***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
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    Input: PURPOSE Observational studies suggested that luteinizing hormone-releasing hormone agonists ( LHRHa ) might prevent premature ovarian failure result ing from adjuvant chemotherapy in premenopausal patients . We aim ed to test the efficacy of ovarian function preservation with the LHRHa goserelin in patients with breast cancer . PATIENTS AND METHODS In a prospect i ve , r and omized , open-label , controlled multicenter study , 60 patients younger than age 46 years with hormone-insensitive breast cancer were allocated to receive anthracycline/cyclophosphamide ( with or without taxane ) -based neoadjuvant chemotherapy with or without goserelin . The first goserelin injection was administered at least 2 weeks before the first chemotherapy cycle , continuing at 3.6 mg subcutaneously every 4 weeks until the end of the last cycle . The primary objective was the reappearance of normal ovarian function , defined as two consecutive menstrual periods within 21 to 35 days at 6 months after end of chemotherapy . RESULTS Fifty-three patients ( 88.3 % ) experienced temporary amenorrhea ( 93.3 % with v 83.3 % without goserelin ) . No significant difference was observed regarding the reappearance of menstruation at 6 months after chemotherapy ( 70.0 % with v 56.7 % without goserelin ; difference of 13.3 % ; 95 % CI , -10.85 to 37.45 ; P = .284 ) . All but one evaluable patient reported regular menses at 2 years after chemotherapy . Time to restoration of menstruation was 6.8 months ( 95 % CI , 5.2 to 8.4 ) with goserelin and 6.1 months ( 95 % CI , 5.3 to 6.8 ) without goserelin ( P = .304 ) . Chemotherapy result ed in a decreased ovarian reserve measured by inhibin B and anti-Müllerian hormone during follow-up , supporting the other findings . CONCLUSION Premenopausal patients with breast cancer receiving goserelin simultaneously with modern neoadjuvant chemotherapy did not experience statistically significantly less amenorrhea 6 months after end of chemotherapy compared with those receiving chemotherapy alone Abstract The aim of this study was to evaluate the protective effect of concomitant leuprolide treatment on ovarian function in young women undergoing adjuvant chemotherapy for early breast cancer . 19 women , median age 36.5 years ( range 26 - 40 years ) , with operable breast cancer and negative hormonal receptors , received six cycles of FEC 100 regimen as adjuvant chemotherapy and co-treatment with leuprolide .  Menstrual resumption was gained in all patients in a median time of 5 months ( range 3 - 8 ) . Follicle-stimulating hormone and estradiol assessment was performed in all patients . The return to pre-menopausal values was achieved within 6 months of the last leuprolide administration . At a median follow-up of 3 years ( range 1 - 5 years ) , no patient relapsed and four full-term pregnancies were recorded in four women , each of whom delivered a healthy infant . Our data are in agreement with similar experiences and confirm the activity of GnRH therapy in preventing ovarian failure BACKGROUND Premature ovarian failure and infertility following chemotherapy in early breast cancer ( EBC ) are major concerns for young women . The role of gonadotrophin-releasing hormone ( GnRH ) agonists with chemotherapy in EBC in reducing the incidence of chemotherapy-induced early menopause remains uncertain , and long-term data on the recovery of fertility are sparse . We report an audit of our experience with the GnRH agonist , goserelin ( Zoladex ® ) , used with chemotherapy to preserve ovarian function and maintain fertility . PATIENTS AND METHODS Pre-menopausal women were given goserelin subcutaneously every 28 days during chemotherapy , starting 0 - 14 days before treatment . The main clinical end point was recovery of menstruation after chemotherapy . The other end points were rate of successful conception and median time to recovery of menses . RESULTS About 84 % of 125 women  recovered menstruation with the median time to recovery of 6 months ( 1 - 43 months ) , including 76 % of 71 patients aged over 35 . Of the 42 patients who attempted pregnancy  , 71 % ( n=30 ) managed to achieve pregnancies . At the time of analysis , there were 42 pregnancies and 30 healthy deliveries . CONCLUSIONS The GnRH agonist , goserelin , given with chemotherapy for EBC is associated with a low risk of long-term chemotherapy-induced amenorrhoea and a high chance of pregnancy . Further r and omised trials are needed The aim of the present trial was to investigate the protective effects on ovarian function , and the efficacy and tolerability of goserelin added to adjuvant chemotherapy for early breast cancer . Following surgical treatment , 64 premenopausal patients with early breast cancer received goserelin 3.6 mg ( every 28 days for 1 year ) and an adjuvant treatment which was chosen according to the patient 's prognosis . Median age was 42 years ( range 27–50 ) . ECOG performance status was 0–1 in all patients . Twenty-eight patients ( 44 % ) had estrogen receptor (ER)+ tumors and 36 ( 56 % ) patients had ER– tumors . Fifty-two ( 81 % ) patients had stage II disease and 12 ( 19 % ) had stage III disease . Eighteen patients received cyclophosphamide , methotrexate and 5-fluorouracil chemotherapy , 46 patients received an anthracycline-based regimen , and nine of them received high-dose chemotherapy and autologous peripheral blood progenitor cell transplantation . Fifty-one patients ( 80 % ) were irradiated . ER+ patients also received tamoxifen for 5 years . Serum estradiol was suppressed to values below 40 pg/ml in all patients . After a median follow-up of 55 months , 86 % of patients had resumed normal menses , 84 % of patients were disease-free and 94 % were alive . The 1- , 3- and 5-year projected recurrence-free survival rates were 100 , 81 and 75 % , respectively . Five years after treatment one patient had a pregnancy that ended with a normal childbirth . No unexpected adverse events were reported . These data show that the addition of goserelin to adjuvant therapy of premenopausal patients with early breast cancer is well tolerated and protects long-term ovarian function OBJECTIVE To determine whether GnRHa administration before and during combination chemotherapy for breast cancer could preserve posttreatment ovarian function in young women or not . DESIGN Prospect i ve r and omized controlled study . SETTING Department of Obstetrics and Gynecology , Mansura University Hospital , Mansura , Egypt . PATIENT(S ) Eighty patients with unilateral adenocarcinoma of the breast and with no metastasis who had undergone modified radical mastectomy or breast-conserving surgery plus full axillary lymph node dissection were included in the study . Patients were assigned r and omly to receive combined GnRHa and chemotherapy or chemotherapy alone . One woman in each group dropped out . MAIN OUTCOME MEASURE(S ) Return of spontaneous menstruation and ovulation . Hormonal changes ( FSH , LH , E(2 ) , P ) during and after the course of treatment . RESULT ( S ) In the study group , 89.6 % resumed menses and 69.2 % resumed spontaneous ovulation within 3 - 8 months of termination of the GnRHa/chemotherapy cotreatment ; 11.4 % experienced hypergonadotrophic amenorrhoea and ovarian failure 8 months after treatment . In the control group ( chemotherapy without GnRHa ) , 33.3 % resumed menses and 25.6 % resumed normal ovarian activity . The median FSH and LH concentrations , 6 months after completion of the GnRHa/chemotherapy cotreatment group , were significantly less than the control group . During the GnRHa/chemotherapy cotreatment the concentrations of FSH , LH , and P decreased to almost prepubertal levels . However , within 1 - 3 months after the last GnRHa injection , an increase in LH and FSH concentrations was detected , followed several weeks later in by an increase in P concentrations to within normal levels . CONCLUSION ( S ) GnRHa administration before and during combination chemotherapy for breast cancer may preserve posttreatment ovarian function in women < 40 years . Long-term studies are required The increased survival of patients with breast cancer has given rise to other problems associated with the complications of chemotherapy . One major complication is premature ovarian failure , an especially harmful outcome for women of reproductive age . This study was performed to evaluate the efficacy of GnRH agonist ( GnRHa ) treatment on protecting ovarian function in young breast cancer patients ( 30.59±5.1 yr ) receiving chemotherapy after surgery . Twenty-two women were enrolled and given subcutaneous injections of leuprolide acetate ( 3.75 mg ) every 4 weeks during chemotherapy . Follow-up laboratory tests ( luteinizing hormone [ LH ] , follicle stimulating hormone [ FSH ] , and estradiol ) were performed 1 , 3 , and 6 months after  chemotherapy . Menstruation patterns and clinical symptoms were followed up for a mean duration of 35.6±1.7 months . FSH and LH levels were normal in all patients 6 months after completing chemotherapy ( 8.0±5.3 , 4.4±2.7 mIU/mL , respectively ) . During follow-up , none of the patients complained of menopausal symptoms and 81.8 % experienced recovery of menstruation . This report is the first trial of GnRHa as a treatment modality to protect ovarian function during adjuvant chemotherapy in young Korean breast cancer patients PURPOSE Breast cancer arising in young women is correlated with inferior survival and higher incidence of negative clinicopathologic features . The biology driving this aggressive disease has yet to be defined . PATIENTS AND METHODS Clinical ly annotated , microarray data from 784 early-stage breast cancers were identified , and prospect ively defined , age-specific cohorts ( young : < /= 45 years , n = 200 ; older : > /= 65 years , n = 211 ) were compared by prognosis , clinicopathologic variables , mRNA expression values , single-gene analysis , and gene set enrichment analysis ( GSEA ) . Univariate and multivariate analyses were performed . RESULTS Using clinicopathologic variables , young women illustrated lower estrogen receptor ( ER ) positivity ( immunohistochemistry [ IHC ] , P = .027 ) , larger tumors ( P = .012 ) , higher human epidermal growth factor receptor 2 ( HER-2 ) overexpression ( IHC , P = .075 ) , lymph node positivity ( P = .008 ) , higher grade tumors ( P < .0001 ) , and trends toward inferior disease-free survival ( DFS ; hazard ratio = 1.32 ; P = .094 ) . Using genomic expression analysis , tumors arising in young women had significantly lower ERalpha mRNA ( P < .0001 ) , ERbeta ( P = .02 ) , and progesterone receptor ( PR ) expression ( P < .0001 ) , but higher HER-2 ( P < .0001 ) and epidermal growth factor receptor ( EGFR ) expression ( P < .0001 ) . Exploratory analysis ( GSEA ) revealed 367 biologically relevant gene sets significantly distinguishing breast tumors arising in young women . Combining clinicopathologic and genomic variables among tumors arising in young women demonstrated that younger age and lower ERbeta and higher EGFR mRNA expression were significant predictors of inferior DFS . CONCLUSION This large-scale genomic analysis illustrates that breast cancer arising in young women is a unique biologic entity driven by unifying oncogenic signaling pathways , is characterized by less hormone sensitivity and higher HER-2/EGFR expression , and warrants further study to offer this poor-prognosis group of women better preventative and therapeutic options Purpose : Ovarian failure and infertility following adjuvant chemotherapy for early breast cancer are major concerns for some young women . Techniques for oocyte harvesting are associated with delay in starting treatment , potentially undesirable estrogen stimulation and a relatively low success rate . We report an audit of our experience with the luteinising hormone-releasing hormone agonist , goserelin , to achieve transient ovarian suppression during chemotherapy as a means of preserving ovarian function . Patient and methods : Pre-menopausal women were offered goserelin 3.6 mg by subcutaneous injection every 28 days during chemotherapy , starting 0–14 days prior to treatment . The primary end-point was recovery of menstruation . Serum luteinising hormone , follicle stimulating hormone and oestradiol were measured at recovery of menstruation or at first year follow-up if amenorrhoea persisted . Subsequent pregnancies were recorded . Results : Fifty-one evaluable women were audited .  Amenorrhoea occurred in all but one . All received combination anthracycline-containing chemotherapy regimens with a mean cumulative cyclophosphamide dose of 3.9 g/m2 . 
    Output:
    
A subgroup analysis showed that addition of GnRH agonists significantly improved the resumption of menses rate in patients who were hormone-insensitive .
GnRH agonists cotreatment with chemotherapy in premenopausal women with breast cancer plays a beneficial role in resumption of ovarian function , with a higher rate of resumption of menses .
However , treatment with GnRH agonists does not appear to exhibit its protective effects in fertility