Division of Medical Oncology, and Department of Medicine, Ottawa Hospital Cancer Centre and University of Ottawa, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada.
Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Support Care Cancer. 2023 Jan 25;31(2):131. doi: 10.1007/s00520-023-07583-z.
The purpose of this systematic review update is to synthesize available data on management of genitourinary symptoms (GUS) in breast cancer patients, a common and challenging clinical scenario.
EMBASE, Ovid Medline, and the Cochrane Library were searched from September 2014 to December 2021 for randomized controlled trials which examined various interventions for GUS in breast cancer patients. Outcomes of interest included improvements in vaginal symptoms (e.g., dryness, pain, dyspareunia, itching), vaginal hormone response measured by validated scales (e.g., Vaginal Health Index, and Vaginal Maturation Index), and Female Sexual Function Index (FSFI). A team of reviewers participated in the processes of study selection, data collection, and risk of bias appraisal. A descriptive approach to synthesis was used.
Of 842 unique citations identified (412 from this update, 430 from previous review), eight studies (n = 539) met inclusion criteria. Interventions included 0.005% estriol gel (EG; n = 50), intravaginal testosterone (IVT; n = 21), intravaginal prebiotic (n = 13), hyaluronic acid (HA; n = 12), polyacrylic acid (PA; n = 25), pH-balanced gel (n = 118), Replens® (n = 24), and Lidocaine (n = 22). These were compared to placebo/saline/lubricants/usual care (n = 228). FSFI total score was significantly improved by all interventions except IVT and lidocaine, and not measured for Replens®. Significant improvements in vaginal hormone responses were reported for EG and pH-balanced gel; however, no significant effects were found for IVT, HA, or prebiotics. Vaginal symptoms were significantly improved by EG, IVT, PA, and PH-balanced gel.
Treatment of GUS remains a challenging issue. It is evident that more prospective trials are needed.
本系统评价更新的目的是综合现有数据，探讨乳腺癌患者泌尿生殖系统症状（GUS）的管理方法，这是一种常见且具有挑战性的临床情况。
我们于 2014 年 9 月至 2021 年 12 月在 EMBASE、Ovid Medline 和 Cochrane 图书馆中检索了关于各种干预措施治疗乳腺癌患者 GUS 的随机对照试验。感兴趣的结局包括阴道症状（如干燥、疼痛、性交困难、瘙痒）的改善、阴道激素反应的测量（如阴道健康指数和阴道成熟指数）以及女性性功能指数（FSFI）。一组评审员参与了研究选择、数据收集和偏倚风险评估过程。我们采用描述性方法进行综合分析。
在 842 篇独特的引用文献中（本次更新 412 篇，之前综述 430 篇），有 8 项研究（n=539，0.005%雌三醇凝胶[EG]组 50 例，阴道内睾酮[IVT]组 21 例，阴道内益生菌组 13 例，透明质酸[HA]组 12 例，聚丙烯酸[PA]组 25 例，pH 值平衡凝胶组 118 例，Replens®组 24 例，利多卡因组 22 例）符合纳入标准。这些干预措施与安慰剂/盐水/润滑剂/常规护理（n=228）进行了比较。除 IVT 和利多卡因外，所有干预措施均显著改善 FSFI 总分，且未对 Replens®进行测量。EG 和 pH 值平衡凝胶显著改善阴道激素反应；然而，IVT、HA 或益生菌对阴道激素反应没有显著影响。EG、IVT、PA 和 pH 值平衡凝胶显著改善阴道症状。
GUS 的治疗仍然是一个具有挑战性的问题。显然，需要更多的前瞻性试验。
Zotero 插件