Kolorektal Kanser Tanısı Alan Premenopozal Kadınlarda Adjuvan Kemoterapiye Bağlı Amenore Sıklığı ve İlişkili Faktörlerin Belirlenmesi

Abstract

Recently, the incidence of colorectal cancer has been increasing in people younger than 50 years old. Using adjuvant chemotherapy after surgery in stage III and high risk stage II colorectal cancer is the current standard of care. Gonadotoxic effects of adjuvant chemotherapy protocols used in colorectal cancer is not widely known. In this study, we aimed to determine adjuvant chemotherapy- induced amenorrhea rate and the factors that increase the persistent amenorrhea risk in reproductive women with colorectal cancer. Patients with stage I, II and III colorectal cancer who were, younger than 50 years old and had applied to Hacettepe University Faculty of Medicine Oncology Hospital, Ankara Abdurrahman Yurtaslan Oncology Hospital, Ankara Oncology Education and Research Hospital and Ankara Numune Education and Research Hospital were included. A questionnaire was filled with the patients who met the inclusion criteria, during outpatient visits. Patients who received pelvic radiotherapy were excluded from the study. There were 60 participants in the study with an average age of 40 years old. Eleven patients received only surgical treatment, 22 patients received only 5- fluorouracil (5- FU) and 27 patients received fluoropyrimidine and oxaliplatin. After 1 year of receiving chemotherapy, the frequency of persistent amenorrhea was %20 in the whole group, %18 among those who received 5-FU containing chemotherapy and %22 among those who received oxaliplatin containing chemotherapy (p=0,727). The frequency of amenorrhea was %3,5 among those who were younger than 44 years old and %42,8 among those who were older. Age ≥ 44 (HR 29,4, 95% CI 2,8-311) and menarche age ≥ 14 (HR 5,5, 95% CI 0,8-36) were associated with increased risk of persistent amenorrhea in multivariate analysis. In this study, there is no difference in the persistent amenorrhea frequency between 5-FU and oxaliplatin based adjuvant chemotherapy protocols in colorectal cancer treatment. Older age (≥44) and higher menarche age (≥14) were the factors that increased the risk of persistent amenorrhea after chemotherapy. Women with early stage colorectal cancer should be informed about the risk of infertility and fertility preservation in the light of this information.