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Frauenheilkunde up2date 2021; 15(04): 303-316
DOI: 10.1055/a-1079-3763
Gynäkologische Onkologie

Hormonersatztherapie bei gynäkologischen Malignomen

Sabine Elisabeth Segerer
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Klimakterische Beschwerden betreffen viele Frauen nach gynäkologischen Malignomen, sei es infolge der Behandlung oder aber im Rahmen der natürlichen Alterung. Am wirksamsten ist die Hormonersatztherapie (HRT). Jedoch sind viele gynäkologische Malignome hormonabhängig, sodass sich hier häufig die Frage stellt, ob eine HRT überhaupt eingesetzt werden darf oder ob diese möglicherweise sogar das Rezidivrisiko steigert.
Kernaussagen

  • Eine HRT sollte bei Frauen nach einem Mammakarzinom nicht durchgeführt werden. Bei Versagen nichthormoneller Therapiemaßnahmen und erheblicher Einschränkung der Lebensqualität kann ein Einsatz im Einzelfall jedoch erfolgen.

  • Eine systemische HRT bzw. vaginale Östrogentherapie kann nach Ausschöpfung nichthormoneller Therapieoptionen und Risikoaufklärung der Patientin insbesondere bei Low-grade, early-stage Endometriumkarzinomen (FIGO I – II) bei Versagen nichthormoneller Alternativen erwogen werden.

  • Bei erheblicher Einschränkung der Lebensqualität kann eine HRT bei Frauen mit nicht serösem Ovarialkarzinom oder malignem Keimzelltumor in der Vorgeschichte durchgeführt werden.

  • Eine systemische oder vaginale HRT bei Vulva-, Vaginal- und Plattenepithelkarzinom der Zervix ist nicht kontraindiziert.

Schlüsselwörter

HRT - Mammakarzinom - Ovarialkarzinom - Endometriumkarzinom - Zervix- und Vulvakarzinom


Publikationsverlauf

Artikel online veröffentlicht:
24. August 2021

© 2021. Thieme. All rights reserved.

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  • Literatur

  • 1 Rossouw JE, Anderson GL, Prentice RL. et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Womenʼs Health Initiative randomized controlled trial. JAMA 2002; 288: 321-333
    CrossrefPubMedGoogle Scholar
  • 2 Chlebowski RT, Anderson GL, Aragaki AK. et al. Association of menopausal hormone therapy with breast cancer incidence and mortality during long-term follow-up of the Womenʼs Health Initiative randomized clinical trials. JAMA 2020; 324: 369-380
    CrossrefPubMedGoogle Scholar
  • 3 Collaborative Group on Hormonal Factors in Breast C. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet 2019; 394: 1159-1168
    CrossrefPubMedGoogle Scholar
  • 4 Morch LS, Hannaford PC, Lidegaard O. Contemporary hormonal contraception and the risk of breast cancer. N Engl J Med 2018; 378: 1265-1266
    PubMedGoogle Scholar
  • 5 Col NF, Kim JA, Chlebowski RT. Menopausal hormone therapy after breast cancer: a meta-analysis and critical appraisal of the evidence. Breast Cancer Res 2005; 7: R535-R540
    CrossrefPubMedGoogle Scholar
  • 6 Holmberg L, Anderson H, Steering H. et al. HABITS (hormonal replacement therapy after breast cancer-is it safe?), a randomised comparison: trial stopped. Lancet 2004; 363: 453-455
    CrossrefPubMedGoogle Scholar
  • 7 von Schoultz E, Rutqvist LE. Stockholm Breast Cancer Study Group. Menopausal hormone therapy after breast cancer: the Stockholm randomized trial. J Natl Cancer Inst 2005; 97: 533-535
    CrossrefPubMedGoogle Scholar
  • 8 Kenemans P, Bundred NJ, Foidart JM. et al. Safety and efficacy of tibolone in breast-cancer patients with vasomotor symptoms: a double-blind, randomised, non-inferiority trial. Lancet Oncol 2009; 10: 135-146
    CrossrefPubMedGoogle Scholar
  • 9 Baumgart J, Nilsson K, Stavreus-Evers A. et al. Urogenital disorders in women with adjuvant endocrine therapy after early breast cancer. Am J Obstet Gynecol 2011; 204: 26.e1-e7
    CrossrefPubMedGoogle Scholar
  • 10 Donders G, Neven P, Moegele M. et al. Ultra-low-dose estriol and Lactobacillus acidophilus vaginal tablets (Gynoflor®) for vaginal atrophy in postmenopausal breast cancer patients on aromatase inhibitors: pharmacokinetic, safety, and efficacy phase I clinical study. Breast Cancer Res Treat 2014; 145: 371-379
    CrossrefPubMedGoogle Scholar
  • 11 Kelly CM, Juurlink DN, Gomes T. et al. Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: a population based cohort study. Br Med J 2010; 340: c693
    CrossrefPubMedGoogle Scholar
  • 12 Stearns V, Beebe KL, Iyengar M. et al. Paroxetine controlled release in the treatment of menopausal hot flashes: a randomized controlled trial. JAMA 2003; 289: 2827-2834
    CrossrefPubMedGoogle Scholar
  • 13 Loprinzi CL, Sloan JA, Perez EA. et al. Phase III evaluation of fluoxetine for treatment of hot flashes. J Clin Oncol 2002; 20: 1578-1583
    CrossrefPubMedGoogle Scholar
  • 14 Carpenter JS, Storniolo AM, Johns S. et al. Randomized, double-blind, placebo-controlled crossover trials of venlafaxine for hot flashes after breast cancer. Oncologist 2007; 12: 124-135
    CrossrefPubMedGoogle Scholar
  • 15 Clayden JR, Bell JW, Pollard P. Menopausal flushing: double-blind trial of a non-hormonal medication. Br Med J 1974; 1: 409-412
    CrossrefPubMedGoogle Scholar
  • 16 Shan D, Zou L, Liu X. et al. Efficacy and safety of gabapentin and pregabalin in patients with vasomotor symptoms: a systematic review and meta-analysis. Am J Obstet Gynecol 2020; 222: 564-579.e12
    CrossrefPubMedGoogle Scholar
  • 17 Iversen L, Sivasubramaniam S, Lee AJ. et al. Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitionersʼ Oral Contraception Study. Am J Obstet Gynecol 2017; 216: 580.e1-580.e9
    CrossrefPubMedGoogle Scholar
  • 18 Chlebowski RT, Anderson GL, Sarto GE. et al. Continuous combined estrogen plus progestin and endometrial cancer: The Womenʼs Health Initiative Randomized Trial. J Natl Cancer Inst 2016; 108
    Google Scholar
  • 19 Barakat RR, Bundy BN, Spirtos NM. et al. Gynecologic Oncology Group Study. Randomized double-blind trial of estrogen replacement therapy versus placebo in stage I or II endometrial cancer: a Gynecologic Oncology Group Study. J Clin Oncol 2006; 24: 587-592
    CrossrefPubMedGoogle Scholar
  • 20 Shim SH, Lee SJ, Kim SN. Effects of hormone replacement therapy on the rate of recurrence in endometrial cancer survivors: a meta-analysis. Eur J Cancer 2014; 50: 1628-1637
    CrossrefPubMedGoogle Scholar
  • 21 Rees M, Angioli R, Coleman RL. et al. European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis. Maturitas 2020; 134: 56-61
    CrossrefPubMedGoogle Scholar
  • 22 Rao BR, Slotman BJ. Endocrine factors in common epithelial ovarian cancer. Endocr Rev 1991; 12: 14-26
    CrossrefPubMedGoogle Scholar
  • 23 Markman M, Iseminger KA, Hatch KD. et al. Tamoxifen in platinum-refractory ovarian cancer: a Gynecologic Oncology Group Ancillary Report. Gynecol Oncol 1996; 62: 4-6
    CrossrefPubMedGoogle Scholar
  • 24 Ramirez PT, Schmeler KM, Milam MR. et al. Efficacy of letrozole in the treatment of recurrent platinum- and taxane-resistant high-grade cancer of the ovary or peritoneum. Gynecol Oncol 2008; 110: 56-59
    CrossrefPubMedGoogle Scholar
  • 25 Gershenson DM, Bodurka DC, Coleman RL. et al. Hormonal maintenance therapy for women with low-grade serous cancer of the ovary or peritoneum. J Clin Oncol 2017; 35: 1103-1111
    CrossrefPubMedGoogle Scholar
  • 26 Eeles RA, Morden JP, Gore M. et al. Adjuvant hormone therapy may improve survival in epithelial ovarian cancer: Results of the AHT Randomized Trial. J Clin Oncol 2015; 33: 4138-4144
    CrossrefPubMedGoogle Scholar
  • 27 Metcalfe KA, Lynch HT, Ghadirian P. et al. The risk of ovarian cancer after breast cancer in BRCA1 and BRCA2 carriers. Gynecol Oncol 2005; 96: 222-226
    CrossrefPubMedGoogle Scholar
  • 28 Gordhandas S, Norquist BM, Pennington KP. et al. Hormone replacement therapy after risk reducing salpingo-oophorectomy in patients with BRCA1 or BRCA2 mutations; a systematic review of risks and benefits. Gynecol Oncol 2019; 153: 192-200
    CrossrefPubMedGoogle Scholar
  • 29 Ploch E. Hormonal replacement therapy in patients after cervical cancer treatment. Gynecol Oncol 1987; 26: 169-177
    CrossrefPubMedGoogle Scholar
  • 30 Lacey jr. JV, Brinton LA, Barnes WA. et al. Use of hormone replacement therapy and adenocarcinomas and squamous cell carcinomas of the uterine cervix. Gynecol Oncol 2000; 77: 149-154
    CrossrefPubMedGoogle Scholar
  • 31 Moss EL, Taneja S, Munir F. et al. Iatrogenic menopause after treatment for cervical cancer. Clin Oncol (R Coll Radiol) 2016; 28: 766-775
    CrossrefPubMedGoogle Scholar
  • 32 Bregar A, Taylor K, Stuckey A. Hormone therapy in survivors of gynecological and breast cancer. The Obstetrician & Gynecologist 2014; 16: 251-258
    CrossrefGoogle Scholar