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Hormone Replacement Therapy After Gynaecological Cancers
and the study was closed prematurely after it became clear that the surgery. Disease-free survival was similar in both groups, as was the
accrual goal of 2,108 patients could not be reached in a reasonable RR of death (RR 0.73, 95% CI 0.44–1.20). Ursic-Vrscaj et al.
16
amount of time. Data have been calculated on the initial 1,236 compared every patient with ovarian cancer at stage I–III treated
assessable patients; eligible patients were allocated to HRT or with oestrogen with two non-treated patients at the same stage of
placebo after surgery. Treated and placebo group patients had similar disease; the disease-free and overall survival rates were similar in
general and tumour characteristics. The recurrence rate was 2.3% the two groups. Guidozzi and Daponte
17
published a randomised
(14/251) in the ORT group and 1.9% (12/305) in the placebo group, clinical trial comprising 59 ovarian cancer patients treated with
with a relative risk (RR) of recurrence or death of 1.27 (95% confidence oestrogens for a median period of four years and 66 untreated
interval [CI] 0.916–1.77) in the ORT group. Although conclusions on the women, and showed a non-significant difference in prognosis
safety of oestrogen administration in EC survivors could not be drawn between the two groups.
because of the premature interruption of the trial, the recurrence rate
in the group of patients treated with oestrogens was very low. The results of these clinical studies are also supported by the
observation that pregnancy and the use of oral contraceptives reduce
In 2006, Ayhan et al.
9
published a case-control study to prospectively the risk of ovarian cancer, and in women with stage I disease treated
evaluate the effect of immediate HRT on the oncological outcome of with unilateral oophorectomy the recurrence rate is not increased
patients with EC. Patients were prospectively recruited after extensive compared with women treated with bilateral oophorectomy.
discussion of the risks and benefits of HRT. A continuous daily Furthermore, there are no experimental data to support the
regimen of 0.625mg conjugated equine oestrogen plus 2.5mg hypothesis that oestrogens may stimulate quiescent epithelial
medroxyprogesterone acetate was initiated four to eight weeks after ovarian cancer (EOC) cells, and there is no evidence of a clinical role
surgery. Overall, 50 patients received HRT. There was no significant of the hormonal receptors in EOCs.
18
difference in terms of prognostic factors between the HRT users and
the control group. Seven patients (14%) stopped using HRT; of these, Mascarenas et al.
19
recently published a case-control study
only two stopped the therapy before 24 months. All of the remaining conducted in Sweden to examine whether the use of HRT before or
women used HRT for at least 24 months, with a mean value of 49.1 after diagnosis of ovarian cancer affects five-year survival. After five
months. No survival comparison was performed between these two years of follow-up, 45% of the patients with EOC and 93% of the
groups because of the low number of events, but it was observed that patients with borderline ovarian tumours (BOTs) were alive. For
the early use of HRT did not increase the recurrence rate. women with BOT, there were no associations between HRT use before
or after diagnosis and survival. There was no overall difference in five-
Currently, no conclusive data are available to support specific year EOC survival according to HRT use before diagnosis (hazard ratio
recommendations regarding the use of HRT in EC patients. Most of the [HR] 0.83, 95% CI 0.65–1.08), except for serous EOC, for which there is
authors
10
suggest that HRT may be used in symptomatic women and a protective effect (HR 0.69, 95% CI 0.48–0.98). Analyses of different
that doctors should base their treatment choice on the perceived HRT preparations, duration and recency of use did not reveal any
risks and benefits for each individual patient. variations in the pattern of survival. A better survival for EOC patients
who used HRT after diagnosis was observed (HR 0.57, 95% CI
Ovarian Cancer 0.42–0.78). This study demonstrated that HRT use prior to diagnosis of
Most ovarian epithelial tumours appear in women over 55 years of EOC does not affect five-year survival, while it appeared to show a
age; however, when the disease occurs in pre-menopausal age, the possible slight survival advantage in serous EOC.
radical surgical treatment induces premature menopause. Irrespective
of age, disease prognosis is poor, and fewer than 40% of patients with As far as we know, there is nothing to show that HRT should not be
stage III–IV tumours survive over five years after diagnosis. Thus, even used in women treated for EOC, irrespective of tumour stage.
if long-term prevention of osteoporosis or cardiovascular disease is
not significant in these patients, it is of great importance to guarantee Breast Cancer
a good quality of life. Breast cancer incidence is increasing worldwide, while its mortality is
decreasing due to early diagnosis and therapeutic advances. Hot
Many physicians
11
are reluctant to prescribe HRT to ovarian cancer flushes, night sweats, vaginal atrophy and osteoporosis are the most
patients, fearing it may increase the risk of recurrence and decrease important problems related to menopause and are particularly
overall survival by promoting tumour progression or stimulating severe for younger women forced to premature menopause.
20
angiogenesis. Data on HRT use in healthy menopausal women and the Traditionally, HRT has been viewed as contraindicated in women with
risk of ovarian cancer are inconclusive. Two meta-analyses reached a history of breast cancer due to a fear of reactivating occult
different results; one shows no increase in the RR of ovarian cancer disease.
21
In the past few years, several clinical trails have failed to
in women taking HRT (RR 1.1, 95% CI 0.9–1.3),
12
while worldwide the demonstrate an increased recurrence or death rate correlated with
other shows a fairly small but significant increase in risk (RR 1.15, 95% HRT use after surgery for breast cancer. However, the limitations of
CI 1.05–1.27), correlated with the duration of use (RR 1.27, CI 95% these studies were the small number of cases, the short period of
1.00–1.61 for more than 10 years of use).
13
However, no significant follow-up, the retrospective design and the lack of a control
association was found in the WHI randomised, placebo-controlled trial group.
22–29
The Consensus Conference of Charlotteville in 1997
(RR 1.58, CI 95% 0.77–3.24).
14
concluded that before offering HRT to patients alternative treatment
options should be prescribed, and that HRT should be reserved for
There are only a few studies on HRT use in ovarian cancer survivors. women who do not respond to other treatments or, specifically
Eeles et al.
15
compared 78 women treated with oestrogens with 78 request HRT for short treatment periods at a low dosage and
controls; the treatment started a median of four months after preferably within controlled clinical trials.
30
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