CHEMOTHERAPY FOR GESTATIONAL TROPHOBLASTIC TUMORS HASTENS MENOPAUSE BY 3 YEARS

Chemotherapy may induce acute ovarian failure, but in women who retain gonadal function throughout chemotherapy, the late effects upon ovari an function are unknown. A retrospective controlled survey was perform ed to ascertain whether chemotherapy for gestational trophoblastic tum ours (GTT) results in premature menopause. Questionnaires were sent to 1,489 women diagnosed between 1971 and 1990 with GTT, including 1089 who had received chemotherapy and 400 who had not received chemotherap y (controls). Responses were obtained from 972 chemotherapy-treated pa tients and 327 controls. 124 women were not evaluable for menopause da te as they had undergone hysterectomy as part of the treatment for GTT or had developed permanent amenorrhoea during chemotherapy. Overall, 172 women reported that they were postmenopausal, including 157 women who had received chemotherapy. The median age at menopause for the eva luable population was 50 years (range 25-56 years). The age at menopau se was significantly earlier in the treated arm (median 50, range 25-5 6 years) than in the controls (median 53, range 40-57 years) (logrank test chi(2)=12.6, P = 0.0004). Menopause occurred significantly earlie r in women treated with combination chemotherapy (median 49, range 25- 56 years) compared with single agent methotrexate (median 51, range 25 -56 years) (logrank test chi(2) = 8.3, P = 0.004). However, the age at completion of chemotherapy in the treated arm did not influence the a ge of menopause (proportional Hazards chi(2)=1.99, P=0.16). Chemothera py for GTT induces menopause 3 years earlier than it occurs in women w ith GTT who do not receive chemotherapy. Although the difference is st atistically significant, the magnitude is modest and most women can be reassured that neither fertility nor postmenopausal osteoporosis will be greatly affected. (C) 1998 Elsevier Science Ltd. All rights reserv ed.