醋酸戈舍瑞林缓释植入剂联合腹腔镜手术治疗子宫内膜异位症效果

目的:探讨醋酸戈舍瑞林缓释植入剂联合腹腔镜手术治疗子宫内膜异位症的临床疗效。方法:选择本院就诊的子宫内膜异位症患者80例,随机分为两组各40例,根据r-AFS分期进行腹腔镜手术,在术后1周内观察组醋酸戈舍瑞林缓释植入剂3.6mg皮下注射,每4周1次,连用6个月;对照组口服孕三烯酮2.5mg,每周2次,连用6个月。比较两组临床疗效,术前和术后6个月测定血清血管内皮生长因子(VEGF)、基质金属蛋白酶-9/组织金属蛋白酶抑制物-1(MMP-9/TIMP-1),评定患者视觉模拟评分法(VAS)和健康生活质量调查问卷(SF-36),随访3年术后不良反应和复发情况。结果:治疗有效率对照组(75.0%)低于观察组(92.5%)(P<0.05)。术后6个月时,对照组和观察组血清VEGF(158.41±56.28 ng/L、119.63±47.13ng/L),MMP-9/TIMP-1(1.35±0.25、1.14±0.23),生理健康评分(64.20±12.81分、78.53±13.23分),心理健康评分(69.14±13.26分、80.35±14.59分),VAS评分(1.21±0.46分、0.84±0.39分)比较均有差异(P<0.05);观察组无不良反应发生,术后3年复发率对照组(27.5%)高于观察组(10.0%)(P<0.05)。结论:醋酸戈舍瑞林缓释植入剂联合腹腔镜手术治疗子宫内膜异位症疗效确切,可降低术后血管侵袭指标及复发率,提高生活质量,安全性高。     

Goserelin plus tamoxifen compared to chemotherapy followed by tamoxifen in premenopausal patients with early stage-, lymph node-negative breast cancer of luminal A subtype

ObjectivesTo study the outcomes of adjuvant goserelin combined with tamoxifen (GosTam) compared to chemotherapy followed by tamoxifen (ChemTam) in premenopausal patients with early stage, luminal A breast cancer.MethodsFrom 2008 until 2013, data were retrospectively collected for premenopausal patients who underwent surgery for invasive tumors that were ≤2.0 cm, node-negative, strongly positive for estrogen and progesterone receptors, HER-2-negative, and Ki-67 < 25%. The patients were divided into two groups according to adjuvant regimen, either GosTam or ChemTam. All patients who underwent different adjuvant regimens were excluded.ResultsIn total, 235 patients underwent GosTam and 171 patients underwent ChemTam. There were significantly more patients younger than 40 years in the GosTam group (32% GosTam vs. 22% ChemTam, p = 0.031). Mean tumor size was significantly smaller (1.19 cm vs. 1.48 cm, p < 0.001), Ki-67 significantly lower (p = 0.049), and nuclear grade was low in a significant number of patients in the GosTam group (2% vs. 13%, p < 0.001). After a median follow-up of 51.3 months, there was no mortality in either group. There was no significant difference in 5-year disease-free survival (DFS) between the two groups even after univariate analysis considering age, tumor size, nuclear grade, and P53% (GosTam = 98.9% vs. ChemTam = 95.7%, HR = 0.404, 95% CI = [0.073, 2.222], p = 0.248).ConclusionThere was no difference between treatment groups, and neither chemotherapy nor ovarian suppression seemed to improve the outcome. Thus, tamoxifen alone might be a sufficient option for this low-risk patient population.     

Incidence rate of injection-site granulomas resulting from the administration of luteinizing hormone-releasing hormone analogues for the treatment of prostatic cancer

PURPOSE: Granulomas resulting from the administration of luteinizing hormone-releasing hormone analogues (LH-RH analogues) are thought to be very rare. We report on our clinical experience with injection-site granulomas that result from the administration of LH-RH analogues, and we evaluate the incidence rate of these granulomas. MATERIALS AND METHODS: We used the clinical records of 118 patients who were administered LH-RH analogues in 2005. We describe the clinical data of patients who experienced injection-site granulomas and evaluated the incidence rate. RESULTS: Five patients demonstrated injection-site granulomas due to LH-RH analogue administration. The incidence rate was 4.2% (5 of 118 patients). Most of the granulomas occurred after the first or second administration of 11.25mg of leuprorelin acetate. CONCLUSION: The occurrence of granulomas resulting from the administration of LH-RH analogues was thought to be very rare. Our study, however, revealed a higher incidence rate than expected, especially for leuprorelin acetate.     

luminal型乳腺癌患者戈舍瑞林用药依从性现状及影响因素分析

目的了解luminal型乳腺癌患者戈舍瑞林用药依从性情况,分析影响其依从性的相关因素。 方法根据纳入及排除标准,收集2015年1月至2017年12月重庆医科大学附属第一医院内分泌乳腺外科使用戈舍瑞林治疗的luminal型乳腺癌女性患者174例进行回顾性分析。中位随访时间16个月(范围：1～54个月),完成随访154例,失访20例,失访率为11.5%(20/174)。采用问卷调查评价其用药依从性,使用χ²检验和Mann-Whitney U检验比较不同特征患者依从性的差异;用Logistic回归分析影响患者依从性的相关因素。将患者分为≤40岁(103例)和>40岁(51例)2个亚组,进行亚组分析。 结果在完成随访的154例患者中,依从性好82例(53.2%,82/154),依从性差72例(46.8%,72/154)。≤40岁组患者中,55.3%(57/103)依从性好,而>40岁组患者中仅49.0%(25/51)依从性好。全部患者中,文化程度、医保类型、不良反应和是否了解疗程时间均与乳腺癌患者戈舍瑞林用药依从性有关(χ²＝13.586、13.042、7.880、14.251,P均<0.050);Logistic回归分析结果显示：高中及以下学历、居民医保和不了解戈舍瑞林的疗程时间为影响依从性的危险因素(OR＝2.772,95%CI：1.243～6.183,P＝0.013;OR＝5.188,95%CI：1.383～19.465,P＝0.015; OR＝3.363,95%CI：1.645～6.878,P＝0.001)。亚组分析显示：文化程度、职业、医保类型和是否了解疗程时间是≤40岁患者戈舍瑞林用药依从性的影响因素(χ²＝15.992、5.978、7.701、10.376,P均<0.050);不良反应及医保类型是>40岁患者用药依从性的影响因素(χ²＝4.763、7.471,P均<0.050)。Logistic回归分析表明：高中及以下文化程度和不了解疗程时间是≤40岁患者用药依从性的危险因素(OR＝5.126,95%CI：2.086～12.598,P<0.001; OR＝3.631, 95%CI：1.500～8.792,P＝0.004);居民医保是>40岁患者用药依从性的危险因素(OR＝64.315,95%CI：2.513～1 646.042,P＝0.012),不良反应是>40岁患者用药依从性的保护因素OR＝0.189,95%CI＝0.047～0.759,P＝0.019)。 结论luminal型乳腺癌患者戈舍瑞林用药依从性较差,文化程度、医保类型及是否了解疗程时间都可能影响患者的依从性。≤40岁组和>40岁组患者依从性有差异,且影响因素不同,建议对不同年龄患者用药采用不同的干预措施。     

中西医结合疗法对巧囊术后慢性盆腔痛及复发的影响

目的:基于治未病理论观察中药多途径疗法联合戈舍瑞林对巧囊术后慢性盆腔痛及复发的影响.方法:将80例巧囊术后患者随机分为两组各40例.对照组予散结镇痛胶囊联合戈舍瑞林治疗,治疗组予清热化瘀方口服、保留灌肠及离子导入联合戈舍瑞林治疗.治疗3个月后,比较两组临床疗效、慢性盆腔痛程度(VAS评分)及血清TNF-α、IL-6、V...     

European randomized, multicenter study of goserelin (Zoladex) in the management of mastalgia

BACKGROUND: Breast pain is a common symptom in patients attending breast clinics. The purpose of this study was to evaluate the efficacy of goserelin (Zoladex) as compared with sham injection in patients with mastalgia. STUDY DESIGN: One hundred forty-seven premenopausal women were randomized to treatment with either goserelin injection (3.6 mg/month) or sham injection for a total of 6 injections. Patients' daily self-assessment of breast pain using Cardiff breast pain chart was recorded during the 6-month treatment period and for 6 months in the posttreatment period. RESULTS: A significant treatment difference between the 2 groups in favor of goserelin was noted during the treatment period. Mean breast pain score improved by 67% in the goserelin group and 35% in the sham group during the treatment period. The mean pain scores increased in both groups in the posttreatment period. No significant posttreatment difference was found between the two groups. Side effects were more common with goserelin than sham injection. Patients receiving goserelin experienced vaginal dryness, hot flushes, decreased libido, oily skin or hair, and a decrease in breast size more frequently than sham patients. CONCLUSION: Goserelin is an effective short-term treatment for mastalgia. However, side effects are common, and thus, goserelin should be kept in reserve for patients who are refractory to other forms of treatment. Potentially, goserelin could be used to induce a rapid relief of symptoms that could be maintained with alternative therapies.     

Injection systems for two luteinising hormone-releasing hormone agonists: A comparative assessment of administration times and nurses’ perceptions

The aim of this study was to compare the speed of administration (preparation and delivery) and nurses' perceived ease of use and relative safety of two injection systems used to administer luteinising hormone-releasing hormone agonists: a depot system used to administer goserelin acetate ('Zoladex', AstraZeneca) and a vial system used to administer leuprorelin acetate ('Prostap', Wyeth). This was a randomised, crossover study with 82 volunteer nurses (50 pre-registration and 32 post-registration). All nurses were timed in the administration of both systems and all were required to assess the two systems by completing a questionnaire. Results indicate that both pre- and post-registration nurses administered the depot system in less time than the vial system. Overall mean times for administration of the depot system and the vial system were 1.70 and 3.34min, respectively. In questionnaire responses, significantly more nurses thought that the depot system had 'good safety precautions' compared with the vial system (85% versus 40%; P<0.001) and significantly more nurses also expressed a preference for the depot system (58% versus 42%; P=0.036). In conclusion, this study demonstrates that nurses prefer the one-step depot system used to administer goserelin acetate over the vial system used to administer leuprorelin acetate.     

戈舍瑞林对绝经前乳腺癌患者化疗期间卵巢功能的保护

目的评估戈舍瑞林对绝经前乳腺癌患者辅助化疗期间卵巢功能的保护作用。方法回顾性分析2年内收治的绝经前乳腺癌患者的临床资料,分成研究组(常规化疗+戈舍瑞林)和对照组(常规化疗),每组40例。观察两组患者月经情况及化疗期间与化疗结束后随访1年内的激素水平变化。结果 80例患者均完成化疗,化疗期间均出现月经周期紊乱。研究组和对照组月经恢复率分别为85%和55%,差异有统计学意义(P=0.007)。研究组在戈舍瑞林联合化疗期间,雌二醇(E2)水平减低到绝经后水平,促卵泡生成素(FSH)和促黄体生成素(LH)也明显降低;对照组在化疗期间E2水平逐渐降低,FSH和LH则明显增加。结论乳腺癌患者化疗期间应用戈舍瑞林,能有效地防止化疗引起的卵巢功能损伤,使大多数中青年患者维持正常月经及生育能力。     

Treatment of leiomyomatosis peritonealis disseminata with goserelin acetate: A case report and review of the literature

BACKGROUNDLeiomyomatosis peritonealis disseminata (LPD) is a rare condition characterized by multiple pelvic and abdominal nodules, which are composed of smooth-muscle cells. To date, no more than 200 cases have been reported. The diagnosis of LPD is difficult and there are no guidelines on the treatment of LPD. Currently, surgical excision is the mainstay. However, hormone blockade therapy can be an alternative choice.CASE SUMMARYA 33-year-old female patient with abdominal discomfort and palpable abdominal masses was admitted to our hospital. She had undergone four surgeries related to uterine leiomyoma in the past 8 years. Computed tomography revealed multiple nodules scattered within the abdominal wall and peritoneal cavity. Her symptoms and the result of the core-needle biopsy were consistent with LPD. The patient refused surgery and was then treated with tamoxifen, ulipristal acetate (a selective progesterone receptor modulator), and goserelin acetate (a gonadotropin-releasing hormone agonist). Both tamoxifen and ulipristal acetate were not effective in controlling the disease progression. However, the patient achieved an excellent response when goserelin acetate was attempted with relieved syndromes and obvious shrinkage of nodules. The largest nodule showed a 25% decrease in the sum of the longest diameters from pretreatment to posttreatment. Up to now, 2 years have elapsed and the patient remains asymptomatic and there is no development of further nodules.CONCLUSIONGoserelin acetate is effective for the management of LPD. The long-term use of goserelin acetate is thought to be safe and effective. Hormone blockade therapy can replace repeated surgical excision in recurrent patients.