Use of a vaginal CO₂ laser for the management of genitourinary syndrome of menopause in gynecological cancer survivors: a systematic review

Genitourinary syndrome of menopause (GSM) may arise from the hypoestrogenism caused by ovarian function destruction following gynecological cancer treatments. GSM may also be present in menopausal women and its symptoms might be exacerbated by cancer treatments. Historically, patients with hormone-dependent gynecological cancer and physicians have been less comfortable using vaginal estrogen due to fear of recurrence. CO₂ vaginal laser therapies have demonstrated efficacy as a non-hormonal alternative for GSM treatment in healthy menopausal patients. The objective of this study was to evaluate the data on the effect of a CO₂ vaginal laser for the management of GSM in gynecological cancer patients. Databases searched included MEDLINE, Embase, PubMed, Cochrane and Google Scholar. Selected studies assessed use of a CO₂ vaginal laser in gynecological cancer patients with GSM. A total of 269 studies were retrieved. Four studies met the inclusion criteria. Each study followed a different type of CO₂ vaginal laser protocol for the management of GSM in gynecological cancer patients. There are no randomized controlled trials that assess the use of a CO₂ vaginal laser in gynecologic cancer patients. The number of published gynecological cancer patients treated with a CO₂ laser for the management of GSM is extremely limited (<i>N</i> 2 laser use to manage GSM in gynecologic cancer patients.绝经泌尿生殖综合征（Genitourinary syndrome of menopause, GSM）可由妇科癌症治疗后卵巢功能破坏引发的低雌激素血症所致。绝经女性亦可罹患该病，且癌症治疗可能加重其相关症状。既往，激素依赖性妇科癌症患者与临床医师均因担忧肿瘤复发，对阴道雌激素疗法的应用顾虑重重。二氧化碳（CO₂）阴道激光疗法已被证实可作为健康绝经患者GSM治疗的非激素替代方案，且疗效确切。本研究旨在评估CO₂阴道激光疗法用于妇科癌症患者GSM管理的相关疗效数据。本次研究检索的数据库包括MEDLINE、Embase、PubMed、Cochrane图书馆及Google Scholar。纳入的研究均评估了CO₂阴道激光疗法在合并GSM的妇科癌症患者中的应用效果。最终共检索到269项相关文献，其中4项符合本研究的纳入标准。每项研究所采用的CO₂阴道激光治疗方案均存在差异。目前尚无针对妇科癌症患者应用CO₂阴道激光疗法的随机对照试验。目前已发表的、采用CO₂激光管理GSM的妇科癌症患者相关病例数极为有限（<i>N</i> 2 laser use to manage GSM in gynecologic cancer patients.）