Zusammenfassung
Patientinnen, die an einem Mamma‑, Endometrium- oder Ovarialkarzinom erkrankten und während adjuvanter Therapiemaßnahmen bzw. nach Abschluss der Primärbehandlung unter Symptomen bzw. Folgen einer natürlichen bzw. therapiebedingten Ovarialfunktionseinschränkung leiden, erwägen eine Hormonersatztherapie („hormone replacement therapy“ [HRT]). Da die Erkrankungen hormonabhängig sind, steigert eine HRT möglicherweise das Rezidivrisiko. Die Datenlage zur Beurteilung der onkologischen Sicherheit einer HRT nach den oben angeführten Malignomerkrankungen ist insgesamt unzureichend. Metaanalysen zeigen überwiegend keine Steigerung des Rezidivrisikos. Aufgrund der Anzahl der eingeschlossenen Patientinnen und anderer methodischer Schwächen sind die Studien jedoch unzureichend, um die Sicherheit einer HRT nach abgeschlossener onkologischer Therapie zu etablieren. Für die drei Malignome liegen jeweils auch randomisierte Studien vor, die bei einer HRT-Anwendung nach Mammakarzinom ein erhöhtes Rezidivrisiko ergaben, für das Endometriumkarzinom keine Risikosteigerung und für das Ovarialkarzinom sogar eine Verbesserung des Überlebens zeigten. Alle Studien haben jedoch eine Reihe von methodischen Schwächen, sodass die Sicherheit der HRT nach den genannten Malignomen unklar ist. Eine HRT nach Mamma‑, Endometrium- oder Ovarialkarzinomerkrankung ist daher grundsätzlich kontraindiziert. Bei ausgeprägter Beeinträchtigung der Lebensqualität durch klimakterische Symptome kann sie im Einzelfall nach entsprechender Aufklärung durchgeführt werden.
Abstract
Patients with breast, endometrial or ovarian cancer who experience ovarian insufficiency during adjuvant treatment or after conclusion of primary treatment and suffer from symptoms or sequelae of a natural or treatment-related impairment of ovarian function, should consider the use of hormone replacement therapy (HRT). Since these diseases are endocrine-dependent, HRT could possibly increase the risk of recurrence. The evidence on assessment of the oncological safety of HRT after the gynecological cancers previously mentioned is overall insufficient. Meta-analyses have predominantly not shown an increase in the risk for relapse during or after HRT; however, due to the low number of patients included in most studies and methodological weaknesses, these studies are insufficient to establish the safety of HRT after completion of oncological treatment. Randomized controlled trials of breast cancer survivors have shown an increased risk for relapse when HRT was used. This was not the case when HRT was given after endometrial cancer and for ovarian cancer a randomized controlled trial even demonstrated improved survival among HRT users; however, all of these studies have a number of methodological limitations and are therefore insufficient to demonstrate safety. Therefore, HRT after breast, endometrial and ovarian cancer cannot be recommended. In cases of severe impairment of quality of life due to climacteric symptoms, HRT can be used in selected cases after appropriate counselling.
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O. Ortmann, Regensburg
L. Kiesel, Münster
Erstveröffentlichung in Gynäkologische Endokrinologie (2019): https://doi.org/10.1007/s10304-019-00296-9.
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Ortmann, O., Emons, G. & Tempfer, C. Hormonersatztherapie nach hormonabhängigen Krebserkrankungen gemäß S3‑Leitlinie. Gynäkologe 53 (Suppl 2), 156–160 (2020). https://doi.org/10.1007/s00129-020-04569-4
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DOI: https://doi.org/10.1007/s00129-020-04569-4