***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*** 
    ***EXAMPLES*** 
    Input: PURPOSE This study was design ed to determine whether increasing the dose of doxorubicin in or adding paclitaxel to a st and ard adjuvant chemotherapy regimen for breast cancer patients would prolong time to recurrence and survival . PATIENTS AND METHODS After surgical treatment , 3,121 women with operable breast cancer and involved lymph nodes were r and omly assigned to receive a combination of cyclophosphamide ( C ) , 600 mg/m(2 ) , with one of three doses of doxorubicin ( A ) , 60 , 75 , or 90 mg/m(2 ) , for four cycles followed by either no further therapy or four cycles of paclitaxel at 175 mg/m(2 ) . Tamoxifen was given to 94 % of patients with hormone receptor-positive tumors . RESULTS There was no evidence of a  doxorubicin dose effect . At 5 years , disease-free survival was 69 % , 66 % , and 67 % for patients r and omly assigned to 60 , 75 , and 90 mg/m(2 ) , respectively . The hazard reductions from adding paclitaxel to CA were 17 % for recurrence ( adjusted Wald chi(2 ) P = .0023 ; unadjusted Wilcoxon P = .0011 ) and 18 % for death ( adjusted P = .0064 ; unadjusted P = .0098 ) . At 5 years , the disease-free survival ( + /- SE ) was 65 % ( + /- 1 ) and 70 % ( + /- 1 ) , and overall survival was 77 % ( + /- 1 ) and 80 % ( + /- 1 ) after CA alone or CA plus paclitaxel , respectively . The effects of adding paclitaxel were not significantly different in subsets defined by the protocol , but in an unplanned subset analysis , the hazard ratio of CA plus paclitaxel versus CA alone was 0.72 ( 95 % confidence interval , 0.59 to 0.86 ) for those with estrogen receptor-negative tumors and only 0.91 ( 95 % confidence interval , 0.78 to 1.07 ) for patients with estrogen receptor-positive tumors , almost all of whom received adjuvant tamoxifen . The additional toxicity from adding four cycles of paclitaxel was generally modest . CONCLUSION The addition of four cycles of paclitaxel after the completion of a st and ard course of CA improves the disease-free and overall survival of patients with early breast cancer 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 Future fertility is an important concern for many cancer survivors . Cancer therapies have been shown to adversely impact reproductive function . However , it is difficult to predict the extent to which reproductive dysfunction will occur . The purpose of this study was to compare measures of ovarian reserve ( MOR ) and pregnancy rates in young female cancer survivors and similar-aged controls . PROCEDURES A prospect i ve cohort study was conducted in a university-hospital setting . Participants were followed annually for a mean 25 months to assess reproductive history , the incidence of pregnancy , and MOR ( serum follicle-stimulating hormone , luteinizing hormone , estradiol , inhibin B , anti-mullerian hormone ( AMH ) , antral follicle counts and mean ovarian volume ) . RESULTS Eighty-four female survivors ( average age 26 , and 14 years post-treatment ) and 98 similar-aged controls that were sexually active with men were included . At baseline , 27/84 survivors and 42/98 controls reported a prior pregnancy . Adjusted models showed that anti-mullerian hormone ( AMH ) and antral follicle count ( AFC ) were impaired in survivors with a prior pregnancy compared to controls with a prior pregnancy ( P < 0.01 , P = 0.03 ) . During follow-up in 56 survivors and 74 controls , 19 pregnancies occurred in survivors and 18 in controls . Comparison of MOR between survivors who became pregnant and controls who became pregnant revealed that AMH and AFC were impaired in survivors ( P < 0.05 ) . Compared to survivors who did not become pregnant , survivors who did were older ( P < 0.01 ) and more likely to be cohabitating ( P < 0.01 ) , but had similar MOR and exposure to alkylators ( P = 0.34 ) . CONCLUSIONS Survivors achieved pregnancy at a rate similar to controls despite impaired MOR 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 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 CONTEXT Premenopausal patients with breast cancer are at high risk of premature ovarian failure induced by systemic treatments , but no st and ard strategies for preventing this adverse effect are yet available . OBJECTIVE To determine the effect of the temporary ovarian suppression obtained by administering the gonadotropin-releasing hormone analogue triptorelin during chemotherapy on the incidence of early menopause in young patients with breast cancer undergoing adjuvant or neoadjuvant chemotherapy . DESIGN , SETTING , AND PATIENTS The PROMISE-GIM6 ( Prevention of Menopause Induced by Chemotherapy : A Study in Early Breast Cancer Patients -Gruppo Italiano Mammella 6 ) study , a parallel , r and omized , open-label , phase 3 superiority trial , was conducted at 16 sites in Italy and enrolled 281 patients between October 2003 and January 2008 . The patients were premenopausal women with stage I through III breast cancer who were c and i date s for adjuvant or neoadjuvant chemotherapy .  Assuming a 60 % rate of early menopause in the group treated with chemotherapy alone , it was estimated that 280 patients had to be enrolled to detect a 20 % absolute reduction in early menopause in the group treated with chemotherapy plus triptorelin . The intention-to-treat analysis was performed by including all r and omized patients and using imputed values for missing data . INTERVENTIONS Before beginning chemotherapy , patients were r and omly allocated to receive chemotherapy alone or combined with triptorelin . Triptorelin was administered intramuscularly at a dose of 3.75 mg at least 1 week before the start of chemotherapy and then every 4 weeks for the duration of chemotherapy . MAIN OUTCOME MEASURE Incidence of early menopause ( defined as no resumption of menstrual activity and postmenopausal levels of follicle-stimulating hormone and estradiol 1 year after the last cycle of chemotherapy ) . RESULTS The clinical and tumor characteristics of the 133 patients r and omized to chemotherapy alone and the 148 patients r and omized to chem 
    Output:
    
( S ) Concurrent GnRH agonists with chemotherapy may not preserve ovarian function in women with breast cancer .
Furthermore , r and omized data are limited regarding fertility after concurrent use of GnRH agonists with chemotherapy