Many patients with gynecologic tumors develop menopause and significant neuropsychiatric symptoms after surgery or radiation therapy. About 30%-40% of gynecologic tumors occur in the premenopausal or perimenopausal period. Rapid menopause produces significant symptoms, manifested as menopause, syndromes (e.g., vasodilatory syndrome, hot flashes, vaginal dryness, osteoporosis, insomnia, and psychiatric disorders), and a significant increase in the incidence of cardiovascular disease. Hormone replacement therapy (HRT) is the most effective treatment for menopausal syndromes. Whether HRT can be used in patients with gynecologic tumors after thorough treatment is still controversial. Some studies have shown that HRT can significantly improve symptoms, prevent cardiovascular disease and osteoporosis, and improve the quality of life of patients with menopausal syndrome compared with placebo treatment. However, some studies have also shown that HRT does not reduce the risk of cardiovascular disease. In theory, HRT has the risk of stimulating and activating quiescent residual tumor cells, so it should be used with greater caution in patients who have had gynecologic tumors. Based on the research results in recent years, we analyze the advantages and disadvantages of using HRT after treatment of various gynecological tumors, in order to guide the clinical rational application of HRT.Lu Yanda, Department of Radiotherapy, Affiliated Hospital of Hainan Medical College, Hainan, China. i. Endometrial cancer Endometrial cancer is a common gynecological malignant tumor, which most often occurs after the menopause, and about 25% of the patients occur in premenopause. The occurrence of endometrial cancer is related to estrogen, so it is often treated by removing both adnexa at the same time, and patients often develop menopausal syndrome after surgery. The safety of HRT was evaluated as early as 1986 by Creasman et al. Forty-seven patients with stage I endometrial cancer were treated with estrogen after surgery, applied for a mean of 26 months, and compared with 174 patients in a placebo-treated group. With a follow-up of 25-150 months, the recurrence rate was 2.1% in the estrogen-treated group of patients and 14.9% in the placebo-treated group, and estrogen therapy did not increase the risk of recurrence in patients with endometrial cancer. The results of some subsequent studies also showed that HRT after surgery in patients with early-stage endometrial cancer did not increase the rate of tumor recurrence or the incidence of other toxic side effects.In the double-blind trial of Barakat et al. 618 patients with early-stage endometrial cancer were treated with estrogen for up to 3 years after surgery, and the other 618 patients were treated with a placebo as a control, with a median follow up of 35.7 months, and the estrogen group had a median follow-up of 35.7 months. The recurrence rate and progression-free survival rate of the patients were 2.3% and 94.3%, respectively, and 1.9% and 95.6% in the control group, and the differences in the recurrence rate and progression-free survival rate of the two groups were not statistically significant (all P>0.05), and the recurrence rates were all very low. In 2009, Wright et al. conducted a multifactorial analysis of the prognosis of 3,000 endometrial cancer patients after treatment (including 402 patients with preserved ovaries). The results showed that treatment with estrogen had no significant effect on either tumor-specific or overall survival, and that preserving the ovaries did not increase the risk of tumor death in young patients, in early stage highly differentiated carcinomas, or in those who did not have suspicious lesions in the adnexa at surgery. In conclusion, we believe that the use of HRT in early endometrial cancer with obvious menopausal syndrome, especially in small doses for short-term use should be safe. II. Ovarian Cancer About 40% of ovarian cancers occur between the ages of 30 and 60. After surgery and chemotherapy, the occurrence of menopausal syndrome is common.Whether HRT increases the risk of recurrence of ovarian cancer is the key to determine the use of HRT. Synthesizing the literature in recent years, we found that HRT does not seem to increase the risk of ovarian cancer recurrence. There has been a study showing that 373 patients with ovarian cancer had undergone bilateral adnexal resection, of which 78 underwent postoperative HRT with a median follow-up of 42 months, and the differences in disease-free survival and overall survival between the patients in the HRT and non-HRT groups were not statistically significant (all P > 0.05). Those who were treated with postoperative chemotherapy for ovarian cancer and received HRT for up to 2 years or more did not have many ovarian cancer recurrences or progression, and the relative risk of death was not high, thus it was concluded that HRT had no effect on the survival rate of postoperative ovarian cancer.Guidozzi et al. reported that 130 patients with advanced ovarian cancer who underwent cytoreduction and chemotherapy were divided into estrogen-treated group and placebo group with a median followup of 4 years. The differences in progression-free survival and overall survival were not statistically significant (P>0.05).In 2006, Mascarenhas et al. retrospectively analyzed the prognosis of 799 patients (649 cases of ovarian cancer and 150 cases of junctional tumors) who had explicitly used HRT either before or after diagnosis, and the results showed that, in the case of junctional tumors, either the use of HRT either before or after diagnosis had no significant effect on the patients’ survival. Having used HRT before the diagnosis of ovarian cancer also did not affect the 5-year survival of patients (HR=0.83, 95% CI 0.65-1.08), whereas the 5-year survival of patients who used HRT after the diagnosis of ovarian cancer was better than that of those who used HRT before the diagnosis (HR=0.57, 95% CI 0.42-0.78), and the first 5-year mortality rate of patients with plasma cancers who used HRT after the operation was particularly lower (HR=0.69, 95% CI 0.48-0.98). However, there are different study findings. Mφrch et al. reported that 3,068 cases of ovarian cancer occurred in 909,946 perimenopausal and menopausal women who had not had hormone-related tumors and had not had a double adnexectomy in seven Danish disease registries, with an average follow-up of 8 years; the incidence of ovarian cancer in those who had not used hormone therapy versus those who had recently used hormone therapy was 0.4/1,000 person-years and 0.52/1,000 person-years, respectively; the incidence of ovarian cancer was higher with the time of discontinuing hormone use, the risk gradually decreased. Therefore, it is believed that hormone therapy will increase the risk of ovarian cancer. In an earlier study, Anderson et al. investigated 16,608 postmenopausal women without hysterectomy who were followed up for 5.6 years, and there was no significant increase in the risk of ovarian cancer among those who were treated with hormones (estrogen + progesterone) when compared with the placebo group (HR = 1.58, 95% CI 0.77-3.24); a Meta-analysis by Coughlin et al. also did not show that hormone therapy would increase the risk of ovarian cancer. Since there are not many studies on the effect of HRT on the development of ovarian cancer, according to the current limited information, the use of HRT after ovarian cancer will not significantly reduce the disease-free survival time and overall survival time, and it can be used for those who have obvious menopausal syndromes after surgery; however, it is not suitable for some hormone-dependent tumors, such as granulosa cell tumors of the ovary, etc. Cervical Cancer Cervical cancer is not a hormone-dependent tumor. Cervical cancer is not a hormone-dependent tumor. Not many cervical cancer metastasized to ovary, so many young patients with cervical adenocarcinoma often adopt surgery to preserve ovary. However, the rate of ovarian metastasis in cervical adenocarcinoma is relatively high, and both adnexa are often removed during surgery. There are few reports on the application of HRT after the treatment of official cervical cancer.Ploch et al. have reported that 120 patients with cervical cancer were divided into HRT group (80 cases) and non-HRT group (40 cases) after the treatment, comparing the effect of HRT on the recurrence rate of cervical cancer and 5-year survival rate. At 5 years of follow-up, the recurrence rates of the HRT and non-HRT groups were 20% and 32%, respectively, and the 5-year survival rates were 80% and 65%, respectively, and none of the differences were statistically significant (all P > 0.05). The results of Persson et al. showed that long-term use of HRT increased the risk of breast cancer but not cervical cancer.Lacey et al. administered a questionnaire to 124 patients with adenocarcinoma of the cervix, 139 patients with squamous carcinoma of the cervix, and 307 healthy women who were matched by age, ethnicity, and place of residence in order to investigate the effect of estrogen use on tumorigenesis. The results showed that those who had used estrogen did not have a significantly higher risk of developing adenocarcinoma of the cervix (OR=2.1, 95% CI 0.95-4.6) or squamous cervical cancer (OR=0.85, 95% CI 0.34-2.1). Thus, it seems that the use of HRT after treatment of cervical cancer, especially after treatment of squamous carcinoma of the official cervix, is safe. Breast cancer Some breast cancer patients are carriers of breast cancer susceptibility gene 1 (BRCA1) or BRCA2 mutation genes, and prophylactic adnexal resection for carriers of these genes can reduce the risk of breast cancer, ovarian cancer, fallopian tube cancer, and primary peritoneal carcinoma.The results of a comprehensive analysis of 10 papers by Rebbeck et al. showed that the use of HRT for carriers of BRCA1 or BRCA2 mutations could be reduced after ovariectomy. carriers of BRCA1 or BRCA2 mutation genes significantly reduced the risk of breast cancer recurrence after oophorectomy. While patients will rapidly develop menopausal syndromes after prophylactic oophorectomy, HRT can alleviate these symptoms, but some scholars are positive about whether HRT increases the risk of breast cancer. More research results show that the use of HRT after prophylactic oophorectomy in BRCA1 or BRCA2 mutation gene carriers does not prolong the survival time of the patients, but it can significantly improve the quality of survival of the patients.Eisen et al. also concluded that the use of hormone therapy in postmenopausal BRCA1 mutation gene carriers does not increase the risk of breast cancer, but rather reduces the risk, and the relative risk of no hormone use vs. The relative risk of hormone use was 0.58 versus 0.6, respectively, and the difference was not statistically significant (P > 0.05). Since HRT is the most effective method of treating menopausal syndrome due to oncological treatment, and since HRT also reduces the incidence of cardiovascular disease and osteoporosis, it will have no serious adverse effects on survivors of gynecological oncological treatments, especially for those with severe menopausal syndrome, and the risk of short-term estrogen replacement therapy is extremely low, but will result in a significant improvement in the quality of life of the patients. Although there are reports of an increased risk of tumors with estrogen use, most of the statistical evidence is weak or not statistically significant, so physicians and patients should weigh the pros and cons of hormone therapy to make the decision to use it. 2013-02-25 10:26 Source: Chinese Journal of Cancer Author: Gao Yongliang et al.