPT

Fertility preservation in cancer patient如何保留癌症病患的生育能力 楊曉君醫師 Fertility preservation in cancer patient Who is appropriate Method In vivo protection Conservative surgery and surgery technique Embryo storage Mature, immature oocytes freeze Ovarian tissue banking Six distinct issues should be considered Fertility preservation in cancer patient The risk of sterility with the proposed treatment program The overall prognosis for the patient The potential risks of delaying chemotherapy The impact of any future pregnancy upon the risk of tumor recurrence The impact of any required hormonal manipulation on tumor itself The possibility of tumor contamination of the harvested tissue C/T and R/T in Prepubertal girl(I) Pre-pubertal ovary extremely resistant to the gonadotoxic chemotherapy agents, such as cyclophosphamide and nitrogen mustard High rates of perservation of fertility among pre-pubertal girls exposed to MOPP C/T for Hodgkin’s disease. The mechanisms of resistance: the quiescent cell-cycle status of germ cell in prepubertal ovary? Oral pills and LHRHa: encouraging early report(chapman and Sutcliffe 1981. Protection of ovarian function by oral contraceptives in women receiving chemotherapy for Hodgkin’s disease.) C/T and R/T in Prepubertal girl(II) The extremely high doses of C/T prior to bone marrow transplantation for treatment of hematological malignancies frequently result in long term sterility.—ovarian cryopreservation should be considered, when the underlying disease may remission and unlikely to contamination the harvest tissue. prepubertal ovary remain extremely sensitive to radiation -with doses of 5-20Gy -ovarian failure. Prognosis of early stage Breast cancer The prognosis for women with ostensibly surgically resectable, early stage breast cancer has improved with the increased application of adjuvant C/T and hormone therapy. The likelihood of woman with node-negative disease remaining free of recurrence at 5 yrs is approximately 85%, 75%