Ovarian ablation in the adjuvant treatment of breast cancer: GnRH-analogues, ovarectomy or radiocastration - 'The philosopher's stone' instead of 'Chamber of secrets'?

Background: Ovarian suppression in the adjuvant treatment of perimenopausal women with breast cancer is an important option. The therapeutic goal can be accomplished by administration of GnRH-analogues, ovarectomy or radiocastration. Patients and methods: We describe the advantages and the therapy related side effects and compare the different treatment modalities with each other. Results: Because of its reversibility and patients' compliance GnRH-analogues seem to be advantageous especially in younger premenopausal women. When longer term side effects of artificially induced menopause are less important, therapeutic alternatives such as radiocastration or ovarectomy are effective without obvious superiority between these options. Conclusion: Even in the background of the increasing use of GnRH-analogues radiocastration remains still a therapeutic alternative because of its cost-effectiveness and feasibility. This accounts especially for peri- or premenopausal women above the age of 45. (orig.)