You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
American Society of Clinical Oncology recommendations on fertility preservation in cancer patients.
Abstract 1:
PURPOSE To develop guidance to practicing oncologists about available fertility preservation methods and related issues in people treated for cancer . METHODS An expert panel and a writing committee were formed . The questions to be addressed by the guideline were determined , and a systematic review of the literature from 1987 to 2005 was performed , and included a search of online data bases and consultation with content experts . RESULTS The literature review found many cohort studies , case series , and case reports , but relatively few r and omized or definitive trials examining the success and impact of fertility preservation methods in people with cancer . Fertility preservation methods are used infrequently in people with cancer . RECOMMENDATIONS As part of education and informed consent before cancer therapy , oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists . Clinician judgment should be employed in the timing of raising this issue , but discussion at the earliest possible opportunity is encouraged .  Sperm and embryo cryopreservation  are considered st and ard practice and are widely available ; other available fertility preservation methods should be considered investigational and be performed in centers with the necessary expertise . CONCLUSION Fertility preservation is often possible in people undergoing treatment for cancer . To preserve the full range of options , fertility preservation approaches should be considered as early as possible during treatment planning


Title 2:
Prevention of chemotherapy-induced menopause by temporary ovarian suppression with goserelin in young, early breast cancer patients.
Abstract 2:
BACKGROUND St and ard methods to prevent chemotherapy-induced early menopause in young , breast cancer patients are unavailable to date . Pre clinical data has suggested that luteinising hormone-releasing hormone ( LH-RH ) analogs given during treatment can decrease the gonado-toxicity induced by chemotherapy . This phase II study aim ed to assess the activity of such a method in young , breast cancer patients undergoing adjuvant chemotherapy . PATIENTS AND METHODS Premenopausal patients received the LH-RH analog goserelin 3.6 mg every 4 weeks before and during chemotherapy . According to two-stage optimal phase II Simon design , treatment was considered clinical ly interesting if it was able to prevent menopause in 19 out of 29 patients of the study population . The resumption of ovarian function was defined by a resumption of menstrual activity or by a follicle-stimulating hormone ( FSH ) value < or = 40 IU/l within 12 months after the last cycle of chemotherapy . RESULTS Thirty patients were enrolled and 29 were evaluable . Median age was 38 years ( range 29 - 47 ) . All but one patient received CEF regimen ( cyclophosphamide , epirubicin , 5-fluorouracil ) .  Resumption of menstrual activity was observed in 21 patients ( 72 % ; 95 % CI 52 % to 87 % ) and a FSH value < or = 40 IU/l in 24 patients ( 83 % ; 95 % CI 63 % to 93 % ) . Menses resumption was observed in 16 out of 17 patients ( 94 % ) with age < 40 years and in five out of 12 patients ( 42 % ) with age > or = 40 years . CONCLUSION Goserelin given before and during chemotherapy may prevent premature menopause in the majority of patients . The different success rate by age , however , indicates the need of a prospect i ve evidence of the efficacy of such a strategy


Title 3:
Goserelin as ovarian protection in the adjuvant treatment of premenopausal breast cancer: a phase II pilot study
Abstract 3:
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


Title 4:
Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression.
Abstract 4:
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


Title 5:
Ovarian protection with goserelin during adjuvant chemotherapy for pre-menopausal women with early breast cancer (EBC)
Abstract 5:
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 . Forty-five ( 90 % ) recovered menstruation during the first year of follow-up ; mean time to recovery 5 months . Eight pregnancies in 10 women attempting this so far . Conclusion : Using goserelin concurrently with chemotherapy is associated with a high rate of ovarian function preservation


Title 6:
Gonadotropin‐releasing hormone analogues added to adjuvant chemotherapy protect ovarian function and improve clinical outcomes in young women with early breast carcinoma
Abstract 6:
The objective of the current study was a retrospective evaluation of 100 consecutive premenopausal women with high‐risk , early breast carcinoma who received a gonadotropin‐releasing hormone ( Gn‐RH ) analogue as ovarian protection during adjuvant chemotherapy


Title 7:
Impact of breast cancer chemotherapy on ovarian reserve: a prospective observational analysis by menstrual history and ovarian reserve markers.
Abstract 7:
OBJECTIVE To determine whether addition of taxanes to anthracycline and cyclophosphamide regimens impact ovarian function as assessed by menstrual history and ovarian reserve markers . DESIGN Prospect i ve observational analysis . SETTING Large university fertility center . PATIENT(S ) Forty-five women with a history of breast cancer of stages I-IIIA who either received anthracycline , cyclophosphamide , and paclitaxel ( ACT ) or received anthracycline with cyclophosphamide ( AC ) .  INTERVENTION(S ) Menstrual histories were obtained at 6 months and at a mean of 28 months after chemotherapy . Early follicular phase FSH and E(2 ) sample s were obtained at the second follow-up . MAIN OUTCOME MEASURE(S ) Incidence of amenorrhea and abnormal laboratory values . RESULT ( S ) There was no statistically significant difference in the rates of amenorrhea at 6 months after chemotherapy ( AC group , 41.7 % ; ACT group , 29 % ) . At the second follow-up , a mean of 28 months after chemotherapy , there was a trend toward higher amenorrhea in the ACT patients ( 35.7 % , vs. 9.1 % in the AC group ) . When the ovarian markers were included , an additional eight menstruating patients were identified with abnormally elevated FSH or E(2 ) levels . CONCLUSION ( S ) We found no significant long- or short-term impact of taxanes on rates of amenorrhea . Future studies on the reproductive effects of chemotherapeutic agents should incorporate ovarian reserve markers , because menstrual history alone may underestimate the impact of these cytotoxic agents
( S ) At present , there are no high-level , evidence -based recommendations for preservation of fertility or of ovarian function in women with breast cancer .