Effects of Postoperative Adjuvant Chemotherapy and Radiotherapy on Ovarian Function in Women Undergoing Treatment for Soft Tissue Sarcoma2

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Abstract
Ovarian funetion was evaluated in 11 women 16 to 43 years of age at treatment who reeeived doxorubiein, cyclophosphamide, and high doses of methotrexate with or without radiotherapy in adjuvant therapy of soft tissue sareoma. Five women (16–33 yr old) who reeeived ehemotherapy alone or eombined with radiotherapy only at sites distant from the ovaries (ehest wall, thigh, and leg) had minimal menstrual irregularities or temporary eessation of menses during therapy; cyclic menses returned promptly after therapy. Gonadotropin levels (expressed as means ± SD) [follicle-stimulating hormone (FSH), 10±5 mIU/ml; luteinizing hormone (LH), 10±4 mlU/ml] and 17β-estradiol (E2) levels (means±SD, 208±147 pg/ml) were normal. By eontrast, 4 older women (ages 36–43 yr) who reeeived similar treatment developed persistent amenorrhea with postmenopausal levels of gonadotropin (FSH, 108±29 mIU/ml; LH, 72±19 mIU/ml) and E2 (19±8 pg/ml). Two additional women (ages 21 and 39 yr) who reeeived radiation (7,000 rad) to the pelvis plus ehemotherapy developed prompt cessation of menses and beeame functional castrates (FSH, 77 and 80 mIU/ml; LH, 40 and 58 mIU/ml; E2, 10 and 19 pg/ml). However, this result would be expected from the radiation dose alone. The data demonstrated that ovarian dysfunction may follow the use of doxorubiein, eyelophosphamide, and high doses of methotrexate and that the injury is age related.

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