Цель работы – провести системный анализ имеющихся результатов исследований, посвященных возможности использования менопаузальной гормональной терапии (МГТ) у пациенток, благополучно завершивших лечение рака эндометрия (РЭ).
Материалы и методы. В обзор включены данные зарубежных статей, опубликованных в PubMed и Medline, и отечественных работ, помещенных на elibrary.ru, за последние 40 лет. Результаты. Полученные результаты позволяют рассмотреть МГТ в качестве самостоятельного метода медицинской реабилитации женщин, перенесших РЭ. Должен быть установлен четкий профиль больных, позволяющий использовать данный метод, со строгим соблюдением мониторирования состояния здоровья. Заключение. Пациентки, успешно завершившие лечение РЭ, требуют создания особых условий реабилитации в интересах поддержания здоровья и качества жизни и должны находиться под пристальным вниманием врача. Аргументированные подходы к назначению МГТ у таких пациенток позволят избежать осложнений, связанных с дефицитом эстрогенов после хирургического, лучевого с или без системного (цитостатического) методов лечения. Ключевые слова: менопаузальная гормональная терапия, системная (цитостатическая) терапия, рак тела матки, рак эндометрия, гормональная терапия эстрогенами, климактерический синдром, реабилитация.
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The aim of the work is to conduct a systematic analysis of the available research results on the possibility of using menopausal hormone therapy (MHT) in patients who successfully completed the treatment of endometrial cancer (EC). Materials and methods. The review includes data from foreign articles published in PubMed and Medline, and domestic works published on elibrary.ru over the past 40 years. Results. The results obtained allow us to consider MHT as an independent method of medical rehabilitation for women who have undergone EC. A clear patient profile should be established, allowing the use of this method, with strict adherence to health monitoring. Conclusion Patients who have successfully completed the treatment of EC require the creation of special rehabilitation conditions in the interests of maintaining health and quality of life and should be under the close attention of the doctor. Argumented approaches to the appointment of MHT in such patients will avoid complications associated with estrogen deficiency after surgery, radiation with or without systemic (cytostatic) treatment methods. Key words: menopausal hormone therapy, systemic (cytostatic) therapy, uterine cancer, endometrial cancer, estrogen hormone therapy, menopausal syndrome, rehabilitation.
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21. Creasman WT, Henderson D, Hinshaw W. Estrogen replacement therapy in the patient treated for endometrial cancer. Obstet Gynecol 1986; 67: 326–30.
22. Lee RB, Burk TW, Park RC. Estrogen replacement therapy following treatment for stage I endometrial carcinoma. Gynecol Oncol 1990; 36: 189–91.
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1. Kaprin A.D., Starinskii V.V., Petrova G.V. Zlokachestvennye novoobrazovaniia v Rossii v 2016 g. (zabolevaemost' i smertnost'). M.: MNIOI im. P.A.Gertsena – filial FGBU "NMITs radiologii' Minzdrava Rossii, 2018. [in Russian]
2. Dumanovskaia M.R., Chernukha G.E., Burmenskaia O.V. i dr. Veroiatnost' neoplasticheskoi transformatsii pri razlichnykh tipakh giperplazii endometriia. Akusherstvo i ginekologiia. 2013; 8: 56–62. [in Russian]
3. Abbaszadegan MR, Asadzadeh Aghdayi H, Rastin F. Microsatellite Instability in Young Women with Endometrioid type Endometrial Cancer. Iranian J Publ Health 2009; 38 (3): 24–30.
4. Colombo N, Creutzberg C, Amant F, Bosse T. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol 2016; 27: 16–41. DOI: 10.1093/annonc/mdv484
5. Prakticheskie rekomendatsii "Rak tela matki i sarkomy matki' RUSSCO. 2017; s. 172. [in Russian]
6. Nechushkina V.M., Den'gina N.V., Kolomiets L.A. i dr. Prakticheskie rekomendatsii po lekarstvennomu lecheniiu raka tela matki i sarkomy matki RUSSCO. 2017; s. 169. [in Russian]
7. FIGO Annual Report on the Results of Treatment in Gynecological Cancer. International J Gynecol Obstet 2006; 95 (Suppl. 1): 262.
8. Kleine W, Maier T, Geyer H, Pfleiderer A. Estrogen and progesterone receptors in endometrial cancer and their prognostic relevance. Gynecol Oncol 1990; 38 (1): 59–65.
9. Shabani N, Kuhn C, Kunze S. Prognostic significance of oestrogen receptor alpha (ERalpha) and beta (ERbeta), progesterone receptor A (PR-A) and B (PR-B) in endometrial carcinomas. Eur J Cancer 2007; 43: 2434–44.
10. Peterson HB, Lee NC, Rubin GL. Genital neoplasia. In Menopause: Physiology and Pharmacology. Edited by DR Mishell. Chicago: Yearbook Medical Publishers, Inc, 1987; p. 275–98.
11. Shapiro S, Kelly JP, Rosenberg L. Risk of localized and widespread endometrial cancer in relation to recent and discontinued use of conjugated estrogens. N Engl J Med 1985; 313: 969–72.
12. Shiff I, Sela HK, Cramer D. Endometrial hyperplasia in women on cyclic or continuous estrogen regimens. Fertil Steril 1982; 37: 79–82.
13. Gambacciani M, Monteleone P, Sacco A, Genazzani AR. Hormone replacement therapy and endometrial, ovarian and colorectal cancer. Best Practice Res Clin End Met 2003; 17 (1): 139–47.
14. Schwartzbaum JA, Hulka BF, Fowler WC et al. The influence of exogenous estrogen use on survival after diagnosis of endometrial cancer. Am J Epidemiol .1987.126:851-860.
15. Gambrell RD, Massey FW, Castaneda TA. Use of the progestogen challenge test to reduce the risk of endometrial cancer. Obstet Gynecol 1980; 55: 732–8.
16. Beral V, Bull D, Reeves G. Million Women Study Collaborators. Endometrial cancer and hormonereplacement therapy in the Million Women Study. Lancet 2005; 365 (9470): 1543–51.
17. Grady D, Gebretsadik T, Kerlikowske K. Hormone replacement therapy and endometrial cancer risk: a meta-analysis. Obstet Gynecol 1995; 85: 304–13.
18. Writing Group for the Women’s Health Initiative Investigators, Risks and benefits of estrogen plus progestin in healthy post-menopausal women: principal results from the Women’s Health Initiative randomized controlled trial. J Am Med Assoc 2002; 288: 321–33.
19. Brinton LA, Lacey JV, Trimble EL. Hormones and endometrial cancer – new data from the Million Women Study. Lancet 2005; 365 (9470): 1517–8.
20. Gunderson CC, Fader AN, Carson KA, Bristow RE. Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review. Gynecol Oncol 2012; 125: 477.
21. Creasman WT, Henderson D, Hinshaw W. Estrogen replacement therapy in the patient treated for endometrial cancer. Obstet Gynecol 1986; 67: 326–30.
22. Lee RB, Burk TW, Park RC. Estrogen replacement therapy following treatment for stage I endometrial carcinoma. Gynecol Oncol 1990; 36: 189–91.
23. Baker DP. Estrogen-replacement therapy in patients with previous endometrial carcinoma. Compr Ther 1990; 16 (1): 28–35.
24. Bryant GW. Administration of estrogen to patients with a previous diagnosis of endometrial adenocarcinoma (Letter). South Med J 1990; 83: 725–6.
25. Suriano KA, McHale M, McLaren CE et al. Estrogen replacement therapy in endometrial cancer patients: a matched control study. Obstet Gynecol 2001; 97: 955–60.
26. Barakat RR, Brundy BN, Spirtos NM et al. Randomized double-blind trial of estrogen replacement therapy versus placebo in stage I or II Endometrial cancer: a Gynaecologic Oncology Group study. J Clin Oncol 2006; 24: 587–92.
27. Ayhan A, Taskiran C, Simsek S, Sever A. Does immediate hormone replacement therapy affect the oncologic outcome in endometrial cancer survivors? Int J Gynecol Cancer 2006; 16: 805–8.
28. Levgur M. Estrogen and combined hormone therapy for women after genital malignancies: a review. J Reprod Med 2004; 49 (10): 837–48.
29. 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 (9): 1628–37. DOI: 10.1016/j.ejca.2014.03.006
30. Angioli R, Luvero D, Armento G, Capriglione S. Hormone replacement therapy in cancer survivors: Utopia? Crit Rev Oncol Hematol 2018; 124: 51–60. DOI: 10.1016/j.critrevonc.2018.02.005
31. Ul'rikh E.A., Urmancheeva A.F. Onkologicheskie aspekty zamestitel'noi menopauzal'noi gormonal'noi terapii. Praktich. onkologiia. 2009; 10 (2): 76–83. [in Russian]
32. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Uterine Neoplasms Version 1. 2018.
33. Hancke K, Foeldi M, Zahradnik HP, Gitsch G. Estrogen replacement therapy after endometrial cancer: a survey of physicians' prescribing practice Gilbert & D. Denschlag J Climacteric 2010; 13 (3): 271–7.
34. Baber RJ, Panay N, Fentonthe A. IMS Writing Group. IMS Recommendations on women’s midlife health and menopause hormone therapy. http://www.tandfonline.com/loi/icmt20
35. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause 2017; 24 (7): 728–53.
36. Quereux C, Pornel B, Bergeron C, Ferenczy A. Continuous combined hormone replacement therapy with 1mg 17b-oestradiol and 5mg dydrogesterone (Femoston-conti): endometrial safety and bleeding profile. Maturitas 2006; 53: 299–305.
37. Bergeron C, Ferenczy A. Endometrial safety of continuous combined hormone replacement therapy with 17b-oestradiol (1 or 2 mg) and dydrogesterone. Maturitas 2001; 37: 191–9.
38. Bergeron C, Nogales FF, Rechberger T et al. Ultra low dose continuous combined hormone replacement therapy with 0.5mg 17b-oestradiol and 2.5 mg dydrogesterone: Protection of the endometrium and amenorrhoea rate. Maturitas 2010; 66: 201–5.
39. Stevenson JC, Panay N, Pexman-Fieth C. Oral estradiol and dydrogesterone combination therapy in postmenopausal women: Review of efficacy and safety. Maturitas 2013; 76: 10–21.
40. Kuznetsov M.R., Papysheva O.V. Menopauzal'naia gormonal'naia terapiia i sosudistye sobytiia: kakova vzaimosviaz'? Doktor.Ru. 2018; 10 (154): 57–61. [in Russian]
41. Menopauza i klimaktericheskoe sostoianie u zhenshchiny. Klinicheskie rekomendatsii ROAG. 2016. [in Russian]
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*aluckyone777@gmail.com
1. V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Akademika Oparina, d. 4;
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4. V.A.Almazov National Medical Research Center of the Ministry of Health of the Russian Federation. 197341, Russian Federation, Saint Petersburg, ul. Akkuratova, d. 2
*aluckyone777@gmail.com