High-intensity focused ultrasound compared with irradiation for ovarian castration in premenopausal females with hormone receptor-positive breast cancer after radical mastectomy

Abstract

The aim of the current study was to determine the feasibility, efficacy and safety of ovarian castration by high-intensity focused ultrasound (HIFU) in premenopausal patients with estrogen receptor (ER)(+)/progesterone receptor (PR)(+) breast cancer subsequent to radical mastectomy. A total of 88 premenopausal females with pathologically confirmed ER(+)/PR(+) breast cancer following radical mastectomy were randomly and equally divided into two groups that received HIFU therapy or radiation treatment. HIFU therapy was applied twice at an interval of three days and radiotherapy was administered to a total prescribed dose of D(T) 18 Gy in nine fractions over 11 days. Outcome measures included serum levels of estradiol and estrone, the Kupperman index and the incidence of secondary amenorrhea. Adverse events were monitored and recorded. All patients were followed up for 12 months. Serum levels of estradiol and estrone were comparable prior to treatment between the HIFU and radiation treatment groups. One month following treatment, serum levels of estradiol and estrone were significantly decreased in the two groups, but a greater decline was observed in the HIFU treatment group (P<0.01 and 0.05, respectively). In addition, more patients developed severe menopausal symptoms and amenorrhea in the HIFU therapy group compared with the radiotherapy group (P<0.01 for the two groups). A total of 3 months following treatment, serum levels of estradiol and estrone and the distribution of patients with severe, moderate and mild menopausal symptoms were comparable between the two groups. Following nine menstrual cycles, the incidence of amenorrhea reached 100% in the two groups. HIFU therapy is superior to radiotherapy for ovarian castration in premenopausal females with ER(+)/PR(+) breast cancer subsequent to radical mastectomy in terms of its minimal invasiveness and faster efficacy. HIFU represents a feasible non-surgical approach for ovarian castration.