Lack of prevention of radiation-induced ovarian damage by a gonadotrophin-releasing hormone agonist administered parallel to radiation therapy

Background: A major complication after infradiaphragmatic radiation is ovar ian damage, with a considerable impact on life quality. If the ovaries are situated within the radiation field, ovarian damage is unavoidable. Since p reliminary studies have indicated that the rare of chemotherapy-induced ova rian damage could be reduced with the use of gonadotrophin-releasing hormon e agonists, we offered this treatment to a 35-year-old patient. Methods: Le uprorelin was applied as a protectant 4 weeks prior to and during radiation therapy. Ovarian function was assessed before, during and after radiothera py by measurement of sex steroids and gonadotrophins in serum. Results: Fou r weeks after the initiation of Leuprorelin treatment a down-regulation of gonadotrophins and the sex steroids was measurable. Twelve weeks after radi otherapy and cessation of the treatment with Leuprorelin, LH and FSH levels increased, while estradiol and progesterone levels fell to subnormal value s, indicating ovarian damage. Conclusions: In our case the Leuprorelin trea tment failed to prevent radiation-induced ovarian damage, possibly due to t he relatively high dose of 30 Gy delivered to the ovaries, it should be fur ther evaluated whether gonadotrophin-releasing hormone agonists can protect the ovaries from radiation-induced damage in cases in which the ovarian do ses can be kept lower.