The Effect of Hormone Replacement Therapy on Osteoporosis Following Irradiation of Gynecologic Cancer Patients / 부인종양

ABSTRACT

OBJECTIVE: This article is based on gynecologic cancer patients who were treated with radiation-therapy. The postmenopausal symptoms and osteporotic change and it's deterioration before and after these treatments were investigated. We represent the effect of appropriate medication for these patients. METHODS: Patients who were diagnosed as cervical cancer, endometrial cancer and ovarian cancer and hospitalized for their treatment in department of gynecology in Ajou Medical Center were selected. Before the treatment, Kupperman's index and bone mineral density of lumbar spine were checked. After the treatment, we divided the patients into 2 groups; a group of patients who were medicated with premarin, tibolone and raloxifen and a control group who were non-medicated. And these groups were reexamined Kupperman's index and bone mineral density of lumbar spine. And then effect on radiation-therapy and result of hormone therapy were analyzed. RESULTS: This study was based on total 63 patients; 47 (74.6%) patients were medicated and 16 (25.4%) patients were not medicated, for hormone therapy used. The average age of patients was 49.6 years old for medicated and 51.2 years old for non-medicated showing no significant differences. The mean period of medication of was 6-30 months. Comparing one group who's treated with radiation-therapy to the other group who's not treated with radiaton-therapy, decrease in BMD and T-score was noted, but statistically not significant (p=0.309, p=0.107). Comparing hormone treated group to control group, the BMD after medication was from 0.89 g/cm2 to 0.91 g/cm2, that of T-score was -1.48 from -1.68, and for the control group, BMD was from 0.91 g/cm2 to 0.96 g/cm2 and that of T-score was from -1.16 to -1.53. This indicates that osteoporotic change was turning in favor in hormone treated group. Especially, for the menopausal women who were treated with radiation-therapy, hormone replacement therapy was proved to be effective. In addition, medicated and non-medicated group showed significant difference in Kupperman's index which account for change in postmenopausal symptom. DISCUSSION: Gynecologic cancer generally occurs in 40-50 years at times when postmenopausal symptom and osteoporotic change begin to appear. In case of patients who're treated with radiation-therapy, this phenomenon is likely to happen much faster. Nowadays, as the average life expectancy becomes longer owing to development of cancer therapy, we suggest a method which improves quality of life, that is taking osteoporosis exam at regular interval and appropriate hormone therapy when needed after radiation-therapy.