Oophorectomy for Advanced Breast Cancer

A series of 168 cases of bilateral oophorectomy in patients with advanced breast cancer operated on during the 4 years 1962-65 at the National Cancer Institute of Milan is studied. There was no criterion of selection apart from the limit of 5 years after menopause; indeed, only 3 patients exceeded that limit. Post-operative mortality (5 cases) was 3%. The clinical success rate was 31.9% (52 cases) with a mean regression period of 13 months 10 days and a mean survival of 20 ½ months. The subjective successes numbered 25 with a mean period of wellbeing of 9 months 6 days and a mean survival of 16 months. The mean survival of the 87 patients who did not benefit from oophorectomy was 6 months 10 days. The success rate has been studied with reference to the chronological and physiological age of the patients, the duration of the free interval, tumor stage at first examination, site and distribution of metastases, cancer familiarity, the degree of estrogenic stimulation according to the karyo-pyknotic index, duration of menstrual life, parity, lactation and any previous hormonal therapy. The results obtained may be summarised as follows: 1) oophorectomy yields a clinical success rate of around 40% in patients who fit at least one of the following conditions: premenopausal women of over 35 or women in menopause for under a year; free interval of over two years; lesions confined to the soft tissues or to the skeleton or the presence of only nodular metastases in the lungs; a high degree of estrogenic stimulation, menstrual life exceeding 35 years; and primiparity; 2) the following are adverse conditions: age under 35; state of menopause exceeding a year; free interval of under two years; presence of pleuropulmonary lymphangitic metastases or of several groups of metastases; low degree of estrogenic stimulation; menstrual life of under 35 years; numerous pregnancies with subsequent lactation, and failure of hormonal therapy; 3) the operation is contraindicated, because never or hardly ever successful, in women in menopause for over a year without signs of estrogenic stimulation, in patients with extensive hepatic metastases and in those with cerebral metastases; 4) cancer familiarity, generic or specific, tumor stage at the time of surgical or of primary radiotheraphy and the presence or absence of ovarian metastases have no influence upon the results of ovariectomy. Oophorectomy is not only the first-line treatment for advanced carcinoma of the breast in patients in premenopause and in menopause for under a year but it is also a sound criterion for secondary treatment, since, as a rule, only patients who have responded to oophorectomy benefit (over 60% of these cases) from further endocrine theraphy, whether additive or ablative.