Ovarian suppression and its supplement by additive hormonal treatment.
5 conditions in breast cancer treatment are discussed: the place for primary castration, a comparison between ovariectomy and ovarian irradiation, the effect of ovarian irradiation in postmenopausal patients, corticosteroid suppression of the adrenal cortex as a supplement to castration, and substitution with anabolic steroids when both ovaries and adrenals are suppressed. The period of disease-free life in premenopausal patients has been shown to be prolonged by castration immediately after removal of the primary tumor. In a series of 117 premenstrual patients with a high risk of recurrences, the result was more favorable with radiological castration than with ovariectomy. Of 175 postmenopausal patients (average age, 60 years), in those treated with ovarian radiation after a natural menopause, the disease-free interval was increased 2.56 years and the crude survival time 1.6 years. It was noted that urinary excretion of both estrone and pregnanediol decreased after ovarian irradiation in naturally potmenopausal patients. Corticosteroid suppression of the adrenal corte x as a supplement to castration by irradiation seemed to delay the progression rate of the disease. However, due to side effects, this treatment is recommended only after recurrences are diagnosed. Substitution with anabolic steroids was investigated when both the ovaries and adrenal functions were suppressed. It is concluded that in vivo testosterone propionate, Durabolin, and Dianabol, in usual therapeutic doses, were all converted to estrogens. However, prednisone, cortisone, dromostanolone, and primobolan-depot were not con verted into estrogens which could be measured as urinary excretion of estrone. Therefore, primobolan-depot (Metenolone enanthate) has been used as an anabolic substitution for breast cancer patients who have had suppression of both their ovarian and adrenocortical functions. No tumor-stimulating effect has been observed. With moderate doses the virilizing effects have been tolerable.