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阴道激光和局部治疗对乳腺癌患者外阴阴道萎缩症状的影响:一项系统评价和荟萃分析

Effect of Vaginal Laser and Topical Therapies on Vulvovaginal Atrophy Symptoms in Breast Cancer Patients: A Systematic Review and Meta-Analysis.

作者信息

Lőczi Lotti Lúcia, Vleskó Gábor, Éliás Máté, Turan Caner, Kajtár Panna, Tóth Réka, Sipos Miklós, Nagy Rita, Hegyi Péter, Ács Nándor, Várbíró Szabolcs, Keszthelyi Márton

机构信息

Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary.

Centre for Translational Medicine, Semmelweis University, 1082 Budapest, Hungary.

出版信息

J Clin Med. 2024 Oct 15;13(20):6131. doi: 10.3390/jcm13206131.


DOI:10.3390/jcm13206131
PMID:39458081
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11508551/
Abstract

: Vulvovaginal atrophy (VVA) significantly impacts the quality of life in breast cancer patients leading to symptoms like vaginal dryness, dyspareunia, and genital discomfort. Quality of life in this context is measured using validated scales like the Vaginal Health Index, Visual Analog Scale (VAS), and the Female Sexual Function Index (FSFI). : We performed a systematic review and meta-analysis to identify effective treatment options for VVA, including topical estrogen, systemic hormone therapy, vaginal DHEA, ospemifene, and non-hormonal methods like intravaginal laser therapy, moisturizers, and lubricants. A systematic search of four databases (MEDLINE, Scopus, CENTRAL, Embase) identified studies on VVA treatment efficacy in breast cancer patients, yielding 13,039 records, with 32 eligible studies and 8 included in the meta-analysis. : Significant improvements were found with intravaginal laser therapy, showing notable differences in the Vaginal Health Index (MD = 8.24, < 0.01), dyspareunia (MD = -4.82, = 0.05), and dryness (MD = -5.05, = 0.01). However, no significant changes were observed in FSFI and vaginal pH. Notably only intravaginal laser therapy was included in the meta-analysis, as other treatment options lacked comparable data. Both hormonal and non-hormonal treatments improved quality of life, with laser therapy showing the most substantial effects. : Intravaginal laser therapy is an effective treatment for VVA symptoms in breast cancer survivors, particularly in improving the Vaginal Health Index and reducing dyspareunia. Despite the strengths of the study, variability among studies, lack of RCT-s and data limitations, especially on long-term effects, present challenges.

摘要

外阴阴道萎缩(VVA)显著影响乳腺癌患者的生活质量,导致阴道干燥、性交困难和生殖器不适等症状。在这种情况下,生活质量通过诸如阴道健康指数、视觉模拟量表(VAS)和女性性功能指数(FSFI)等经过验证的量表来衡量。

我们进行了一项系统评价和荟萃分析,以确定VVA的有效治疗方案,包括局部雌激素、全身激素治疗、阴道脱氢表雄酮、奥培米芬以及非激素方法,如阴道内激光治疗、保湿剂和润滑剂。对四个数据库(MEDLINE、Scopus、CENTRAL、Embase)进行的系统检索确定了关于乳腺癌患者VVA治疗疗效的研究,共获得13039条记录,其中32项符合条件的研究,8项纳入荟萃分析。

阴道内激光治疗有显著改善,在阴道健康指数(MD = 8.24,P < 0.01)、性交困难(MD = -4.82,P = 0.05)和干燥(MD = -5.05,P = 0.01)方面显示出显著差异。然而,FSFI和阴道pH值未观察到显著变化。值得注意的是,荟萃分析中仅纳入了阴道内激光治疗,因为其他治疗方案缺乏可比数据。激素和非激素治疗均改善了生活质量,激光治疗效果最为显著。

阴道内激光治疗是乳腺癌幸存者VVA症状的有效治疗方法,尤其在改善阴道健康指数和减轻性交困难方面。尽管该研究有优势,但研究之间的变异性、缺乏随机对照试验以及数据限制,尤其是关于长期影响的数据限制,带来了挑战。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7f9/11508551/c18ce903c591/jcm-13-06131-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7f9/11508551/39e163ab6ebd/jcm-13-06131-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7f9/11508551/8e72e09f3a16/jcm-13-06131-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7f9/11508551/4f39d4fae39b/jcm-13-06131-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7f9/11508551/08843f20ed70/jcm-13-06131-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7f9/11508551/c18ce903c591/jcm-13-06131-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7f9/11508551/39e163ab6ebd/jcm-13-06131-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7f9/11508551/8e72e09f3a16/jcm-13-06131-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7f9/11508551/4f39d4fae39b/jcm-13-06131-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7f9/11508551/08843f20ed70/jcm-13-06131-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7f9/11508551/c18ce903c591/jcm-13-06131-g005.jpg

相似文献

[1]
Effect of Vaginal Laser and Topical Therapies on Vulvovaginal Atrophy Symptoms in Breast Cancer Patients: A Systematic Review and Meta-Analysis.

J Clin Med. 2024-10-15

[2]
Short-Term Efficacy and Safety of Non-Ablative Laser Treatment Alone or with Estriol or Moisturizers in Postmenopausal Women with Vulvovaginal Atrophy.

J Sex Med. 2022-5

[3]
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Bioengineering (Basel). 2023-10-2

[4]
Vaginal CO laser for the treatment of vulvovaginal atrophy in women with breast cancer: LAAVA pilot study.

Breast Cancer Res Treat. 2019-8-3

[5]
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Medicina (Kaunas). 2024-6-27

[6]
New Innovations for the Treatment of Vulvovaginal Atrophy: An Up-to-Date Review.

Medicina (Kaunas). 2022-6-6

[7]
Therapeutic Choices for Genitourinary Syndrome of Menopause (GSM) in Breast Cancer Survivors: A Systematic Review and Update.

Pharmaceuticals (Basel). 2023-4-6

[8]
Management of genitourinary syndrome of menopause in breast cancer survivors: An update.

World J Clin Oncol. 2022-2-24

[9]
Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause : A Systematic Review.

Ann Intern Med. 2024-10

[10]
Management of postmenopausal vulvovaginal atrophy: recommendations of the International Society for the Study of Vulvovaginal Disease.

Gynecol Endocrinol. 2021-8

本文引用的文献

[1]
Effect of Fractional Carbon Dioxide vs Sham Laser on Sexual Function in Survivors of Breast Cancer Receiving Aromatase Inhibitors for Genitourinary Syndrome of Menopause: The LIGHT Randomized Clinical Trial.

JAMA Netw Open. 2023-2-1

[2]
Genitourinary Syndrome of Menopause: Epidemiology, Physiopathology, Clinical Manifestation and Diagnostic.

Front Reprod Health. 2021-11-15

[3]
Vaginal laser therapy versus hyaluronic acid suppositories for women with symptoms of urogenital atrophy after treatment for breast cancer: A randomized controlled trial.

Maturitas. 2023-1

[4]
Assessment of the strength of recommendation and quality of evidence: GRADE checklist. A descriptive study.

Sao Paulo Med J. 2022

[5]
Management of genitourinary syndrome of menopause in breast cancer survivors: An update.

World J Clin Oncol. 2022-2-24

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Nat Med. 2021-8

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Culture and Sexual Medicine: A Road Map for Clinical Inquiry and Practice.

J Sex Med. 2021-9

[9]
The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.

BMJ. 2021-3-29

[10]
Microablative Fractional CO Laser for Vulvovaginal Atrophy in Women With a History of Breast Cancer: A Pilot Study at 4-week Follow-up.

Clin Breast Cancer. 2021-10

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