Učinak hormonske terapije na uznapredovali ili recidivirajući karcinom endometrija

Karcinom endometrija nastaje od stanica unutarnjeg sloja maternice. Većini žena s karcinomom endometrija dijagnoza se postavi dok je tumor još uvijek ograničen na tijelo maternice. Međutim, u oko 10% žena s karcinomom endometrija dijagnoza se postavi kad je bolest već uznapredovala, i ova skupina pacijentica ima mnogo lošiju prognozu za preživljenje.

Liječenje žena koje imaju uznapredovali ili recidivirajući (koji se ponovno javlja) karcinom endometrija veliki je izazov jer često pate i od drugih bolesti, a agresivna kemoterapija s ili bez kirurgije ne mora biti učinkovita, a može biti čak i štetna. Smatra se da je u ovim slučajevima hormonsku terapiju lakše primijeniti i da uzrokuje manje nuspojava nego sustavna kemoterapija, koja predstavlja standardno liječenje.

Svrha ovoga sustavnoga pregleda bila je procijeniti dostupnu literaturu o učinku hormonske terapije na preživljenje pacijenata s uznapredovalim ili redicivirajućim karcinomom endometrija. Pronađeno je 6 randomiziranih kontroliranih pokusa u kojima je procijenjen učinak hormonske terapije u različitim formama i kombinacijama na uzorku od 542 pacijentice. Analizom ovih istraživanja nije pronađeno dovoljno dokaza koji bi pokazali da hormonska terapija povećava preživljenje u pacijentica s uznapredovalim ili recidivirajućim karcinomom endometrija.

Glavno ograničenje ovoga sustavnoga pregleda bio je mali broj pacijentica uključenih u randomizirane kontrolirane pokuse, velike razlike između ispitanica i hormonskih lijekova koji su se analizirali, kao i činjenica da nijedno istraživanje nije analiziralo kvalitetu života ispitanica. Kvaliteta života s terapijom osobito je važna za stanja koja imaju lošu prognozu.

Zaključci autora: 

We found insufficient evidence that hormonal treatment in any form, dose or as part of combination therapy improves the survival of patients with advanced or recurrent endometrial cancer. However, a large number of patients would be needed to demonstrate an effect on survival and none of the included RCTs had a sufficient number of patients to demonstrate a significant difference. In the absence of a proven survival advantage and the heterogeneity of patient populations, the decision to use any type of hormonal therapy should be individualised and with the intent to palliate the disease. It is debatable whether outcomes such as quality of life, treatment response or palliative measures such as relieving symptoms should take preference over overall and PFS as the major objectives of future trials.

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Dosadašnje spoznaje: 

Endometrial cancer is a cancer of the lining of the womb and worldwide is the seventh most common cancer in women. Treatment with hormones is thought to be beneficial in patients with endometrial cancer.

Ciljevi : 

To assess the indications, effectiveness and safety of hormone therapy for advanced or recurrent epithelial endometrial cancer.

Način pretraživanja: 

We searched the Cochrane Gynaecological Cancer Group Trials Register, MEDLINE, EMBASE up to May 2009 and and CENTRAL (Issue 2, 2009). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies, and contacted experts in the field.

Kriteriji odabira: 

Randomised controlled trials (RCTs) that studied hormonal therapy in adult women diagnosed with advanced or recurrent endometrial cancer.

Prikupljanje i analiza podataka: 

Two review authors independently abstracted data and assessed risk of bias. Comparisons were restricted to single-trial analyses so we did not synthesise data in meta-analyses.

Ključni rezultati : 

We found six trials (542 participants) that met our inclusion criteria. These trials assessed the effectiveness of hormonal therapy in women with advanced or recurrent endometrial cancer as a single agent, as part of combination therapy and as low versus high dose. 

All comparisons were restricted to single-trial analyses, where we found no evidence that hormonal therapy as a single agent or as a combination treatment prolonged overall or five-year disease-free survival of women with advanced or recurrent endometrial cancer. However, low-dose hormonal therapy may have had a benefit in terms of overall and progression-free survival (PFS) compared to high-dose hormonal therapy (HR 1.31, 95% CI 1.04 to 1.66 and HR 1.35, 95% CI 1.07 to 1.71 for overall and PFS, respectively).

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