Rehabilitation targeted late adverse effects after radiotherapy for cervical cancer – Different gains in different settings

Background: Since continuing advances in radiotherapy technology broaden the role of radiotherapy in the treatment of gynaecologic malignancies, the use of vaginal dilators has been introduced in order to mitigate the risk of vaginal stenosis. The main aims of this study were to investigate the vaginal dilator use efficacy in the treatment of radiation-induced vaginal stenosis and the vaginal dilator effect on sexual quality of life. Methods: We studied fifty-three patients with endometrial or cervical cancer. The participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined at four time points post-radiotherapy when also they were asked to fill in a validated sexual function-vaginal changes questionnaire. A p-value less than 0.05 was considered statistically significant. Results: The vaginal stenosis grading score was decreased and the size of the vaginal dilator comfortably insertable was gradually increased throughout the year of vaginal dilator use while radiation-induced vaginal and sexual symptoms were improved throughout the year of VD use. All patients with initial grade 3 showed vaginal stenosis of grade 2 after 12 months of vaginal dilator use and 65.8% of the patients with grade 2 initial vaginal stenosis demonstrated final vaginal stenosis grade 1 while 77.8% of the participants with initial 1st size of vaginal dilators reached the 3rd vaginal dilator size after 12 months. Starting time of dilator therapy <= 3 months after the end of radiotherapy was associated with a significant decrease in vaginal stenosis. Additionally, there was an overall upward trend regarding patients’ satisfaction with their sexual life. Conclusion: Endometrial and cervical cancer survivors should be encouraged to use vaginal dilators for the treatment of vaginal stenosis and sexual rehabilitation after radiotherapy.

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Multiple severe late adverse effects after definitive chemoradiation for locally advanced cervical cancer

Precision Radiation Oncology ◽

10.1002/pro6.1126 ◽

2021 ◽

Author(s):

Calida Marie Danko ◽

Linda Jahwa Hong ◽

Jerry Donald Slater

Keyword(s):

Cervical Cancer ◽

Adverse Effects ◽

Locally Advanced ◽

Advanced Cervical Cancer ◽

Locally Advanced Cervical Cancer ◽

Definitive Chemoradiation ◽

Late Adverse Effects

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Vaginal Dilator Use to Promote Sexual Wellbeing After Radiotherapy in Gynaecological Cancer Survivors: A Prospective Observational Study

10.31487/j.ijcst.2021.03.01 ◽

2021 ◽

pp. 1-13

Author(s):

Dimitra Charatsi ◽

Polyxeni Vanakara ◽

Michail Nikolaou ◽

Aikaterini Evaggelopoulou ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Survivors ◽

External Beam Radiotherapy ◽

Sexual Life ◽

P Value ◽

Sexual Rehabilitation ◽

Vaginal Stenosis ◽

Sexual Symptoms ◽

Radiation Induced ◽

Vaginal Dilators

Background: Since continuing advances in radiotherapy technology broaden the role of radiotherapy in the treatment of gynaecologic malignancies, the use of vaginal dilators has been introduced in order to mitigate the risk of vaginal stenosis. The main aims of this study were to investigate the vaginal dilator use efficacy in the treatment of radiation-induced vaginal stenosis and the vaginal dilator effect on sexual quality of life. Methods: We studied fifty-three patients with endometrial or cervical cancer. The participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined at four time points post-radiotherapy when also they were asked to fill in a validated sexual function-vaginal changes questionnaire. A p-value less than 0.05 was considered statistically significant. Results: The vaginal stenosis grading score was decreased and the size of the vaginal dilator comfortably insertable was gradually increased throughout the year of vaginal dilator use while radiation-induced vaginal and sexual symptoms were improved throughout the year of VD use. All patients with initial grade 3 showed vaginal stenosis of grade 2 after 12 months of vaginal dilator use and 65.8% of the patients with grade 2 initial vaginal stenosis demonstrated final vaginal stenosis grade 1 while 77.8% of the participants with initial 1st size of vaginal dilators reached the 3rd vaginal dilator size after 12 months. Starting time of dilator therapy <= 3 months after the end of radiotherapy was associated with a significant decrease in vaginal stenosis. Additionally, there was an overall upward trend regarding patients’ satisfaction with their sexual life. Conclusion: Endometrial and cervical cancer survivors should be encouraged to use vaginal dilators for the treatment of vaginal stenosis and sexual rehabilitation after radiotherapy.

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Effect of three therapeutic strategies for FIGO stage IB2/IIA2 cervical Cancer

10.21203/rs.3.rs-22534/v1 ◽

2020 ◽

Author(s):

yong zhang ◽

Xiaobi Tang ◽

Meizhu Shen ◽

Shanshan Ma ◽

Wenchao Yuan ◽

...

Keyword(s):

Cervical Cancer ◽

Adverse Effects ◽

Lower Extremity ◽

Figo Stage ◽

Therapeutic Strategies ◽

Group Differences ◽

Stromal Invasion ◽

Late Adverse Effects ◽

Cervical Stromal Invasion ◽

Grade 3

Abstract Background: To evaluate the long-term efficacy and toxicities of three therapeutic strategies for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB2/IIA2 cervical cancer. Methods : 206 patients with stage IB2/IIA2 cervical cancer were selected in this retrospective study. The patients were classed into three groups according to the primary therapy: primary surgical treatment (PST), neoadjuvant chemotherapy followed by radical surgery (NAC+RS), and concurrent chemoradiotherapy (CCRT). We observed the inter-group differences in patient characteristics, surgery approaches, postoperative rick factors, supplemental therapies and overall survival (OS), disease-free survival (DFS) and acute and late toxicities. Results: Less patients in NAC+RS group had deep cervical stromal invasion than those in PST group (p=0.024). No differences in lymph node metastasis, intravascular tumor embolus, vaginal margin and the need of postoperative supplement treatment were observed between PST and NAC+RS ( P =0.734, P =0.704, P =0.487 and P =0.714, respectively). With a median follow-up time of 57 months, the 3-year DFS and OS in PST, NAC+RS and CCRT were 85.6%, 79.2%, 85.7% and 87.5%, 84.9%, 85.7% ( P =0.424 and P =0.856, respectively). The most frequently observed acute toxicities were hematologic side effects. No significant inter-group differences in leukopenia, neutropenia, thrombocytopenia and anemia were observed (all P >0.05). No patient experienced grade 3-4 hepatotoxicity and nephrotoxic. Late toxicity ≥grade 3 mainly consisted of lower extremity lymphedema (4/104, 3.8%), bowel obstruction (3/104, 2.9%) and thrombosis (1/104, 1.0%) in PST, lower extremity lymphedema (5/53, 9.4%) and bowel obstruction (1/53, 1.9%) in NAC+RS and radiation proctitis (4/49, 8.2%) and femoral head necrosis (1/49, 2.0%) in CCRT. No grade 5 toxicities were observed. There was no significant difference in cumulative late adverse effects rate in the three groups ( P =0.777). The patients in NAC+RS had increased hospitalization cost than that in PST ( P =0.000) and CCRT ( P =0.000) and prolonged hospitalization time than that in PST ( P =0.000) and same as that in CCRT ( P =0.07). Conclusion: Preoperative NAC decreased the incidence of deep cervical stromal invasion but had no effect on other high risk factors and the need of postoperative supplement treatment. No inter-group differences were demonstrated in 3-year DFS and OS and cumulative acute and late adverse effects. NAC+RS would need longer hospitalization time and cost more. Nevertheless, we believe it should be further explored in prospective trials.

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