Existe-t-il des arguments pour contre-indiquer une hormonotherapie substitutive apres traitement d'un adenocarcinome ovarien?

The hormonal status of 95% of the women treated for epithelial ovarian carcinoma is menopausal, either naturally or after treatment. This raises the important question of the hormonal replacement therapy (HRT) among these patients. Several retrospective studies have explored the potentiel positive or negative influence of HRT on the genesis of ovarian adenocarcinoma. Although somehow contradictory, these studies token all together fail to show any favouring nor protective role of HRT. In vitro, estrogens have been shown to induce the proliferation of ovarian cancer cell lines. On the opposite, progesterone and antiestrogens have antiproliferative effects. Both types of effects are mediated by intracellular steroid hormone receptors (ER, PgR). Although high dose progesterone derivatives and antiestrogens have been shown to obtain therapeutic responses in patients carrying advanced ovarian carcinoma, response rates were usually less than 20%, and no clinico- biological correlation (with ER, PgR status) could be demonstrated. There is therefore no evidence for a clinical significance of the presence of hormonal receptors in these tumors. A single retrospective study explored the possible influence of HRT on the prognosis of patients treated for ovarian carcinoma, and did not demonstrate any deleterious effect. This review of recent epidemiological, biological and clinical data fails to find any argument against the prescription of HRT in patients treated for ovarian adenocarcinoma, in the absence of other contra-indications.