Hormone replacement therapy for women previously treated for endometrial cancer

Edey, Katharine; Rundle, Stuart; Hickey, Martha

doi:10.1002/14651858.cd008830.pub3

Cited by 45 publications

(41 citation statements)

References 59 publications

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“…[7][8][9][10][11] Exogenous hormone replacement therapy may relieve these menopausal symptoms, but can also induce other complications. [12,13] Meta-analysis [14] and other research [4,5,15,16] on ovarian preservation surgery in young, premenopausal early stage endometrial cancer patients has produced conflicting results. Some studies claim that it is safer to remove the ovaries, although preservation of the ovary generally does not affect patient recurrence or survival.…”

Section: Characteristicsmentioning

confidence: 99%

The Survival Effect of Ovary Preservation in Early Stage Endometrial Cancer: A Single Institution Retrospective Analysis

Shin¹,

Park

Kang

et al. 2020

Preprint

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Purpose: We investigated the effect of ovary preserving surgery in early International Federation of Obstetrics and Gynecology (FIGO) stage endometrial cancer patients.Methods: Medical records were retrospectively reviewed for 539 patients who were diagnosed with early stage endometrial cancer between Jan 2006 and Dec 2017. Patients were categorized into ovary preservation and ovary removal groups. Demographics, recurrence free survival (RFS), and five-year overall survival (OS) rate were compared, and the clinical factors affecting survival were evaluated by univariate and multivariate analysis.Results: The median follow-up period was 85 months (range, 6-142 months), and the median age was 52.7 years. The mean age was higher in the ovary removal group than in the ovary preservation group (54.4 vs 40.94 years; P < 0.001). The ovary preservation group showed an earlier FIGO stage than the ovary removal group. (P = 0.0264). There was a greater incidence of adjuvant chemotherapy administration in the removal group. There were no statistical differences in other baseline characteristics.When comparing the RFS and OS rates, there were no statistical differences between the preservation and removal groups. (recurrence free rate 98.5% vs 92.7%, p = 0.4360, and 5-year survival rate 98.6% vs 93.0%, p = 0.0892, respectively). Endometrioid histology (p=0.006) and post-operative adjuvant chemotherapy (p=0.0062) were related to OS, and adjuvant chemotherapy (p<0.001) and radiotherapy (p=0.005) were related to RFSConclusions: Ovary preservation in early stage endometrial cancer is worth considering, as it does not affect survival in early stage endometrial cancer patients

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Section: Characteristicsmentioning

confidence: 99%

The Survival Effect of Ovary Preservation in Early Stage Endometrial Cancer: A Single Institution Retrospective Analysis

Shin¹,

Park

Kang

et al. 2020

Preprint

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“…In 2018 a Cochrane systematic review concluded that there is insufficient high‐quality evidence to inform women considering menopausal hormone therapy after treatment of endometrial cancer. However, the evidence does not suggest significant harm after surgical treatment for early‐stage disease based on FIGO classification 37. There is no information available regarding the use of menopausal hormone therapy in higher‐stage endometrial cancer.…”

Section: Introductionmentioning

confidence: 99%

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

Rees

Angioli

Coleman

et al. 2020

Int J Gynecol Cancer

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Worldwide, it is estimated that about 1.3 million new gynecological cancer cases are diagnosed each year. For 2018, the predicted annual totals were cervix uteri 569 847, corpus uteri 382 069, ovary 295 414, vulva 44 235, and vagina 17 600. Treatments include hysterectomy with or without bilateral salpingo-oophorectomy, radiotherapy, and chemotherapy. These can result in loss of ovarian function and, in women under the age of 45 years, early menopause. The aim of this position statement is to set out an individualized approach to the management, with or without menopausal hormone therapy, of menopausal symptoms and the prevention and treatment of osteoporosis in women with gynecological cancer. Our methods comprised a literature review and consensus of expert opinion. The limited data suggest that women with low-grade, early-stage endometrial cancer may consider systemic or topical estrogens. However, menopausal hormone therapy may stimulate tumor growth in patients with more advanced disease, and non-hormonal approaches are recommended. Uterine sarcomas may be hormone dependent, and therefore estrogen and progesterone receptor testing should be undertaken to guide decisions as to whether menopausal hormone therapy or non-hormonal strategies should be used. The limited evidence available suggests that menopausal hormone therapy, either systemic or topical, does not appear to be associated with harm and does not decrease overall or disease-free survival in women with non-serous epithelial ovarian cancer and germ cell tumors. Caution is required with both systemic and topical menopausal hormone therapy in women with serous and granulosa cell tumors because of their hormone dependence, and non-hormonal options are recommended as initial therapy. There is no evidence to contraindicate the use of systemic or topical menopausal hormone therapy by women with cervical, vaginal, or vulvar cancer, as these tumors are not considered to be hormone dependent.

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“…Between June 1997 and January 2003, a double‐blind, randomised trial to investigate whether estrogen replacement therapy was detrimental for patients with a history of endometrial cancer was undertaken . This study was the only one to be included in a recent systematic review . Women were included who had undergone total hysterectomy and BSO (± pelvic and para‐aortic lymphadenectomy) for stage I or II, grade 1, 2 or 3 endometrial adenocarcinoma.…”

Section: Endometrial Cancermentioning

confidence: 99%

“…29 This study was the only one to be included in a recent systematic review. 31 Women were included who had undergone total hysterectomy and BSO (AE pelvic and para-aortic lymphadenectomy) for stage I or II, grade 1, 2 or 3 endometrial adenocarcinoma. The aim was to recruit 2108 women, but the study closed prematurely following the announcement, in 2002, that the estrogen and progestogen arm of the Women's Health Initiative study was being stopped because of the risks of treatment 32 (conclusions that have since been retracted 33,34 ).…”

Section: Endometrial Cancermentioning

confidence: 99%

Hormone replacement therapy following treatment of gynaecological malignancies

Richardson

Ayres

Cust

et al. 2019

The Obstetric & Gynaecologis

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Key content Approximately 21 000 women in the UK were diagnosed with a gynaecological malignancy in 2015; although most of these malignancies occurred in postmenopausal women, 30–40% present in premenopausal or perimenopausal women. Management typically involves surgery and/or chemotherapy and/or radiotherapy, which in younger women may result in an induced menopause. Many women struggle with both the immediate symptoms and the long‐term consequences of estrogen deficiency, all of which are debilitating and compromise the quality and quantity of life, in addition to the cancer diagnosis and treatment. These patients represent a complex group and most units in the UK do not have easy access to menopause specialists. Gynaecologists may be reluctant to prescribe hormone replacement therapy (HRT) to these women; clinicians involved in the care of these women must appreciate when HRT is and is not contraindicated. Learning objectives To understand the safety of HRT in women who have undergone treatment for endometrial, ovarian, cervical, vulval or vaginal malignancies, with particular emphasis on the type, stage and grade of cancer. To establish an evidence‐based approach to the management of menopausal symptoms using HRT in women who have previously been treated for a gynaecological malignancy. To appreciate the role of non‐hormonal alternatives to HRT in these women. Ethical issues How to balance the known benefits of HRT against the potential risks, when evidence is limited in women who have undergone treatment for a gynaecological malignancy.

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Hormone replacement therapy for women previously treated for endometrial cancer

Cited by 45 publications

References 59 publications

The Survival Effect of Ovary Preservation in Early Stage Endometrial Cancer: A Single Institution Retrospective Analysis

The Survival Effect of Ovary Preservation in Early Stage Endometrial Cancer: A Single Institution Retrospective Analysis

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

Hormone replacement therapy following treatment of gynaecological malignancies

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