Zusammenfassung
Das Antiöstrogen Tamoxifen wird seit etwa 20 Jahren erfolgreich in der adjuvanten und palliativen Therapie des hormonrezeptorpositiven Mammakarzinoms eingesetzt.
Im Rahmen von randomisierten Studien wurde ein gehäuftes Auftreten von Endometriumkarzinomen unter der Tamoxifenbehandlung beobachtet, wobei das relative Risiko als zwischen 2 und 8fach erhöht beschrieben wurde. Die östrogene Aktivität am Endometrium kann zu pathologischen Veränderungen, wie z. B. Hyperplasien oder Karzinomen, führen. Der Nutzen einer adjuvanten Therapie mit Tamoxifen überwiegt jedoch gegenüber dem Risiko. Trotzdem verursacht die endometriale Wirkung der Substanz teilweise erhebliche Verunsicherung. In der folgenden Übersicht wird die Wirkungsweise von Tamoxifen auf das Endometrium erläutert. Eine Literaturübersicht stellt den derzeitigen Kenntnisstand zu den klinisch relevanten endometrialen Veränderungen und den praktischen Umgang mit Tamoxifenanwenderinnen dar.
Abstract
For about 20 years the antiestrogen tamoxifen is successfully used in the adjuvant and palliative treatment of estrogen receptor-positive breast cancer. Randomised trials showed an increased risk for the development of endometrial cancer related to tamoxifen. There is an 2 - 8fold increased relative risk. The estrogen-activity results in endometrial changes, like hyperplasia or carcinoma. On the contrary the benefit of tamoxifen in the adjuvant treatment overweighs its risks. Nevertheless the effects of the substance on the endometrium make patients feel uncomfortable. In this review we explain mechanisms of tamoxifens action on the endometrium. A review of literature shows the latest skills of clinical relevant endometrial changes and gives practical advice for the approach to patients using tamoxifen.
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Prof. Dr. med. Olaf Ortmann
Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Lübeck
Ratzeburger Allee 160
23538 Lübeck
Email: ortmann@medinf.mu-luebeck.de
