Gynecological malignancies and hormonal therapies: Clinical management and recommendations

Table 1 Epithelial ovarian cancer

Ref.	Study design	HRT vs control	Stage	Type of HRT	Months HRT	Months follow up	Recurrence HRT vs controls	Study conclusions
Eeles et al[37]	Retrospective case-control	78/295	1-2: 55% 3-4: 45%	Oral Estrogen	Median 28	Median 42	-	No effects of HRT on prognosis
				Estrogen + Progestogen
				Estrogen + Tibolone
Guidozzi et al[12]	Randomized controlled trial	59/66	1-2: 27% 3-4: 73%	Conjugate Estrogen	28	Mean 42	32 vs 41	No effect of HRT on DFS and OFS
Bebar et al[36]	Retrospective cohort study	31/0	NS	Non-conjugated-Estrogen + Progestogen	Mean 25	Mean 55	3	No effect of HRT on progression of EOC
Ursic-Vrscaj et al[38]	Retrospective case-control	24/48	1-2: 54% 3-4: 46%	Non-conjugated-Estrogen	Mean 24	Mean 49	5 vs 15	No effect of HRT on survival
				Estrogen + Progestogen
				Estrogen + Tibolone
Mascarenhas et al[33]	Prospective cohort study	649 EOC	1-2: 60% 3-4: 40%	Estrogen	Up to 24	60	-	Better survival in HRT users vs non users
		150 BOT		Estrogen + Progestogen
Li et al[39]	Prospective cohort study	31/45	1-2: 28% 3-4: 72%	Conjugated-Estrogen + Progestogen	Mean 28.7	Mean 31.4	-	No effect of HRT on cumulative survival HRT improve quality of life

HRT: Hormone replacement therapy; EOC: Epithelial ovarian cancer; NS: Not specified; BOT: Borderline ovarian tumor; DFS: Disease free survival; OFS: Overall free survival.

Table 2 Endometrial cancer

Ref.	Study design	HRT vs control	Stage	Type of HRT	Months HRT	Months follow up	Recurrence HRT vs controls	Study conclusions
Creasman et al[58]	Retrospective case-control	47/174	1	Oral/Vaginal/Oral + Vaginal Estrogen	Mean 32	25-150	2 vs 15	Estrogen has a good effect on DFS an OS
Lee et al[59]	Case-control	44/99	1	Oral Estrogen	Median 64	24-84	0 vs 8	Estrogen are safe in low risk patients
Bryant[60]	Retrospective cohort	20	1-2	Conjugated Estrogen ± Depo Provera	12-132	42-168	NS	No recurrences in patients treated with HRT
Baker[61]	Retrospective cohort	31	NS	Oral/Vaginal/transdermal Estrogen		192	NS	No increase of recurrence or mortality in HRT users
Chapman et al[62]	Retrospective case-control	62/61	1-2	Oral/Vaginal Estrogen ± MPA 2.5 mg	Mean 49.1	Median 57.1	2 vs 8	No decreased DFI or increased recurrence in users vs non users in early stage
Suriano et al[63]	Retrospective cohort with matched controls	75/75	1-3	Oral Estrogen ± MPA 2.5 mg	Mean 83	Mean 83	2 vs 11	HRT ± Progestogen do not increate recurrence rate
Barakat et al[64]	Randomised double blind trial	618 vs 618	1-2	Oral Estrogen	Planned 36	Median 35.7	14 vs 12	Not completed. Low recurrence rate
Ayhan et al[65]	Prospective case-control	50/52	1-2	Conjugated Estrogen + Progesteron	Mean 49.1	Mean 49.1	0 vs 1	Postoperative HRT did not increase recurrence or death rate

HRT: Hormone replacement therapy; MPA: Medroxyprogesterone acetate; DFS: Disease free survival; OS: Overall survival; DFI: Disease free interval; NS: Not specified.

Table 3 Recommendations

Site	Tumour type	HRT
Ovary	EOC
	Endometrioid	No1
	Others	Yes
	Germ cell ovarian tumour	Yes
	Sex cord ovarian tumour	No
Uterus	Endometrial cancer
	Type 1	No1
	Type 2	No1
	Uterine sarcoma
	Endometrial stroma sarcoma	No
	Leiomyosarcoma	No
Cervix	Adenocarcinoma	No
	Squamous	Yes

¹To evaluate in a multidisciplinary team. HRT: Hormone replacement therapy; EOC: Epithelial ovarian cancer.