МЕНОПАУЗАЛЬНАЯ ГОРМОНОТЕРАПИЯ У ОНКОГИНЕКОЛОГИЧЕСКИХ БОЛЬНЫХ
PDF

Ключевые слова

МЕНОПАУЗАЛЬНАЯ ГОРМОНОТЕРАПИЯ
ОНКОГИНЕКОЛОГИЧЕСКИЕ ПАЦИЕНТЫ

Как цитировать

Новикова, О., Ульрих, Е., Носов, В., & Чархифалакян, А. (2017). МЕНОПАУЗАЛЬНАЯ ГОРМОНОТЕРАПИЯ У ОНКОГИНЕКОЛОГИЧЕСКИХ БОЛЬНЫХ. Вопросы онкологии, 63(6), 843–854. https://doi.org/10.37469/0507-3758-2017-63-6-843-854

Аннотация

Представлен обзор отечественных и зарубежных публикаций по сохраняющей дис-куссионность онкологической безопасности использования менопаузальной гормонотерапии после лечения рака эндометрия, шейки матки, пограничных и злокачественных опухолей яичников, различных вариантов сарком матки, рака вульвы и влагалища. По мнению авторов обзора, отказ в назначении менопаузальной гормонотерапии пациенткам с онкогинекологическими заболеваниями в анамнезе обычно не обоснован, категория больных, которым заместительная гормонотерапия противопоказана, хорошо описана и упоминается в тексте. В остальных случаях половые гормоны могут применяться для лечения менопаузальных симптомов и улучшения качества жизни пациенток.

https://doi.org/10.37469/0507-3758-2017-63-6-843-854
PDF

Библиографические ссылки

Каприн А.Д., Старинский В.В., Петрова Г.В. Злокачественные новообразования в России в 2014 году (заболеваемость и смертность). - М., 2016. - 250 с.

Сметник В.П. Медицина климактерия. - М, 2006. - 847 с.

Ульрих Е.А., Урманчеева А.Ф. Онкологические аспекты заместительной менопаузальной гормональной терапии // Практ онкол. - 2009. - Т. 10. - № 2. - С. 76-83.

Урманчеева А.Ф. Бурнина М.М., Ульрих Е.А. Онкологические проблемы заместительной менопаузальной гормонотерапии / Лекции по фундаментальной и клинической онкологии/ под ред. В.М. Моисеенко, А.Ф. Урманчеевой, К.П. Хансона. - Санкт-Петербург: Издательство Н-Л, 2004. - 704 с.

Урманчеева А.Ф., Бурнина М.М. Заместительная гормонотерапия и злокачественные опухоли // Журн. акуш. и жен. бол. - 2000. - Т. XLIX. - № 1. - С. 58-62.

Урманчеева А.Ф., Михайлюк Г.И., Ульрих Е.А Заместительная гормональная терапия в реабилитации больных раком эндометрия после радикального лечения // журнал акушерства и женских болезней. - 2004. - Т. LIII. - № 4. - С. 53-58.

Amant F., De Knijf A., Van Calster B. et.al. Clinical study investigating the role of lymphadenectomy, surgical castration, and adjuvant hormonal treatment in endometrial stromal sarcoma // Br. J. Cancer. - 2007. - Vol. 97. - P. 1194-1199.

Ash P The influence of radiation on fertility in man // Br. J. Radiol. - 1980. - Vol. 53. - P 271-278.

Auborn K.J., Woodworth C., DiPaolo J.A., Bradlow H.L. The interaction between HPV infection and estrogen metabolism in cervical carcinogenesis // Int. J. Cancer. - 1991. - Vol. 49. - P 867-869.

Ayhan A., Taskiran C., Simsek S., Sever A. Does immediate hormone replacement therapy affect the oncologic outcome in endometrial cancer survivors? // Int. J. Gynecol. Cancer. - 2006. - Vol. 16. - P. 805-808.

Baker D.D. Estrogen replacement therapy in patient with previous endometrial carcinoma // Compr. Ther. - 1990. - Vol. 16. - P. 28-35.

Barakat R.R., Brundy B.N., Spirtos N.M., Bell J. Mannel R.S. Randomized double-blind trial of estrogen replacement therapy versus placebo in stage I or II Endometrial cancer: a Gynaecologic Oncology Group study // J. Clin. Oncol. - 2006. - Vol. 24. - P. 587-592.

Bebar S., Ursic-Vrscaj M. Hormone replacement therapy after epithelial ovarian cancer treatment // Eur. J. Gynecol. Oncol. - 2000. - Vol. 21. - P 192-196.

Benshushan A., Rojansky N., Chaviv M. et al. Climacteric symptoms in women undergoing risk-reducing bilateral salpingo-oophorectomy // Climacteric. - 2009. - Vol. 25. - P. 1-6.

Biglia N., Gadducci A., Ponzone R., Roagna R., Sismondi P. Hormone replacement therapy in cancer survivors // Maturitas. - 2004. - Vol. 48. - № 4. - P. 333-346.

Billmire D., Vinocur C., Rescorla F. et al. Outcome and staging evaluation in malignant germ cell tumors of the ovary in children and adolescents: an intergroup study // J. Pediatr. Surg. - 2004. - Vol. 39. - P. 424-429.

Brand A.H., Bull C.A., Cakir B. Vaginal stenosis in patients treated with radiotherapy for carcinoma of the cervix // Int. J. Gynecol. Cancer. - 2006. - Vol. 16. - P. 288-293.

Brunner R.L., Gass M., Aragaki A. et al. Effects of conjugated equine estrogen on health-related quality of life in postmenopausal women with hysterectomy: results from Women's Health Initiative. Randomized clinical trial // Arch. Intern. Med. - 2005. - Vol. 165. - P 19761986.

Burger C.W., van Leeuwen F.E., Scheele F., Kenemans P. Hormone replacement therapy in women treated for gynaecological malignancy // Maturitas. - 1999. - Vol. 32. - P. 69-76.

Byrant G.W. Administration of estrogens to patients with a previous diagnosis of endometrial adenocarcinoma // South Med. J. - 1990. - Vol. 83. - P. 725-726.

Casali P.G., Blay J.Y Soft tissue sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up // Ann. Oncol. - 2010. - Vol. 21. - P 198-203.

Chan J.K., Kawar N.M., Shin J.Y et al. Endometrial stromal sarcoma: A population-based analysis // Br. J. Cancer. - 2008. - Vol. 99. - P 1210-1215.

Cochrane Database Syst Rev, 2009. - CD004143.

Controversial issues in climacteric medicine II: hormone replacement therapy and cancer-position paper. In: International Menopause Society Expert Workshop, 2001.

Coughlin S.S., Giustozzi A., Smith S.J., Lee N.C. A metaanalysis of estrogen replacement therapy and risk of epithelial ovarian cancer // J. Clin. Epidemiol. - 2000. - Vol. 53. - P. 367-375.

Creasman W.T., Henderson D., Hinshaw W., Clarke-Pearson D.L. Estrogen replacement therapy in the patient treated for endometrial cancer // Obstet. Gynecol. - 1986. - Vol. 67. - P. 326-330.

Creasman W.T., Phillips J.L., Menck H.R. The National Cancer Data Base report on Cancer of the vagina. Cancer 1998; 83: 1033-40.

DiSaia P.J., Creasman W.T. Clinical gynaecologic oncology. 7th ed. Philadelphia: Mosby; 2007.

Ditkoff E.C., Crary W.G., Cristo M., Lobo R.A. Estrogen improves psychological function in asymptomatic postmenopausal women // Obstet. Gynecol. - 1991. - Vol. 78. - P. 991-995.

Eeles R.A., Morden J.P., Gore M. et al. Adjuvant hormone therapy may improve survival in epithelial ovarian cancer: Results of the AHT randomized trial // J. Clin. Oncol. - 2015. - Vol. 33(35). - P. 4138-4144.

Eeles R.A., Tan S., Wiltshaw E. et al. Hormone replacement therapy and survival after surgery for ovarian cancer // BMJ. - 1991. - Vol. 302. - P. 259-262.

Eltabbakh G.H., Piver M.S., Hempling R.E. et al. Estrogen replacement therapy following oophorectomy in women with a family history of ovarian cancer // Gynecol. Oncol. - 1997. - Vol. 66. - P. 103-107.

Ettinger B., Black D., Mitlak B.H. et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene // JAMA. - 1999. - Vol. 282. - P. 637-645.

Ferenczy A., Gelfand M.M. Franco E. Mansour N. Human papillomavirus infection in post menopausal women with and without hormone therapy // Obstet. Gynecol. - 1997. - Vol. 90. - P. 7-11.

Gadducci A., Cosio S., Romanini A. et.al. The management of patients with uterine sarcoma: A debated clinical challenge // Crit. Rev. Oncol. Hematol. - 2008. - Vol. 65. - P. 129-142.

Gallup D.G., Stock R.J. Adenocarcinoma of the endometrium in women 40 years of age or younger // Obstet. Gynecol. - 1984. - Vol. 64. - P. 417-420.

Gambacciani M., Monteleone P., Sacco A., Genazzani A.R. Hormone replacement therapy and endometrial, ovarian and colorectal cancer // Best Pract. Res. Clin. Endocrinol. Metab. - 2003. - Vol. 17(1). - P. 139-147.

Garg P.P., Kerlikowske K., Subak L., Grady D. Hormone replacement therapy and the risk of epithelial ovarian carcinoma: a meta-analysis // Obstet. Gynecol. - 1998. - Vol. 92. - P. 472-479.

Garrett A., Quinn M.A. Hormonal therapies and gynaecological cancers // Best Pract. Res. Clin. Obstet. Gynaecol. - 2008. - Vol. 22(2). - P. 407-421.

Genazzani A.R., Gadducci A., Gambacciani M. Controversial issues in climateric medicine. II. Hormone replacement therapy and cancer // International Menopause Society Expert Workshop Climacteric. - 2001. - Vol. 4. - P. 181-193.

Gershenson D.M., Bodurka D.C., Coleman R.L. et al. Hormonal Maintenance Therapy for Women With Low-Grade Serous Cancer of the Ovary or Peritoneum // J. Clin. Oncol. - 2017. - JCO2016710632. - DOI: 10.1200/JCO.2016.71.0632

Gershenson D.M., Miller A.M., Champion V.L. et al. Reproductive and sexual function after platinum-based chemotherapy in long-term ovarian germ cell tumor survivors: a Gynecologic Oncology Group Study // J. Clin. Oncol. - 2007. - Vol. 25. - P. 2792-2797.

Goff B.A., Rice L.W., Fleischhacker D. et al. Uterine leiomyosarcoma and endometrial stromal sarcoma: lymph node metastases and sites of recurrence // Gynecol. Oncol. - 1993. - Vol. 50. - P. 105.

Gotlieb W.H., Chetrit A., Menczer J. et al. Demographic and genetic characteristics of patients with borderline ovarian tumors as compared to early stage invasive ovarian cancer // Gynecol. Oncol. - 2005. - Vol. 97. - P. 780-783.

Grady D., Gebrestsadik T, Kerlikowske K., Ernstr V., Petitti D. Hormone replacement therapy and endometrial cancer risk: a meta-analysis // Obstet. Gynecol. - 1995. - Vol. 85. - P. 304-313.

Grimer R., Judson I., Peake D. et al. Guidelines for the management of soft tissue Sarcomas // Sarcoma. - 2010. - Vol. 2010. - P. 506182.

Guidozzi F, Daponte A. Estrogen replacement therapy for ovarian carcinoma survivors: a randomised control trial // Cancer. 1999. - Vol. 86. - P. 1013-1018.

Habeshaw T., Pinion S.B. The incidence of persistent functioning endometrial tissue following successful radiotherapy for cervical carcinoma // Int. J. Gynecol. Cancer. - 1992. - Vol. 2. - P. 332-335.

Heaps J.M., Nieberg R.K., Berek J.S. Malignant neoplasms arising in endometriosis // Obstet. Gynecol. - 1990. - Vol. 75. - P. 1023-1028.

Hlatky M.A., Boothroyd D., Vittinghoff E. et al. Quality-of-life and depressive symptoms in postmenopausal women after receiving hormone therapy: results from the Heart and Estrogen/Progestin Replacement Study (HERS) trial // JAMA. - 2002. - Vol. 287. - P. 591597.

Ibeanu O., Modesitt S.C., Ducie J. et al. Hormone replacement therapy in gynecologic cancer survivors: Why not? // Gynecol. Oncol. - 2011.

Jemal A., Siegel R., Ward E. et al. Cancer Statistic // CA Cancer J. Clin. - 2009. - Vol. 59. - P. 225-249.

Kapp D.S., Shin J.Y, Chan J.K. Prognostic factors and survival in 1396 patients with uterine leiomyosarcomas: emphasis on impact of lymphadenectomy and oophorectomy // Cancer. - 2008. - Vol. 112. - P. 820.

Karabakhtsian R., Heller D.S., Singhal P., Sama J. Malignant mixed mesodermal tumor in a young woman with polycystic ovary syndrome. A case report // J. Reprod. Med. - 2002. - Vol. 47. - P. 946-948.

Keys H.M., Roberts J.A., Brunetto V.L. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study // Gynecol Oncol. - 2004. - Vol. 92(3). - P. 744-751.

King M.C., Marks J.H., Mandell J.B. New York Breast Cancer Study Group.Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2 // Science. - 2003. - Vol. 302(5645). - P. 643-646.

Kotsopoulos J., Lubinski J., Neuhausen S.L. et al. Hormone replacement therapy and the risk of ovarian cancer in BRCA1 and BRCA2 mutation carriers // Gynecol. Oncol. - 2006. - Vol. 100. - P. 83-88.

Lacey J.V., Brinton L.A., Barnes W.A. et al. Use of hormone replacement therapy and adenocarcinomas and squamous cell carcinomas of the uterine cervix // Gynecol. Oncol. - 2000. - Vol. 77. - P. 149-154.

Lee R.B., Burke T.W., Park R.C. Estrogen replacement therapy following treatment for stage 1 endometrial carcinoma // Gynecol. Oncol. - 1990. - Vol. 36. - P. 189-191.

Li A.J., Giuntoli R.L., Drake R. et.al. Ovarian preservation in stage I low-grade endometrial stromal sarcomas // Obstet. Gynecol. - 2005. - Vol. 106. - P. 1304-1308.

Loprinzi C.L., Kugler J.W., Sloan J.A. et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial // Lancet. - 2000. - Vol. 356. - P. 2059-2063.

Loprinzi C.L., Sloan J.A., Perez E.A. et al. Phase III evaluation of fluoxetine for treatment of hot flushes // J. Clin. Oncol. - 2002. - Vol. 20. - P. 1578-1583.

MacLennan A.H., Lester S., Moore V. Oral estrogen replacement therapy versus placebo for hot flushes: a systematic review // Climacteric. - 2001. - Vol. 4. - P. 58-74.

Madsen B.S., Jensen H.L., Van den Brule A.J., Wohlfahrt J., Frisch M. Risk factors for invasive squamous cell carcinoma of the vulva and vagina-population-based case-control study in Denmark // Int. J. Cancer. - 2008. -Vol. 122. - P. 2827-2834.

Manson J.E., Chlebowski R.T., Stefanick M.L. et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials // JAMA. - 2013. - Vol. 310 (13). - P. 1353-1368.

Mascarenhas C., Lambe M., Bellocco R. et al. Use of hormone replacement therapy before and after ovarian cancer diagnosis and ovarian cancer survival // Int. J. Cancer. - 2006. - Vol. 119. - P. 2907-2915.

McMeekin D.S., Burger R.A., Manetta A. et al. Endometrioid adenocarcinoma of the ovary and its relationship to endometriosis // Gynecol. Oncol. - 1995. - Vol. 59. -P. 81-86.

Messing M.J., Gallup D.G. Carcinoma of vulva in young women // Obstet. Gynecol. - 1995. - Vol. 86. - P. 51-54.

Michaelson-Cohen R., Beller U. Managing menopausal symptoms after gynecological cance // Curr. Opin. Oncol. - 2009. - Vol. 21(5). - P. 407-411.

Natsume N., Aoki Y, Kase H. et al. Ovarian metastasis in stage 1 B and 11 cervical adenocarcinoma // Gynecol. Oncol. - 1999. - Vol. 74. - P. 255-258.

Odunsi K., Pejovic T. Gynecologic Cancers: A Multidisciplinary Approach to Diagnosis and Management // Demos Medical Publishing. - 2013. - Vol. 165. -P. 167.

Parker H., Broder M.S., Chang E. et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurse‘s health study // Obstet. Gynecol. - 2009. - Vol. 113. - P. 1027-1037.

Persson I., Yuen J., Bergkvist L., Schairer C. Cancer incidence and mortality in women receiving estrogen and es-trogen-progestin replacement therapy-long term follow-up of a Swedish cohort // Int. J. Cancer. - 1996. - Vol. 67. - P. 327-332.

Pink D., Lindner T., Mrozek A. et al. Harm or benefit of hormone replacement in metastatic low-grade endometrial stromal sarcoma: Single centre experience with

cases and review of literature // Gynecol. Oncol. -2006. - Vol. 101. - P. 464-469.

Ploch E. Hormone replacement therapy in patients after cervical cancer treatment // Gynecol. Oncol. - 1987. -Vol. 26. - P. 169-177.

Puliyath G., Nair M.K. Endometrial stromal sarcoma: A review of the literature // Indian J. Med. Paediatr. Oncol. - 2012. - Vol. 33(1). - P. 1-6.

Reich O., Regauer S. Estrogen replacement therapy and tamoxifen are contraindicated in patients with endometrial stromal sarcoma // Gynecol. Oncol. - 2006. - Vol. 102. - P. 413-414.

Reich O., Regauer S. Hormonal therapy of endometrial stromal sarcoma // Curr. Opin. Oncol. - 2007. - Vol. 19. - P. 347-352.

Reis LAG, Melbert D., Krapcho M. et al. editors. SEER Cancer statistics Review, 1975-2005. - Bethesda, MD: NCI; 2008.

Rossouw J.E., Anderson G.L., Prentice R.L. et al. Writing group for the Women's Health Initiative investigators. Risks and Benefits of estrogen plus progestin in healthy postmenopausal women // JAMA. - 2002. - Vol. 288. - P. 321-333.

Russell P., Kurman R.J. editors. Surface epithelial-stromal tumors of the ovary. Blaustein's pathology of the female genital tract. - New York: Springer Verlag, 1994. - 705 p.

Schindler A.E.: Hormone replacement therapyin women after genital cancer // Maturitas. - 2002. - Vol. 41 (suppl 1). - P. 105-111.

Sharpe M., Noble S., Spencer C.M. Alendronate: an update of its use in osteoporosis // Drugs. - 2001. - Vol. 61(7). - P. 99-1039.

Sheehan J.F., Schmitz H.E., Towne J. Changes in the uterus after eradication of endometrial adenocarcinoma by radiotherapy // Arch. Pathol. - 1943. - Vol. 39. -P. 237-245.

Sherman K.J., Daling J.R., McKnight B., Chu J. Hormonal factors in vulval cancer. A case-control study // J. Re-prod. Med. - 1994. - Vol. 39. - P. 857-861.

Shimada M., Kigawa J., Nishimura R. et al. Ovarian metastasis in cancer of the uterine cervix // Gynecol. Oncol. - 2006. - Vol. 101. - P. 234-237.

Singer G., Stohr R., Cope L. et al. Patterns of p53 mutations separate ovarian serous borderline tumors and low- and high-grade carcinomas and provide support for a new model of ovarian carcinogenesis: a mutational analysis with immunohistochemical correlation // Am J. Surg. Pathol. - 2005. - Vol. 29. - P. 218-224.

Singh P., Oehler M.K. Hormone replacement after gynaecological cancer // Maturitas. - 2010. - Vol. 65(3). -P. 190-197.

Smith J.S., Green J., Berrington de Gonzalez A. et al. Cervical cancer and use of hormonal contraceptives: a systematic review // Lancet. - 2003. - Vol. 361. - P. 1159-1167.

Soares C.N., Almeida O.P., Joffe H., Cohen L.S. Efficacy of estradiol for the treatment of depressive disorders in perimenopausalwomen:a double blind, randomised, placebo-controlled trial // Arch. Gen. Psychiatry. - 2001. -Vol. 58. - P. 529-534.

Spano J.P., Soria J.C., Kambouchner M. et al. Long-term survival of patients given hormone therapy for metastatic endometrial stromal sarcoma // Case Report. Med. Oncol. - 2003. - Vol. 20. - P. 87-93.

Suriano K.A., McHale M., McLaren C.E., Li K.T. et al. Estrogen replacement therapy in endometrial cancer patients: a matched control study // Obstet. Gynecol. - 2001. - Vol. 97. - P 555-560.

Surveillance, Epidemiology, and End Results (SEER) Program. SEER (Stat Database: Incidence-Seer 9 Regs Public use, Nov 2007 Sub (1973-2005)) - Linked to county attributes - Total US, 1969-2005 counties. Bethesda, MD: National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch; 2008.

Tabata M., Ichnoe K., Sakuragi N. et al. Incidence of ovarian metastasis in patients with cancer of uterine cervix // Gynecol. Oncol. - 1987. - Vol. 28. - P 255-261.

Tanner E.J., Garg K., Leitao M.M. et al. High grade undifferentiated uterine sarcoma: surgery, treatment, and survival outcomes // Gynecol. Oncol. - 2012. - Vol. 127(1). - P. 27-31.

Tavassoli F.A., Devilee P Tumors of the Breast and Female Genital Tract. Pathology and Genetics. World Health Organization Classification of Tumors. Lyon: IARC, 2003.

Teufel G., Geyer H. et. al. Estrogen and Progesteron receptors in malignant ovarian neoplasms // Geburtshilfe Frauenheilkd. - 1983. - Vol. 43(12). - P. 732-740.

Ursic-Vrscaj M., Bebar S., Zakelj M.P Hormone replacement therapy after invasive ovarian cystadenocarcino-ma treatment: the effect on survival // Menopause. - 2001. - Vol. 8. - P 70-75.

Ursic-Vrscaj M. Hormone replacement therapy after uterine leiomyosarcoma treatment. Case reports // Eur. J. Gynaecol. Oncol. - 1999. - Vol. 20. - P. 379-382.

Van Eijkeren M.A., Van Der Wijk I., El Sharouni S.Y, Heintz A.P Benefits and side effects of lateral ovarian transposition (LOT) performed during radical hysterectomy and pelvic lymphadenectomy for early stage cervical cancer // Int. J. Gynecol. Cancer. - 1999. - Vol. 9. - P. 396-400.

Vang R., Shih L.M., Kurman R.J. Ovarian low-grade and high-grade carcinoma Pathogenesis, Clinicopathologic and Molecular Biologic Features, and Diagnostic Problems // Adv. Anat. Pathol. - 2009. - Vol. 16(5). - P. 267-282.

Walsh C., Holschneider C., Hoang Y et al. Coexisting Ovarian Malignancy in Young Women With Endometrial Cancer // Obstetrics and Gynecology. - 2004. - Vol. 106 (4). - P. 693-699.

Wang PH., Chang C. Androgens and ovarian cancers // Eur. J. Gynecol. Oncol. - 2004. - Vol. 25. - P. 157-163.

Weiderpass E., Adami H.O., Baron J.A. et al. Risk of endometrial cancer following estrogen replacement therapy with and without progestin // J. Natl. Cancer. Inst. - 1991. - Vol. 91. - P. 1131-1317.

Wren B. Hormonal therapy and genital tract cancer // Curr. Opin. Obstet. Gynecol. - 1996. - Vol. 8. - P. 38-41.

Wright J., Buck A., Shah M. et.al. Safety of ovarian preservation in premenopaulal women with endometrial cancer // Journal of Clinical Oncology. - 2009. - Vol. 27. - P 1214-1219.

Writing Group for the Women's Health Initiative Investigators: Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial // JAMA. - 2002. - Vol. 288. - P. 321-333.

Zalel Y., Piura B., Elchalal U. et al. Diagnosis and management of malignant germ cell ovarian tumors in young females // Int. J. Gynecol. Obstet. - 1996. - Vol. 55. - P. 1-10.

Лицензия Creative Commons

Это произведение доступно по лицензии Creative Commons «Attribution-NonCommercial-NoDerivatives» («Атрибуция — Некоммерческое использование — Без производных произведений») 4.0 Всемирная.

© АННМО «Вопросы онкологии», Copyright (c) 2017