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Noorian F, Abellana R, Zhang Y, Herreros A, Lancellotta V, Tagliaferri L, Sabater S, Torne A, Agusti-Camprubi E, Rovirosa A. Impact of Vaginal Dilator Use and 68 Gy EQD2 (α/β=3) Dose Constraint on Vaginal Complications in External Beam Irradiation Followed by Brachytherapy in Post-Operative Endometrial Cancer. J Pers Med 2024; 14:838. [PMID: 39202029 PMCID: PMC11355937 DOI: 10.3390/jpm14080838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/08/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND This study evaluated the clinical outcomes of applying a 68 Gy EQD2(α/β=3) dose constraint to the most exposed 2 cm3 area of the vagina in post-operative endometrial cancer patients treated with vaginal-cuff brachytherapy after external beam irradiation and the impact of vaginal dilator use on late vaginal complications. MATERIAL AND METHODS We analyzed 131 patients treated with vaginal-cuff brachytherapy after external beam irradiation. Group-1 (65 patients) received one fraction of 7 Gy, and Group-2 (66 patients) received one fraction of between 5.5 and 7.0 Gy after applying a 68 Gy EQD2(α/β=3) dose constraint. Vaginal-cuff relapse, late toxicity, clinical target volume, vaginal dilator use, D90, and EQD2(α/β=3) at 2 cm3 of the most exposed part of the clinical target volume were evaluated. Descriptive analysis, the chi-squared test, Student's t-test, and the Cox proportional and Kaplan-Meier models were used for the statistical analysis. RESULTS With a median follow-up of 60 months, the vaginal-cuff relapse rate was 1/131 (0.8%). Late vaginal complications appeared in 36/65 (55.4%) Group-1 patients and 17/66 (25.8%) Group-2 patients (p = 0.003). Multivariate analysis showed that belonging to Group-1 and vaginal dilator use of <9 months were independent prognostic factors of late vaginal complications with hazard ratios of 1.99 (p = 0.021) and 3.07 (p = 0.010), respectively. CONCLUSIONS A 68 Gy EQD2(α/β=3) constraint at 2 cm3 of clinical target volume and vaginal dilator use of ≥9 months were independent prognostic factors, having protective effects on late vaginal complications.
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Affiliation(s)
- Faegheh Noorian
- Fonaments Clínics Department, Universitat de Barcelona, 08036 Barcelona, Spain; (F.N.); (R.A.); (A.H.)
- Radiation Oncology Department, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Rosa Abellana
- Fonaments Clínics Department, Universitat de Barcelona, 08036 Barcelona, Spain; (F.N.); (R.A.); (A.H.)
| | - Yaowen Zhang
- Cancer Center, Henan Provincial People’s Hospital, No.7 Weiwu Road, Zhengzhou 450003, China;
| | - Antonio Herreros
- Fonaments Clínics Department, Universitat de Barcelona, 08036 Barcelona, Spain; (F.N.); (R.A.); (A.H.)
- Radiation Oncology Department, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Valentina Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Policlinic Universitario Gemelli, 00168 Rome, Italy; (V.L.); (L.T.)
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Policlinic Universitario Gemelli, 00168 Rome, Italy; (V.L.); (L.T.)
| | - Sebastià Sabater
- Radiation Oncology Department, Hospital General Universitario de Albacete, 02006 Albacete, Spain;
| | - Aureli Torne
- Gynaecological Cancer Unit, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Eduard Agusti-Camprubi
- Radiological Protection Department, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Angeles Rovirosa
- Fonaments Clínics Department, Universitat de Barcelona, 08036 Barcelona, Spain; (F.N.); (R.A.); (A.H.)
- Radiation Oncology Department, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
- Gynaecological Cancer Unit, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain;
- Institut d’Investigació Biomèdica Agustí Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
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Liu Y, Xin W, Wang P, Ji M, Guo X, Ouyang Y, Zhao D, Hua K. Intraoperative frozen section pathology of vaginal margin in radical hysterectomy on the prognosis and quality of life for patients with IB2-IIA2 cervical cancer: study protocol for a multicenter randomized controlled trial. J Gynecol Oncol 2024; 35:e81. [PMID: 38522951 PMCID: PMC11107279 DOI: 10.3802/jgo.2024.35.e81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/18/2023] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Several risk factors have been identified that compromise the treatment outcome in patients with early-to-mid-stage cervical cancer (CC) who are primarily treated with radical surgery. However, there is no report on the impact of intraoperative frozen pathology examination of vaginal margins on the prognosis of patients with CC. This study aimed to conduct a randomized controlled trial (RCT) to determine whether selective vaginal resection can reduce the incidence of operative complications and the risk of postoperative radiotherapy. The impact of the length of the vagina removed in radical hysterectomy (RH) on prognosis and quality of life (QoL) for IB2-IIA2 CC patients will be investigated. METHODS A multicenter, non-inferiority, RCT at 7 institutions in China is designed to investigate the effect of intraoperative frozen pathology exam of vaginal margin in RH on the survival outcomes for patients with IB2-IIA2 CC. Eligible patients aged 18-70 years will be randomly assigned online by one-to-one random allocation to receive intraoperative frozen pathology exam of vaginal margin or not. If frozen pathology indicates positive margin, continue resection of 1 centimeter of vaginal tissue until negative margin is achieved. The primary end point is 2-year disease-free survival (DFS). Adverse events (AEs) caused by further vagina resection, 5-year DFS, 2-year overall survival (OS), 5-year OS and AEs caused by radiotherapy and QoL are secondary end points. A total of 310 patients will be enrolled from 7 tertiary hospitals in China within 3-year period and followed up for 5 years. TRIAL REGISTRATION Chinese Clinical Trial Registry Identifier: ChiCTR2000035668.
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Affiliation(s)
- Yu Liu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Weijuan Xin
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ping Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Mei Ji
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoqing Guo
- Department of Gynecology, First Maternity and Infant Hospital Affiliated to Tongji University, Shanghai, China
| | - Yunyan Ouyang
- Department of Gynecology, Ganzhou People's Hospital, Ganzhou, China
- Department of Gynecology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
| | - Dong Zhao
- Department of Obstetrics and Gynecology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
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3
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Shen J, Sun H, Chu J, Gong X, Liu X. Cervicovaginal microbiota: a promising direction for prevention and treatment in cervical cancer. Infect Agent Cancer 2024; 19:13. [PMID: 38641803 PMCID: PMC11027553 DOI: 10.1186/s13027-024-00573-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/18/2024] [Indexed: 04/21/2024] Open
Abstract
Cervical cancer is a common malignancy in women, with high incidence rate and mortality. Persistent infection of high-risk human papillomavirus (HPV) is the most important risk factor for cervical cancer and precancerous lesions. Cervicovaginal microbiota (CVM) plays an essential role in the defense of HPV infections and prevention of subsequent lesions. Dominance of Lactobacillus is the key of CVM homeostasis, which can be regulated by host, exogenous and endogenous factors. Dysbiosis of CVM, including altered microbial, metabolic, and immune signatures, can contribute to persist HPV infection, leading to cervical cancer. However, there is no evidence of the causality between CVM and cervical cancer, and the underlying mechanism remains unexplored. Considering the close correlation between CVM dysbiosis and persistent HPV infection, this review will overview CVM, its role in cervical cancer development and related mechanisms, and the prospects for therapeutic applications.
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Affiliation(s)
- Jie Shen
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), 200003, Shanghai, China
| | - Hao Sun
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), 200003, Shanghai, China
| | - Jing Chu
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), 200003, Shanghai, China
| | - Xiaodi Gong
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), 200003, Shanghai, China.
| | - Xiaojun Liu
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), 200003, Shanghai, China.
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Fijardo M, Kwan JYY, Bissey PA, Citrin DE, Yip KW, Liu FF. The clinical manifestations and molecular pathogenesis of radiation fibrosis. EBioMedicine 2024; 103:105089. [PMID: 38579363 PMCID: PMC11002813 DOI: 10.1016/j.ebiom.2024.105089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/25/2024] [Accepted: 03/12/2024] [Indexed: 04/07/2024] Open
Abstract
Advances in radiation techniques have enabled the precise delivery of higher doses of radiotherapy to tumours, while sparing surrounding healthy tissues. Consequently, the incidence of radiation toxicities has declined, and will likely continue to improve as radiotherapy further evolves. Nonetheless, ionizing radiation elicits tissue-specific toxicities that gradually develop into radiation-induced fibrosis, a common long-term side-effect of radiotherapy. Radiation fibrosis is characterized by an aberrant wound repair process, which promotes the deposition of extensive scar tissue, clinically manifesting as a loss of elasticity, tissue thickening, and organ-specific functional consequences. In addition to improving the existing technologies and guidelines directing the administration of radiotherapy, understanding the pathogenesis underlying radiation fibrosis is essential for the success of cancer treatments. This review integrates the principles for radiotherapy dosimetry to minimize off-target effects, the tissue-specific clinical manifestations, the key cellular and molecular drivers of radiation fibrosis, and emerging therapeutic opportunities for both prevention and treatment.
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Affiliation(s)
- Mackenzie Fijardo
- Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Cell and Systems Biology, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Yin Yee Kwan
- Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | | | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, Bethesda, MD, United States of America
| | - Kenneth W Yip
- Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Cell and Systems Biology, University of Toronto, Toronto, Ontario, Canada
| | - Fei-Fei Liu
- Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.
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Owrangi A, Medrano A, Gao Y, Kazemifar S, Hrycushko B, Medin P, Nwachukwu C, Jia X, Albuquerque K. Definitive radiation for advanced cervix cancer is not associated with vaginal shortening-a prospective vaginal length and dose correlation. Brachytherapy 2024; 23:136-140. [PMID: 38242726 DOI: 10.1016/j.brachy.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE Prospectively measure change in vaginal length after definitive chemoradiation (C-EBRT) with Intracavitary Brachytherapy (ICBT) for locally advanced cervix cancer (LACC) and correlate with vaginal dose (VD). MATERIALS AND METHODS Twenty one female patients with LACC receiving C-EBRT and ICBT underwent serial vaginal length (VL) measurements. An initial measurement was made at the time of the first ICBT procedure and subsequently at 3 month intervals up to 1 year post radiation. The vagina was contoured as a 3-dimensional structure for each brachytherapy plan. The difference in VL before and at least 6 months after the last fraction of brachytherapy was considered as an indicator of toxicity. RESULTS The mean initial VL was 8.7 cm (6.5-12) with median value of 8.5 cm. The mean VL after 6 months was 8.6 cm (6.5-12) and VL change was not found to be statistically significant. The median values (interquartile ranges) for vaginal D0.1cc, D1cc, and D2cc were 129.2 Gy (99.6-252.2), 96.9 Gy (84.2-114.9), and 89.6 Gy (82.4-102.2), respectively. No significant correlation was found between vaginal length change and the dosimetric parameters calculated for all patients. CONCLUSION Definitive C-EBRT and ICBT did not significantly impact VL in this prospective cohort probably related to acceptable doses per ICRU constraints. Estimate of vaginal stenosis and sexual function was not performed in this cohort which is a limitation of this study and which we hope to study prospectively going forward.
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Affiliation(s)
- Amir Owrangi
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas.
| | - Astrid Medrano
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Yin Gao
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Samaneh Kazemifar
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Brian Hrycushko
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Paul Medin
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Chika Nwachukwu
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Xun Jia
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
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Chen PH, Li YM, Morris K, Makale MT, Mayadev J, Talke FE. Design and Material Characterization of an Inflatable Vaginal Dilator. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1050. [PMID: 38473522 DOI: 10.3390/ma17051050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
There are more than 13,000 new cases of cervical cancer each year in the United States and approximately 245,000 survivors. External beam radiation and brachytherapy are the front-line treatment modalities, and 60% of patients develop vaginal damage and constriction, i.e., stenosis of the vaginal vault, greatly impeding sexual function. The incidence of vaginal stenosis (VS) following radiotherapy (RT) for anorectal cancer is 80%. VS causes serious quality of life (QoL) and psychological issues, and while standard treatment using self-administered plastic dilators is effective, acceptance and compliance are often insufficient. Based on published patient preferences, we have pursued the design of a soft inflatable dilator for treating radiotherapy-induced vaginal stenosis (VS). The critical component of the novel device is the dilator balloon wall material, which must be compliant yet able to exert therapeutic lateral force levels. We selected a commercially available silicone elastomer and characterized its stress-strain characteristics and hyperelastic properties. These parameters were quantified using uniaxial tensile testing and digital image correlation (DIC). Dilator inflation versus internal pressure was modeled and experimentally validated in order to characterize design parameters, particularly the dilator wall thickness. Our data suggest that an inflatable silicone elastomer-based vaginal dilator warrants further development in the context of a commercially available, well-tolerated, and effective device for the graded, controlled clinical management of radiotherapy-induced VS.
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Affiliation(s)
- Po-Han Chen
- Center for Memory and Recording Research, UC San Diego, 9500 Gilman Dr. MC 0401, La Jolla, CA 92093, USA
| | - Yu Ming Li
- Center for Memory and Recording Research, UC San Diego, 9500 Gilman Dr. MC 0401, La Jolla, CA 92093, USA
| | - Karcher Morris
- Center for Memory and Recording Research, UC San Diego, 9500 Gilman Dr. MC 0401, La Jolla, CA 92093, USA
| | - Milan T Makale
- Moores Cancer Center, UC San Diego, 3855 Health Sciences Dr, San Diego, CA 92037, USA
| | - Jyoti Mayadev
- Moores Cancer Center, UC San Diego, 3855 Health Sciences Dr, San Diego, CA 92037, USA
| | - Frank E Talke
- Center for Memory and Recording Research, UC San Diego, 9500 Gilman Dr. MC 0401, La Jolla, CA 92093, USA
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Zhang S, Blokker AM, Borazjani A, Hong CX, Chaikof M, Giroux M, Edell H, Eltahawi A, Ameri G, McDermott CD. A feasibility study of three-dimensional ultrasound imaging of the vagina under distension. Med Phys 2024; 51:80-92. [PMID: 37905819 DOI: 10.1002/mp.16810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The distension properties of the vagina are critical to its function including support of surrounding organs, childbirth, and intercourse. It could be altered by many pathophysiological processes like pregnancy, radiotherapy, and reconstruction surgery. However, there are no clinically available diagnostic tools capable of quantifying the distension properties of the vagina. PURPOSE A proof-of-concept study was designed to assess the feasibility of a novel three-dimensional (3D) ultrasound imaging technique that allows quantitative evaluation of the vagina under distension. METHODS Patients with symptomatic pelvic organ prolapse (POP) were recruited for the study. An ultrathin, oversized bag was inserted into the vagina and filled with water using a modified urodynamics system. The instilled water volume and intravaginal pressure were continuously recorded. At maximum vaginal capacity, 3D transintroital ultrasound of the distended vagina and surrounding pelvic structures was performed. Exams were performed in duplicate for each patient, two hours apart (round A and round B). Following the development of a 3D surface model of the distended vagina from each scan, several measurements were obtained, including cross-sectional area, anteroposterior (AP) length and lateral width in the plane of minimum hiatal dimensions (PMHD), AP and lateral diameter at the pubic symphysis (PS) level, maximum and minimum diameter, and maximum vertical length. To assess repeatability between measurements in two rounds, the coefficient of variation (CV) and the intraclass correlation coefficient (ICC) were calculated for each measurement. Correlations between physical measurements including the pelvic organ prolapse quantification (POP-Q) system and vaginal diameter measurements, and obtained metrics were also assessed. RESULTS Sixteen patients with POP (average age 69 years) completed both rounds of imaging. There was sufficient echogenicity on 3D transintroital ultrasound of the distended vaginal wall to establish boundaries for 3D surface models of the vagina. Overall, all metrics had good or excellent reliability (ICC = 0.77-0.93, p < 0.05; CV = 3%-18%) except maximum diameter, which demonstrated only moderate reliability (ICC = 0.67, p = 0.092). Strong correlations were found between physical exam measurements including D point of POP-Q, introitus diameter and lateral diameter at apex, and maximum vaginal capacity, maximum vertical length, lateral diameter at PS, minimum diameter, and distended PMHD measurements. The results demonstrated that this system could generate 3D models of the shape of the distended vagina and provide multiple metrics that could be reliably calculated from automated analyses of the models. CONCLUSIONS A novel system for evaluation of the distension properties of the vagina was developed and preliminary evaluation was performed. This system may represent a technique for evaluation of the biomechanical and structural properties of the vagina.
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Affiliation(s)
| | | | - Ali Borazjani
- Cosm Medical Corp., Toronto, Ontario, Canada
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Christopher X Hong
- Cosm Medical Corp., Toronto, Ontario, Canada
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Chaikof
- Division of Urogynecology, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Maria Giroux
- Division of Urogynecology, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Humara Edell
- Division of Urogynecology, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Eltahawi
- Cosm Medical Corp., Toronto, Ontario, Canada
- Information System Department, Faculty of Computers and Informatics, Suez Canal University, Ismailia, Egypt
| | | | - Colleen D McDermott
- Cosm Medical Corp., Toronto, Ontario, Canada
- Division of Urogynecology, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Singh A, Mani N, Aggarwal LM, Agarwal S, Mourya A, Verma A, Bagchi A, Gupta N, Choudhary S. Dose at posterior-inferior border of symphysis point: A predictor for vaginal stricture in cervical cancer. Brachytherapy 2023; 22:616-622. [PMID: 37286402 DOI: 10.1016/j.brachy.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To study the effect of various dose-volume parameters on the severity of vaginal stricture (VS) and the correlation of the latter with the posterior-inferior border of symphysis (PIBS) points in locally advanced cervical cancer patients treated with concurrent chemoradiation and brachytherapy. METHODS AND MATERIALS A prospective study was done on 45 histologically proven locally advanced cervical cancer patients between January 2020 and March 2021. All of them were treated with concurrent chemoradiation with 6 MV photon linear accelerator to a dose of 45 Gy/25 fractions in 5 weeks. Twenty-three patients were treated with intracavitary brachytherapy with a dose of 7 Gy/fraction/week for three fractions. Twenty-two patients were treated with interstitial brachytherapy, with 6 Gy/fraction for four fractions, each fraction 6 h apart. Grading of VS was done as per Common Terminology Criteria for Adverse Events version 5. RESULTS The median followup was 21.5 months. About 37.8% of patients had VS with a median duration of 8.0 months (4.0-12 months). About 22.2% had Grade 1, 6.7% had Grade 2, and 8.9% had Grade 3 toxicity. Doses at PIBS and PIBS-2 points had no correlation with vaginal toxicity, however, the dose at PIBS+2 was significantly associated with VS (p = 0.004). The treated length of the vagina at the time of brachytherapy (p = 0.001), initial tumor volume (p = 0.009), and vaginal involvement after completion of external beam radiotherapy (EBRT) (p = 0.01) were also statistically significant with the development of VS of Grade 2 or more. CONCLUSIONS Dose at PIBS + 2, treated length of the vagina with brachytherapy, initial tumor volume, and post-EBRT vaginal involvement are strong predictors for the severity of VS.
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Affiliation(s)
- Ankita Singh
- Department of Radiotherapy & Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Nilesh Mani
- Department of Radiation Oncology, Mahaveer Cancer Sansthan and Research Centre, Patna, Bihar, India
| | - Lalit M Aggarwal
- Department of Radiotherapy & Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sumit Agarwal
- Department of Radiotherapy & Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ankur Mourya
- Department of Radiotherapy & Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Antara Bagchi
- Department of Radiotherapy & Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Neha Gupta
- Apex Hospital, Varanasi, Uttar Pradesh, India
| | - Sunil Choudhary
- Department of Radiotherapy & Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
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Abstract
IMPORTANCE AND OBJECTIVES Evaluation and treatment of dyspareunia remains a significant unmet need despite the availability of safe and effective treatments. The objectives of this review are to consider evaluation techniques, the medical causes, and treatment options for dyspareunia in postmenopausal women. METHODS This narrative review used PubMed to search for English-language articles related to postmenopausal dyspareunia. Search terms included, but were not limited to, dyspareunia, genitourinary syndrome of menopause, sexual dysfunction, postmenopausal dyspareunia, posthysterectomy dyspareunia, and postcancer dyspareunia. FINDINGS Many postmenopausal women with dyspareunia do not discuss their symptoms with their physicians. Healthcare clinicians should broach the topic of dyspareunia with their patients using oral or written questionnaires. In addition to a thorough medical history and physical examination, various tools can be used as further assessments, including vaginal pH, vaginal dilators, imaging, vulvar biopsy, vulvoscopy and photography, the cotton swab test, sexually transmitted infection screening, and vaginitis testing. Although dyspareunia in postmenopausal women is often due to the genitourinary syndrome of menopause, other conditions can also cause dyspareunia, including hypertonic pelvic floor, hysterectomy, cancer treatment, lichen conditions, vulvar cancer, vestibulodynia, and pelvic organ prolapse. Some of the treatments discussed include lubricants, moisturizers, vaginal estrogen, ospemifene, dehydroepiandrosterone, local testosterone therapy, cannabidiol, and fractional CO2 laser treatments. In some cases, dyspareunia may need to be specifically addressed by pelvic floor physical or sex therapists. CONCLUSIONS Dyspareunia is a common issue in postmenopausal women, which remains largely untreated. Women with dyspareunia require a thorough history, targeted physical examination, and coordination of multiple disciplines including medical clinicians, pelvic floor physical therapists, and sex therapists.
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Affiliation(s)
- Lauren F Streicher
- From the Northwestern Medicine Center for Sexual Medicine and Menopause, Northwestern Medicine, Chicago, IL
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10
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Kibaara M, Degu A. Assessment of adverse events among cervical cancer patients at Kenyatta National Hospital. J Oncol Pharm Pract 2023; 29:326-332. [PMID: 34907833 DOI: 10.1177/10781552211068133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Due to their cytotoxic nature, anticancer drugs and radiotherapy have the potential to cause toxic adverse events. As a result, they can increase the risk of morbidity and mortality. However, there was a lack of data among cervical cancer patients in our setting. Hence, this study was aimed to assess the prevalence of adverse events among cervical cancer patients at Kenyatta National Hospital. METHODS A cross-sectional study design was employed among a consecutive sample of 151 adult cervical cancer patients. The data were collected by reviewing the medical records and interviewing the patients. The data were entered and analyzed using SPSS 27.0 software. The results were presented with frequency tables and graphs. RESULTS A total of 214 adverse events (prevalence of 100%) were identified from 151 patients. The most common adverse events identified were ulcerated sores (52.8%), dysuria (7.5%), thrombocytopenia (5.6%), and loss of appetite (5.6%). The majority of the patients (80.8%) who had adverse events were on radiotherapy. As per the Naranjo causality assessment scale, the predominant (80.1%) proportion of the adverse event was a probable adverse event with a total score of 5-8. Besides, 15.9% of the adverse events had a possible causality. The present study also reported that 61.6% of patients with a probable adverse event were treated with radiotherapy. CONCLUSION The prevalence of adverse events among cervical patients was high in our setting. The predominant proportion of the adverse event was a probable adverse event and most of them were treated with radiotherapy.
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Affiliation(s)
- Muthoni Kibaara
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy and Health Sciences, 54663United States International University-Africa, Nairobi, Kenya
| | - Amsalu Degu
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy and Health Sciences, 54663United States International University-Africa, Nairobi, Kenya
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De Felice F, Vicenzi L, Macchia G, Vavassori A, Perrucci E, Cerrotta A, Lancellotta V, Meregalli S, Draghini L, Augurio A, De Sanctis V. Vaginal Toxicity Management in Patients with Locally Advanced Cervical Cancer following Exclusive Chemoradiation-A Nationwide Survey on Knowledge and Attitudes by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gynecology Study Group. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:385. [PMID: 36837584 PMCID: PMC9963963 DOI: 10.3390/medicina59020385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/23/2023] [Accepted: 02/06/2023] [Indexed: 02/19/2023]
Abstract
Background and Objective: Exclusive radiotherapy, including external beam radiotherapy (EBRT) and interventional radiotherapy/brachytherapy (IRT/BT), with concurrent cisplatin-based chemotherapy, represents the standard of care in patients with locally advanced cervical cancer (LACC). The emerging topic of vaginal toxicity has become a key endpoint in LACC management, although different approaches and non-standardized procedures were available. Our aim was to analyze a nationwide study of the attitudes of Italian gynecological radiation oncology teams in the management of LACC patients' vaginal toxicities. Methods: A nationwide survey of radiation oncologists specializing in the treatment of gynecological malignancies was performed, using the free SurveyMonkey platform, consisting of 26 items. The questionnaire was proposed by the Italian Association of Radiation Oncologists (AIRO) gynecological working group to all 183 Italian radiation oncology institutions, as per AIRO's website. Results: Fifty-eight questionnaires (31%) were completed and returned. The assessment of acute and late vaginal toxicities was systematic in 32 (55.2%) and 26 (44.8%) centers, respectively. In the case of EBRT, 70.7% of centers, according to the contouring and treatment plan data, did not contour the vagina as an organ at risk (OAR). Vaginal dose constraints were heterogeneous for both EBRT and IRT/BT. Local treatment to prevent vaginal toxicity was prescribed by 60.3% of radiation oncologists, mostly vaginal hyaluronic acid cream, and one center recommended vaginal estrogen preparations. During follow-up visits, vaginal toxicity was considered an issue to be investigated always (n = 31) or in sexually active women only (n = 11). Conclusions: This survey showed that wide variation exists with regard to recording and treating vaginal toxicity after exclusive chemoradiation for cervical cancer, underscoring the need to develop more comprehensive guidelines for contouring e-dose reporting of the vagina, so as to implement clinical approaches for vaginal toxicity.
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Affiliation(s)
- Francesca De Felice
- Radiation Oncology, Policlinico Umberto I, Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, Viale Regina Elena 326, 00161 Rome, Italy
| | - Lisa Vicenzi
- Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 1, 86100 Campobasso, Italy
| | - Andrea Vavassori
- Department of Radiotherapy, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141 Milano, Italy
| | - Elisabetta Perrucci
- Radiation Oncology Section, Perugia General Hospital, Piazzale Giorgio Menghini, 3, 06129 Perugia, Italy
| | - Annamaria Cerrotta
- Radioterapia Oncologica, Fondazione IRCS, Istituto Nazionale dei Tumori di Milano, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - Valentina Lancellotta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via Giuseppe Moscati, 31, 00168 Rome, Italy
| | - Sofia Meregalli
- Radioterapia Ospedale San Gerardo-ASST Via G. B. Pergolesi, 33, 20900 Monza, Italy
| | - Lorena Draghini
- Radiotherapy Oncology Centre, S. Maria Hospital, Viale Tristano di Joannuccio, 05100 Terni, Italy
| | - Antonietta Augurio
- Radiation Oncology Unit, “SS Annunziata” Hospital, “G. D’Annunzio” University, Via dei Vestini, 66100 Chieti, Italy
| | - Vitaliana De Sanctis
- Department of Medicine, Surgery and Translational Medicine, “Sapienza” University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
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Chin C, Damast S. Brachytherapy impacts on sexual function: An integrative review of the literature focusing on cervical cancer. Brachytherapy 2023; 22:30-46. [PMID: 36567175 DOI: 10.1016/j.brachy.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022]
Abstract
There is growing awareness of the importance of sexual health in the quality of life of cancer patients and survivors. Brachytherapy, a vital component for the curative treatment of cervical cancer, leads to both direct and indirect sequelae that result in vaginal and sexual morbidity. The emergence of 3D image-guided adaptive brachytherapy has led to a better understanding of dose-and-effect relationships for critical organs-at-risk and there are new recommendations for vaginal dose reporting in the ongoing EMBRACE II study. An understanding of the vagina as an organ-at-risk and its dose-and-effect relationships can help brachytherapists limit dose to the vagina and improve sexual morbidity. Brachytherapists play a critical role in the primary and secondary prevention of vaginal and sexual sequelae resulting from treatment. Through close surveillance and recognition of common symptoms, brachytherapists can intervene with effective strategies to prevent and treat vaginal and sexual symptoms. This review summarizes the current literature on dosimetric factors that may predict for vaginal morbidity. It will focus on quantitative and qualitative reports of brachytherapy-related vaginal toxicity and sexual dysfunction. Lastly, it will review the available evidence supporting clinical interventions to mitigate the development and progression of vaginal and sexual sequelae to improve functional quality post-treatment.
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Affiliation(s)
- Christine Chin
- Radiation Oncology, Columbia University Irving Medical Center New York, New York, NY.
| | - Shari Damast
- Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
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13
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Elia E, Brownell D, Chabaud S, Bolduc S. Tissue Engineering for Gastrointestinal and Genitourinary Tracts. Int J Mol Sci 2022; 24:ijms24010009. [PMID: 36613452 PMCID: PMC9820091 DOI: 10.3390/ijms24010009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
The gastrointestinal and genitourinary tracts share several similarities. Primarily, these tissues are composed of hollow structures lined by an epithelium through which materials need to flow with the help of peristalsis brought by muscle contraction. In the case of the gastrointestinal tract, solid or liquid food must circulate to be digested and absorbed and the waste products eliminated. In the case of the urinary tract, the urine produced by the kidneys must flow to the bladder, where it is stored until its elimination from the body. Finally, in the case of the vagina, it must allow the evacuation of blood during menstruation, accommodate the male sexual organ during coitus, and is the natural way to birth a child. The present review describes the anatomy, pathologies, and treatments of such organs, emphasizing tissue engineering strategies.
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Affiliation(s)
- Elissa Elia
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - David Brownell
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Chabaud
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Bolduc
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Correspondence: ; Tel.: +1-418-525-4444 (ext. 42282)
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Julius A, Croke J, Giannopoulos E, Manhertz JA, Lawrie K, Quartey NK, Papadakos J. Exploring Brachytherapy Discharge Educational Needs of Gynecological Cancer Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022:10.1007/s13187-022-02249-6. [PMID: 36512253 DOI: 10.1007/s13187-022-02249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Brachytherapy (BT) plays a fundamental role in the treatment of gynecological cancers. Patient education for vaginal self-management and dilator use post-BT involves an interdisciplinary team of healthcare professionals (HCPs) and there is a paucity of post-BT education guidelines. Our objective was to determine the educational needs of gynecological cancer patients surrounding vaginal self-management post-BT and to determine enablers and barriers to the provision of education by HCPs. This cross-sectional study recruited gynecological oncology patients receiving external beam radiotherapy and BT for curative intent. Patients completed a questionnaire to assess their vaginal self-management educational needs, preferred education modality, and desired timing of post-BT education. HCPs were invited to complete a questionnaire to identify enablers and barriers to providing BT education. Twenty patients and 53 HCPs participated. All patients rated each topic as very important/important with information about preventing vaginal stenosis as the most important overall (89%). When asked about topics they addressed during BT education, most HCPs reported that "explaining what vaginal stenosis is and the negative effects of stenosis" was always discussed with patients (N = 37/49, 77%). Barriers to providing post-BT education, including the patients' language and culture, as well as enablers, such as the use of written resources and tools for patients, were identified. Despite a high level of engagement, current education surrounding vaginal self-management post-BT may be inadequate.
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Affiliation(s)
- Anet Julius
- Collaborative Academic Practice (CAP), Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jennifer Croke
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Eleni Giannopoulos
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada
| | | | - Karen Lawrie
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada
| | - Naa Kwarley Quartey
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada
| | - Janet Papadakos
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada.
- The Institute for Education Research, University Health Network, Toronto, Canada.
- The Institute for Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Mohamad Muhit AM, Sy-Cherng Woon L, Nik Mhd Nor NS, Sidi H, Mohd Kalok AH, Kampan N@C, Shafiee MN. Sexual Dysfunction among Gynaecological Cancer Survivors: A Descriptive Cross-Sectional Study in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15545. [PMID: 36497627 PMCID: PMC9737182 DOI: 10.3390/ijerph192315545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/09/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Sexual dysfunction is a major issue among gynaecological cancer survivors. This study aimed to evaluate the prevalence of sexual dysfunction among survivors of gynaecological cancer in Malaysia and to determine its risk factors. METHODS A cross-sectional study was conducted of 116 married women with gynaecological cancer who attended the gynaeoncology and oncology clinics at Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Sociodemographic and clinical data were collected. Sexual dysfunction was measured using the Malay Version Female Sexual Function Index (MVFSFI). Univariate and multivariate logistic regression analyses were used to determine the risk factors of female sexual dysfunction. RESULTS The prevalence of sexual dysfunction among gynaecological cancer survivors was 60% (70 out of 116). Sexual dissatisfaction was the most prevalent domain of sexual dysfunction at 68.1%. Sexual dysfunction was significantly associated with low education levels (Primary level, AOR = 4.92, 95% CI: 1.12-21.63; secondary level, AOR = 4.06, 95% CI: 1.14-14.44). Non-Malays were significantly more likely to have sexual dysfunction compared with Malays (AOR = 3.57, 95% CI: 1.16-11.06). In terms of treatment, combinations of surgery and radiotherapy (AOR = 4.66, 95% CI: 1.01-21.47) as well as surgery and chemoradiation (AOR = 5.77, 95% CI: 1.20-27.85) were considered. CONCLUSIONS Gynaecological cancer survivors with lower education levels, non-Malay ethnicity, and receiving treatment combinations of surgery and radiotherapy or surgery and chemoradiation have a higher risk of sexual dysfunction. A holistic approach in managing the various sociocultural and clinical issues is required to prevent sexual dysfunction among these patients.
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Affiliation(s)
- Akmal Muzamir Mohamad Muhit
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Luke Sy-Cherng Woon
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Nik Sumayyah Nik Mhd Nor
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Hatta Sidi
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Aida Hani Mohd Kalok
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Nirmala @ Chandralega Kampan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Mohamad Nasir Shafiee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
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Smith T, Kingsberg SA, Faubion S. Sexual dysfunction in female cancer survivors: Addressing the problems and the remedies. Maturitas 2022; 165:52-57. [DOI: 10.1016/j.maturitas.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/11/2022] [Accepted: 07/16/2022] [Indexed: 10/31/2022]
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Brownell D, Chabaud S, Bolduc S. Tissue Engineering in Gynecology. Int J Mol Sci 2022; 23:12319. [PMID: 36293171 PMCID: PMC9603941 DOI: 10.3390/ijms232012319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 12/01/2022] Open
Abstract
Female gynecological organ dysfunction can cause infertility and psychological distress, decreasing the quality of life of affected women. Incidence is constantly increasing due to growing rates of cancer and increase of childbearing age in the developed world. Current treatments are often unable to restore organ function, and occasionally are the cause of female infertility. Alternative treatment options are currently being developed in order to face the inadequacy of current practices. In this review, pathologies and current treatments of gynecological organs (ovaries, uterus, and vagina) are described. State-of-the-art of tissue engineering alternatives to common practices are evaluated with a focus on in vivo models. Tissue engineering is an ever-expanding field, integrating various domains of modern science to create sophisticated tissue substitutes in the hope of repairing or replacing dysfunctional organs using autologous cells. Its application to gynecology has the potential of restoring female fertility and sexual wellbeing.
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Affiliation(s)
- David Brownell
- Centre de Recherche en Organogéneèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Chabaud
- Centre de Recherche en Organogéneèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Bolduc
- Centre de Recherche en Organogéneèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
- Department of Surgery, Faculty of Medicine, Laval University, Québec, QC G1V 0A6, Canada
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Morgan O, Lopez MD, Martinez AJC, Marshall DC, Schnur JB. Systematic Review of Comparisons Between Plastic and Silicone Dilators: Revealing a Knowledge Gap. Sex Med Rev 2022; 10:513-519. [PMID: 36030181 PMCID: PMC9561033 DOI: 10.1016/j.sxmr.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Vaginal stenosis is a distressing side effect of radiation therapy that can impair quality of life. Dilator therapy is an option for patients undergoing pelvic radiotherapy to mitigate vaginal stenosis. Currently, the dilators given to patients by most hospitals are made of plastic, compared to silicone dilators which are available on the market for purchase. OBJECTIVES We conducted a systematic literature review to find information to guide clinical recommendations to pelvic radiotherapy patients on potential differences regarding the use of plastic vs silicone dilators with regard to efficacy, cost, and patient preferences. METHODS A systematic literature review was conducted in Embase, MEDLINE, and PubMed using Emtree terms. To be included in the review, papers needed to: focus on female patients undergoing radiation therapy, assess a vaginal dilator, measure any dilator intervention outcome, and specifically compare plastic vs silicone dilators for any measured outcome (either qualitative or quantitative). RESULTS The initial search yielded 195 articles. Two area experts, with a third expert for arbitration, read each article and found that none met all review inclusion criteria. No studies were found that compared silicone to plastic dilators with regard to efficacy in treating vaginal stenosis due to radiation therapy, no studies were found that compared cost or cost-effectiveness of the 2 dilator types, and no studies were found comparing patient preferences or experiences (eg, comfort, adherence, ease of use) between the 2 dilator types. CONCLUSION The materials used to create dilators have never been rigorously compared in the context of radiotherapy-related vaginal stenosis. Institutions and patients have no data to guide their choice. Significantly more research at the patient and institutional level is needed to explore the potential long-term quality of life and cost benefits of improved adherence with silicone dilator use, and to guide shared decision-making regarding dilator choice. Morgan O, Lopez MD, Martinez AJC, et al. Systematic Review of Comparisons Between Plastic and Silicone Dilators: Revealing a Knowledge Gap. Sex Med Rev 2022;10:513-519.
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Affiliation(s)
- Orly Morgan
- University of Miami, Miller School of Medicine, Miami, FL, USA; University of Miami, Department of Public Health Sciences, Miami, FL, USA.
| | | | - Alberto J Caban Martinez
- University of Miami, Miller School of Medicine, Miami, FL, USA; University of Miami, Department of Public Health Sciences, Miami, FL, USA
| | - Deborah C Marshall
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York City, NY, USA; Icahn School of Medicine at Mount Sinai, Department of Radiation Oncology, New York City, NY, USA
| | - Julie B Schnur
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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Impact of Definitive Chemoradiation on Quality-of-Life Changes for Patients With Anal Cancer: Long-term Results of a Prospective Study. Dis Colon Rectum 2022; 65:642-653. [PMID: 35067501 DOI: 10.1097/dcr.0000000000002385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Maintaining and improving quality of life (QOL) are important goals of anal cancer management. This disease is generally curable, with many long-term survivors. OBJECTIVE Long-term QOL after chemoradiation for patients with anal cancer was evaluated. DESIGN This was a prospective cohort study. SETTINGS This study used data from a prospective study of patients with anal cancer who were treated with chemoradiation between 2008 and 2013. PATIENTS Patients with anal cancer who were treated with image-guided intensity-modulated radiation therapy were included. INTERVENTIONS English-speaking patients completed European Organization for Research and Treatment of Cancer cancer-specific (C30) and site-specific (CR29) QOL questionnaires at baseline, at end of radiation, at 3 and 6 months, and then annually. MAIN OUTCOMES MEASURES Long-term QOL was evaluated clinically (a change in score of ≥10 points was considered clinically significant) and statistically (using repeated-measurement analysis) by comparing the subscale scores at 1, 2, and 3 years with baseline scores. Subanalysis compared patients who received a radiation dose of 45 to 54 Gy versus 63 Gy. RESULTS Ninety-six patients were included (median follow-up of 56.5 months). The symptom and functional scales showed a clinically significant decline at the end of treatment with improvement by 3 months after treatment. There was a long-term statistically significant decline in dyspnea, body image, bowel embarrassment, fecal incontinence, and hair loss, and there was long-term statistically and clinically significant worsening of impotence. Higher radiation dose (63 Gy) was not associated with significantly worse QOL. LIMITATIONS Limitations included single-institution, single-arm study design, and lack of dose reconstruction (ie, analyses were based on prescribed, rather than delivered, dose). CONCLUSIONS Patients with anal cancer treated with chemoradiation reported recovery of overall QOL to baseline levels. Specific symptoms remained bothersome, emphasizing the need to address and manage the chemoradiation-induced symptoms, during treatment and in the long term. See Video Abstract at http://links.lww.com/DCR/B905. IMPACTO DE LA QUIMIORRADIACIN DEFINITIVA EN CAMBIOS EN LA CALIDAD DE VIDA DE LOS PACIENTES CON CNCER ANAL RESULTADOS A LARGO PLAZO DE UN ESTUDIO PROSPECTIVE ANTECEDENTES:Mantener y mejorar la calidad de vida son objetivos importantes del tratamiento del cáncer anal, ya que esta enfermedad generalmente es curable, con muchos sobrevivientes a largo plazo.OBJETIVO:Se evaluó la calidad de vida a largo plazo después de la quimiorradiación en pacientes con cáncer anal.DISEÑO:Este fue un estudio de cohorte prospectivo.ENTORNO CLINICO:Utilizamos datos de un estudio prospectivo en pacientes con cáncer anal tratados con quimiorradiación entre 2008-2013.PACIENTES:Los pacientes con cáncer anal fueron tratados con radioterapia de intensidad modulada guiada por imágenes.INTERVENCIONES:Los pacientes de habla inglesa completaron los cuestionarios de calidad de vida específicos de cáncer (C30) y específicos del sitio (CR29) de la Organización Europea para la Investigación y el Tratamiento del Cáncer al inicio, al final de la radiación, 3 y 6 meses, y luego anualmente.PRINCIPALES MEDIDAS DE RESULTADOS:Se evaluó a largo plazo la calidad de vida clínicamente (un cambio en la puntuación de ≥10 puntos se consideraron clínicamente significativo) y estadísticamente (usando análisis de medición repetida) comparando las subescalas de puntuación al 1, 2, y 3 años. Con puntuaciones de referencia. El subanálisis comparó pacientes que recibieron 45-54 Gy versus 63 Gy.RESULTADOS:Se incluyeron un total de 96 pacientes (mediana de seguimiento: 56,5 meses). La mayoría de las escalas funcionales y de síntomas mostraron una disminución clínicamente significativa al final del tratamiento con una mejoría a los 3 meses posteriores al tratamiento. Hubo una disminución estadísticamente significativa a largo plazo en disnea, imagen corporal, vergüenza intestinal, incontinencia fecal y pérdida de cabello; y hubo un empeoramiento a largo plazo estadística y clínicamente significativo en impotencia. La dosis de radiación más alta (63 Gy) no se asoció con una calidad de vida significativamente peor.LIMITACIONES:Institución única, diseño de estudio de un solo brazo y falta de recomposición de la dosis (es decir, los análisis se basan en la dosis prescrita, en lugar de la administrada).CONCLUSIÓNES:Los pacientes con cáncer anal tratados con quimiorradiación reportaron una recuperación de la QOL en general a los niveles de base. Síntomas específicos siguieron siendo molestos, lo que enfatiza la necesidad de resolver y tartar los síntomas inducidos por la quimiorradiación no solo durante el tratamiento, sino a largo plazo. Consulte Video Resumen en http://links.lww.com/DCR/B905. (Traducción- Dr. Francisco M. Abarca-Rendon).
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Charatsi D, Vanakara P, Evaggelopoulou E, Simopoulou F, Korfias D, Daponte A, Kyrgias G, Tolia M. Vaginal dilator use to promote sexual wellbeing after radiotherapy in gynecological cancer survivors. Medicine (Baltimore) 2022; 101:e28705. [PMID: 35089231 PMCID: PMC8797530 DOI: 10.1097/md.0000000000028705] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/06/2022] [Indexed: 01/05/2023] Open
Abstract
This study investigated the efficacy of a vaginal dilator (VD) for the treatment of radiation-induced vaginal stenosis (VS) and the effect of a VD on sexual quality of life.Fifty three patients with endometrial or cervical cancers participated in this prospective observational study. All participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined 4 times after radiotherapy (RT) and were also asked to complete a validated sexual function-vaginal changes questionnaire. SPSS version 20 and Minitab version 16 were used for the statistical analysis. The statistical significance was set at P < .05.The VS grading score decreased and the comfortably insertable VD size gradually increased throughout a year of VD use; all patients with initial grade 3 showed a VS of grade 2 after 12 months of VD use and 65.8% of the patients with initial grade 2 demonstrated a final VS of grade 1, while 77.8% of the participants who started with the first size of VD reached the third size after 12 months. Starting VD therapy ≤3 months after the end of RT was associated with a significant decrease in VS. A total of 60.9% of participants reported that they did not feel their vaginas were too small during intercourse after 12 months of dilation, whereas only 11.5% gave the same answer before starting dilation. Furthermore, 47.17% rated their satisfaction with their sexual life 5 out of 7 and only 3.77% gave a score of 3 after 12 months of dilation.Endometrial and cervical cancer survivors are encouraged to use VD to treat VS and for sexual rehabilitation after RT. This study recommends starting vaginal dilation no more than 3 months after treatment at least 2 to 3 times a week for 10 to 15 minutes over 12 months. However, larger, well-designed randomized clinical trials should be conducted to develop specific guidelines for VD use and efficacy in VS and sexual sexual quality of life after RT.
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Affiliation(s)
- Dimitra Charatsi
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Polyxeni Vanakara
- Department of Obstetrics and Gynecology, University Hospital of Larissa, Larissa, Greece
| | | | - Foteini Simopoulou
- Department of Radiation Oncology, Iaso Thessaly Hospital, Larissa, Greece
| | - Dimitrios Korfias
- Department of Gynecology, Metaxa Cancer Hospital, Mpotasi 51, Piraeus, Greece
| | - Alexandros Daponte
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
- Department of Obstetrics and Gynecology, University Hospital of Larissa, Larissa, Greece
| | - George Kyrgias
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
- Department of Radiation Oncology, University Hospital of Larissa, Larissa, Greece
| | - Maria Tolia
- Radiotherapy Department, Faculty of Medicine, School of Health Sciences, University of Crete, University Hospital of Heraklion, Heraklion, Crete, Greece
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Woelber L, Hampl M, zu Eulenburg C, Prieske K, Hambrecht J, Fuerst S, Klapdor R, Heublein S, Gass P, Rohner A, Canzler U, Becker S, Bommert M, Bauerschlag D, Denecke A, Hanker L, Runnebaumn I, Forner DM, Schochter F, Klar M, Schwab R, Koepke M, Kalder M, Hantschmann P, Ratiu D, Denschlag D, Schroeder W, Tuschy B, Baumann K, Mustea A, Soergel P, Bronger H, Bauerschmitz G, Kosse J, Koch MC, Ignatov A, Sehouli J, Dannecker C, Mahner S, Jaeger A. Risk for Pelvic Metastasis and Role of Pelvic Lymphadenectomy in Node-Positive Vulvar Cancer-Results from the AGO-VOP.2 QS Vulva Study. Cancers (Basel) 2022; 14:cancers14020418. [PMID: 35053582 PMCID: PMC8773532 DOI: 10.3390/cancers14020418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary In node-positive vulvar squamous cell cancer, questions of when and how to perform pelvic lymphadenectomy (LAE) as well as the optimal extent of pelvic treatment in general have been surrounded by considerable controversy. In Germany, systematic pelvic LAE is currently recommended as a staging procedure in patients at risk for pelvic nodal involvement in order to prevent morbidity caused by pelvic radiotherapy (RT) in patients without histologically-confirmed pelvic involvement. However, the population at risk for pelvic metastases remains insufficiently described, resulting in the potential overtreatment of a considerable proportion of patients with groin-positive disease. This applies to the indication to perform surgical staging but also to adjuvant RT of the pelvis without previous pelvic staging. Our study aims to describe the risk for pelvic lymph node metastasis with regard to positive groin nodes and to clarify the indication criteria for pelvic treatment in node-positive vulvar cancer. Abstract The need for pelvic treatment in patients with node-positive vulvar cancer (VSCC) and the value of pelvic lymphadenectomy (LAE) as a staging procedure to plan adjuvant radiotherapy (RT) is controversial. In this retrospective, multicenter analysis, 306 patients with primary node-positive VSCC treated at 33 gynecologic oncology centers in Germany between 2017 and 2019 were analyzed. All patients received surgical staging of the groins; nodal status was as follows: 23.9% (73/306) pN1a, 23.5% (72/306) pN1b, 20.4% (62/306) pN2a/b, and 31.9% (97/306) pN2c/pN3. A total of 35.6% (109/306) received pelvic LAE; pelvic nodal involvement was observed in 18.5%. None of the patients with nodal status pN1a or pN1b and pelvic LAE showed pelvic nodal involvement. Taking only patients with nodal status ≥pN2a into account, the rate of pelvic involvement was 25%. In total, adjuvant RT was applied in 64.4% (197/306). Only half of the pelvic node-positive (N+) patients received adjuvant RT to the pelvis (50%, 10/20 patients); 41.9% (122/291 patients) experienced recurrent disease or died. In patients with histologically-confirmed pelvic metastases after LAE, distant recurrences were most frequently observed (7/20 recurrences). Conclusions: A relevant risk regarding pelvic nodal involvement was observed from nodal status pN2a and higher. Our data support the omission of pelvic treatment in patients with nodal status pN1a and pN1b.
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Affiliation(s)
- Linn Woelber
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg—Eppendorf, 20246 Hamburg, Germany; (K.P.); (J.H.); (A.J.)
- Colposcopy Center at the Jerusalem Hospital Hamburg, 20357 Hamburg, Germany
- Correspondence:
| | - Monika Hampl
- Department of Gynecology, University Medical Center Duesseldorf, 40225 Duesseldorf, Germany;
| | - Christine zu Eulenburg
- Department of Epidemiology, UMCG, Universität Groningen, 9713 Groningen, The Netherlands;
| | - Katharina Prieske
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg—Eppendorf, 20246 Hamburg, Germany; (K.P.); (J.H.); (A.J.)
- Colposcopy Center at the Jerusalem Hospital Hamburg, 20357 Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
| | - Johanna Hambrecht
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg—Eppendorf, 20246 Hamburg, Germany; (K.P.); (J.H.); (A.J.)
| | - Sophie Fuerst
- Department of Obstetrics and Gynecology, University Hospital, LMU—University of Munich, 80377 Munich, Germany; (S.F.); (S.M.)
| | - Ruediger Klapdor
- Department of Obstetrics and Gynecology, Hannover Medical School, 30625 Hannover, Germany;
| | - Sabine Heublein
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Paul Gass
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Annika Rohner
- Department of Gynecology, University Medical Center Tuebingen, 72076 Tuebingen, Germany;
| | - Ulrich Canzler
- Department of Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany & National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany;
| | - Sven Becker
- Department of Gynecology and Obstetrics, University Medical Center Frankfurt, 60590 Frankfurt, Germany;
| | - Mareike Bommert
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, 45136 Essen, Germany;
| | - Dirk Bauerschlag
- Department of Gynecology, University Medical Center Kiel, 24105 Kiel, Germany;
| | - Agnieszka Denecke
- Department of Gynecology, Medical Center Wolfsburg, 38440 Wolfsburg, Germany;
| | - Lars Hanker
- Department of Gynecology and Gynecologic Oncology, University Medical Center Luebeck, 23562 Luebeck, Germany;
| | - Ingo Runnebaumn
- Department of Gynecology, Jena University Hospital, 07743 Jena, Germany;
| | - Dirk M. Forner
- Department of Gynecology, Evangelisches Krankenhaus Kalk, 51103 Cologne, Germany;
| | - Fabienne Schochter
- Department of Obstetrics and Gynecology, University of Ulm Medical Center, 89081 Ulm, Germany;
| | - Maximilian Klar
- Department of Gynecology, University Medical Center Freiburg, 79106 Freiburg, Germany;
| | - Roxana Schwab
- Department of Gynecology, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Melitta Koepke
- Department of Obstetrics and Gynaecology, University Hospital Augsburg, 86156 Augsburg, Germany; (M.K.); (C.D.)
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, University Hospital Marburg, 35043 Marburg, Germany;
| | - Peer Hantschmann
- Department of Gynecology and Obstetrics, Medical Center Altoetting, 84503 Altoetting, Germany;
| | - Dominik Ratiu
- Department of Gynecology, University Medical Center Koeln, 50937 Koeln, Germany;
| | - Dominik Denschlag
- Department of Gynecology, Hochtaunuskliniken, 61352 Bad Homburg, Germany;
| | - Willibald Schroeder
- Department of Gynecology, Medical Center Gynaecologicum Bremen, 28209 Bremen, Germany;
| | - Benjamin Tuschy
- Department of Gynecology, University Medical Center Mannheim, 68167 Mannheim, Germany;
| | - Klaus Baumann
- Department of Gynecology, Medical Center Ludwigshafen, 67063 Ludwigshafen, Germany;
| | - Alexander Mustea
- Department of Gynecology and Gynecologic Oncology, University Medical Center Bonn, 53127 Bonn, Germany;
| | - Philipp Soergel
- Department of Gynecology, University Medical Center Minden, 32429 Minden, Germany;
| | - Holger Bronger
- Department of Gynecology and Obstetrics, Technical University of Munich, 81675 Munich, Germany;
| | - Gerd Bauerschmitz
- Department of Gynecology, University Medical Center Goettingen, 37075 Goettingen, Germany;
| | - Jens Kosse
- Department of Gynecology, Sana Klinikum Offenbach, 63069 Offenbach am Main, Germany;
| | - Martin C. Koch
- Department of Gynecology, Medical Center Ansbach, 91522 Ansbach, Germany;
| | - Atanas Ignatov
- Department of Obstetrics and Gynecology, University Hospital Magdeburg, 39120 Magdeburg, Germany;
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological SurgeryNOGGO e.V., Charite Universitatsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany;
| | - Christian Dannecker
- Department of Obstetrics and Gynaecology, University Hospital Augsburg, 86156 Augsburg, Germany; (M.K.); (C.D.)
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU—University of Munich, 80377 Munich, Germany; (S.F.); (S.M.)
| | - Anna Jaeger
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg—Eppendorf, 20246 Hamburg, Germany; (K.P.); (J.H.); (A.J.)
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Adjuvant radiotherapy and local recurrence in vulvar cancer - a subset analysis of the AGO-CaRE-1 study. Gynecol Oncol 2021; 164:68-75. [PMID: 34794839 DOI: 10.1016/j.ygyno.2021.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The impact of adjuvant radiotherapy (RT) to the vulva with regard to prognosis and local recurrence in patients with vulvar squamous cell cancer (VSCC) is poorly described. PATIENTS AND METHODS In the AGO-CaRE-1 study 1618 patients with primary VSCC FIGO stage ≥ IB, treated between 1998-2008, were documented. In this retrospective subanalysis, 360 patients were included based on the following criteria: nodal involvement (pN+), known RT treatment and known radiation fields. RESULTS The majority had pT1b/pT2 tumors (n=299; 83.1%). In 76.7%, R0 resection was achieved. 57/360 (15.8%) N+ patients were treated with adjuvant RT to the groins/pelvis and 146/360 (40.5%) received adjuvant RT to the vulva and groins/pelvis. 157/360 (43.6%) patients did not receive any adjuvant RT. HPV status was available in 162/360 patients (45.0%), 75/162 tumors were HPV+(46.3%), 87/162 (53.7%) HPV-. During a median follow-up of 17.2 months, recurrence at the vulva only occurred in 25.5% of patients without adjuvant RT, in 22.8% of patients with adjuvant RT to groins/pelvis and in 15.8% of patients with adjuvant RT to the vulva and groins/pelvis respectively. The risk reducing effect of local RT was independent of the resection margin status. 50% disease free survival time (50% DFST) indicated a stronger impact of adjuvant RT to the vulva in HPV+ compared to HPV- patients (50% DFST 20.7 months vs. 17.8 months). CONCLUSION Adjuvant RT to the vulva was associated with a lower risk for local recurrence in N+ VSCC independent of the resection margin status. This observation was more pronounced in patients with HPV+ tumors in comparison to HPV- tumors.
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23
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Lai S, Rozen G, Polyakov A. Sexual function in reproductive-aged women following radiotherapy: a cross sectional study. Sex Health 2021; 18:358-365. [PMID: 34742363 DOI: 10.1071/sh20227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 07/16/2021] [Indexed: 11/23/2022]
Abstract
Background While female sexual dysfunction post-radiation therapy has been previously described, much of the literature is focused on older, often postmenopausal, women; and neglects the experiences of younger populations. Our study aims to describe the changes in sexual functioning following radiotherapy among women of a reproductive age. Methods A cross-sectional survey was conducted on reproductive-aged women post-radiation therapy. Information on sexual frequency, pleasure, discomfort and habit was collected and compared to responses from healthy women of comparable ages. Results Reproductive-aged women post-radiotherapy experienced decreased pleasure, more discomfort and had less sexual activity than healthy controls. However, sexual habit was comparable. Conclusions Our findings illustrated that most domains of sexual function are negatively affected in our study population. Understanding the sexual sequelae of radiation therapy may help guide clinicians in counselling their patients and planning their future needs.
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Affiliation(s)
- Shimona Lai
- Monash Women's, Monash Health, 246 Clayton Road, Clayton, Vic., Australia
| | - Genia Rozen
- Reproductive Services, The Royal Women's Hospital, 20 Flemington Road, Parkville, Vic., Australia; and Gynaecology Research Unit, The University of Melbourne, Parkville, Vic., Australia; and Melbourne IVF, Melbourne, Vic., Australia
| | - Alex Polyakov
- Reproductive Services, The Royal Women's Hospital, 20 Flemington Road, Parkville, Vic., Australia; and Melbourne IVF, Melbourne, Vic., Australia
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24
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Limkin EJ, Guérin F, Espenel S, Terlizzi M, Martelli H, Haie-Meder C, Minard V, Chargari C. Use of an intravaginal spacer in young girls treated with brachytherapy for bladder neck rhabdomyosarcoma: Dosimetric impact for organs at risk sparing and acute tolerance. Cancer Radiother 2021; 26:486-490. [PMID: 34711484 DOI: 10.1016/j.canrad.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Interstitial brachytherapy is indicated as part of a conservative strategy for children with bladder and/or prostate rhabdomyosarcoma (RMS), providing high local control probability with acceptable functional results. Vaginal and/or rectal complications were however reported, due to the close proximity to the implanted volume. We investigated the dosimetric impact of a vaginal spacer in terms of rectal and vaginal doses. METHODS AND PATIENTS Medical records of 12 consecutive female patients with bladder neck RMS, median age 32 months (range: 1.3-6 years), were reviewed. Five patients were treated prior to 2017 without a vaginal spacer and seven patients treated after 2017 had their brachytherapy delivered with a vaginal spacer placed at time of implant. RESULTS Minimal doses delivered to the most exposed 2cm3, 1cm3, and 0.5cm3 of the rectum were all statistically significantly lower among patients treated with a vaginal spacer, as compared to those treated without a spacer. Median rectal D2cm3 was 22GyEQD2 versus 38GyEQD2 (P=0.02), D1cm3 was 29GyEQD2 versus 51GyEQD2 (P=0.013), and D0.5cm3 was 32GyEQD2 versus 61GyEQD2 (P=0.017), with and without the vaginal spacer, respectively. The posterior vaginal wall D0.5cm3 dose was also significantly decreased, with median D0.5cm3 of 92GyEQD2 versus 54GyEQD2 (P<0.0001), with and without the spacer, respectively. Acute tolerance was excellent in all patients, with no need for replanning and no acute complication. CONCLUSIONS The use of vaginal spacers in brachytherapy of female pediatric patients with bladder neck RMS resulted in significantly decreased doses to the rectum and the posterior vaginal wall. Though the clinical impact of such dose reduction remains undemonstrated, routine utilization of a vaginal spacer could be a method to decrease long-term morbidity in these patients.
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Affiliation(s)
- E J Limkin
- Department of radiation oncology, Gustave Roussy Cancer Campus, université Paris-Saclay, 94805 Villejuif, France
| | - F Guérin
- Department of pediatric surgery, Kremlin-Bicêtre university hospital, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - S Espenel
- Department of radiation oncology, Gustave Roussy Cancer Campus, université Paris-Saclay, 94805 Villejuif, France
| | - M Terlizzi
- Department of radiation oncology, Gustave Roussy Cancer Campus, université Paris-Saclay, 94805 Villejuif, France
| | - H Martelli
- Department of pediatric surgery, Kremlin-Bicêtre university hospital, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - C Haie-Meder
- Department of radiation oncology, Gustave Roussy Cancer Campus, université Paris-Saclay, 94805 Villejuif, France
| | - V Minard
- Department of pediatric oncology, Gustave Roussy, université Paris-Saclay, 94805 Villejuif, France
| | - C Chargari
- Department of radiation oncology, Gustave Roussy Cancer Campus, université Paris-Saclay, 94805 Villejuif, France.
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25
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Elwood AD, Girda E. Decompression of hematocolpos caused by acquired obstruction in patient with prior radiation therapy for vaginal cancer. GYNECOLOGY & OBSTETRICS CASE REPORTS 2021; 7:161. [PMID: 36276805 PMCID: PMC9586845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND This report is intended to present a unique patient with acquired vaginal obstruction due to prior radiation therapy and subsequent development of hematocolpos. We present a method of surgical decompression for the hematocolpos as well as this patient's follow-up and prevention of re-epithelialization. CASE One patient was recruited and consented for this case study. Pre-operative evaluation, including examination and imaging, intra-operative findings, and post-operative evaluation were reported in this study. After surgical evaluation and drainage of hematocolpos via incision and drainage, a foley balloon was placed to prevent re-epithelialization. Intra-operative fluid cultures yielded no growth. At her follow-up appointment, the foley balloon was removed and the vaginal canal was intact without agglutination or re-accumulation of hematocolpos. CONCLUSIONS This is a unique case of acquired obstruction from radiation therapy causing significant symptomatic hematocolpos. We offer a minimally invasive approach for decompression, evaluation of malignancy, and prevention of re-obstruction. Her post-operative appointment showed resolution of symptoms and patent vaginal canal. Long-term outcomes are still required, including monitoring for malignant recurrence, re-obstruction and stenosis, and sexual health. If re-epithelialization occurs, more definitive therapy will be required, including excision of the vaginal septum or hysterectomy.
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Affiliation(s)
- Adam D Elwood
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ 08901
| | - Eugenia Girda
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ 08901
- Department of Gynecologic Oncology, Cancer Institute of New Jersey, New Brunswick, NJ 08901
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26
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Matanes E, Linder R, Lauterbach R, Mick I, Matanis J, Abdah-Bortnyak R, Reiss A, Amit A, Lowenstein L. The impact of radiation therapy on vaginal biomechanical properties. Eur J Obstet Gynecol Reprod Biol 2021; 264:36-40. [PMID: 34273752 DOI: 10.1016/j.ejogrb.2021.06.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/06/2021] [Accepted: 06/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In women with cervical cancer (CC), treatment with radiation causes changes in vaginal biomechanical properties, anatomy and function. The aims of the current study were to objectively assess effects of radiotherapy (RT) on vaginal elasticity, wall mobility and contraction strength; and to evaluate associations of these changes with sexual function. STUDY DESIGN This prospective cohort study was approved by our Institutional Review Board. Between May 2018 and June 2020, women with CC who were candidates for RT were eligible to participate. Participants underwent vaginal tactile imaging (VTI) evaluation and were asked to fill the Female Sexual Function Index (FSFI) questionnaire at the time of first RT session and at a 6-month post-treatment follow up visit. Women who underwent radical hysterectomy, or had pelvic side-wall, pelvic or distant organ metastasis were not included. RESULTS A total of 25 women with locally advanced CC were included in the final analysis. The mean age was 39 ± 2.7 years, the mean BMI was 24.8 ± 2.2 kg/m2 and the median parity was 2 (range: 1-5). Following RT, the mean scores for vaginal elasticity and vaginal tightening were significantly lower than at pre-treatment: 11.3 ± 2.5 vs. 28.3 ± 9, P < 0.0001 and 2.6 ± 0.7 vs. 16.7 ± 3, P < 0.0001, respectively. Following RT, significant decreases were demonstrated in vaginal wall mobility and pelvic muscle contraction strength: from 1.77 ± 0.34 to 0.36 ± 0.15, P < 0.0001 and from 2.55 ± 0.48 to 0.52 ± 0.23, P < 0.0001, respectively. Compared to pre-treatment, post-RT vaginal length was significantly shorter (3.30 ± 0.22 vs. 7.64 ± 0.63, P = 0.0023) and sexual intercourse frequency significantly lower: 1 (range 1-2) vs. 2 (range 1-4), P = 0.014). The mean total FSFI score was significantly lower following RT (6.7 ± 1 vs. 14.5 ± 2.7, P < 0.0001). CONCLUSIONS Women with locally advanced CC who have been treated with RT exhibit persistent vaginal biomechanical changes that compromise sexual activity and result in considerable distress.
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Affiliation(s)
- Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Revital Linder
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ido Mick
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Jawad Matanis
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Roxolyana Abdah-Bortnyak
- Department of Radiation Oncology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ari Reiss
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Amnon Amit
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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27
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Martins J, Vaz AF, Grion RC, Costa-Paiva L, Baccaro LF. Topical estrogen, testosterone, and vaginal dilator in the prevention of vaginal stenosis after radiotherapy in women with cervical cancer: a randomized clinical trial. BMC Cancer 2021; 21:682. [PMID: 34112100 PMCID: PMC8191143 DOI: 10.1186/s12885-021-08274-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/29/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We aimed to evaluate the effects of different therapeutic options to prevent the evolution of vaginal stenosis after pelvic radiotherapy in women with cervical cancer. METHODS open-label randomized clinical trial of 195 women, stage I-IIIB, aged 18-75 years, using topical estrogen (66), topical testosterone (34), water-based intimate lubricant gel (66), and vaginal dilators (29) to assess the incidence and severity of vaginal stenosis after radiotherapy at UNICAMP-Brazil, from January/2013 to May/2018. The main outcome measure was vaginal stenosis assessed using the Common Terminology Criteria for Adverse Events (CTCAE) scale and percental changes in vaginal volume. The women were evaluated at four different times: shortly after the end of radiotherapy, and four, eight, and 12 months after the beginning of the intervention. Statistical analysis was carried out using Symmetry test, Kruskal-Wallis test and multiple regression. RESULTS the mean age of women was 46.78 (±13.01) years, 61,03% were premenopausal and 73,84% had stage IIB-IIIB tumors. The mean reduction in vaginal volume in the total group was 25.47%, with similar worsening in the four treatment groups with no statistical difference throughout the intervention period. There was worsening of vaginal stenosis evaluated by CTCAE scale after 1 year in all groups (p < 0.01), except for the users of vaginal dilator (p = 0.37). CONCLUSIONS there was a reduction in vaginal volume in all treatment groups analyzed, with no significant difference between them. However, women who used vaginal dilators had a lower frequency and severity of vaginal stenosis assessed by the CTCAE scale after one year of treatment. TRIAL REGISTRATION Brazilian Registry of Clinical Trials, RBR-23w5fv . Registered 10 January 2017 - Retrospectively registered.
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Affiliation(s)
- Jumara Martins
- Radiotherapy Section, Woman's Hospital - Caism/Unicamp, Campinas, SP, Brazil
| | - Ana Francisca Vaz
- Radiotherapy Section, Woman's Hospital - Caism/Unicamp, Campinas, SP, Brazil
| | - Regina Celia Grion
- Radiotherapy Section, Woman's Hospital - Caism/Unicamp, Campinas, SP, Brazil
| | - Lúcia Costa-Paiva
- Department of Gynecology, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - Luiz Francisco Baccaro
- Department of Gynecology, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil.
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McCracken JM, Calderon GA, Robinson AJ, Sullivan CN, Cosgriff-Hernandez E, Hakim JCE. Animal Models and Alternatives in Vaginal Research: a Comparative Review. Reprod Sci 2021; 28:1759-1773. [PMID: 33825165 PMCID: PMC8204935 DOI: 10.1007/s43032-021-00529-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/01/2021] [Indexed: 12/13/2022]
Abstract
While developments in gynecologic health research continue advancing, relatively few groups specifically focus on vaginal tissue research for areas like wound healing, device development, and/or drug toxicity. Currently, there is no standardized animal or tissue model that mimics the full complexity of the human vagina. Certain practical factors such as appropriate size and anatomy, costs, and tissue environment vary across species and moreover fail to emulate all aspects of the human vagina. Thus, investigators are tasked with compromising specific properties of the vaginal environment as it relates to human physiology to suit their particular scientific question. Our review aims to facilitate the appropriate selection of a model aptly addressing a particular study by discussing pertinent vaginal characteristics of conventional animal and tissue models. In this review, we first cover common laboratory animals studied in vaginal research-mouse, rat, rabbit, minipig, and sheep-as well as human, with respect to the estrus cycle and related hormones, basic reproductive anatomy, the composition of vaginal layers, developmental epithelial origin, and microflora. In light of these relevant comparative metrics, we discuss potential selection criteria for choosing an appropriate animal vaginal model. Finally, we allude to the exciting prospects of increasing biomimicry for in vitro applications to provide a framework for investigators to model, interpret, and predict human vaginal health.
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Affiliation(s)
- Jennifer M McCracken
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Gisele A Calderon
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Andrew J Robinson
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Courtney N Sullivan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, 77030, USA
| | | | - Julie C E Hakim
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, 77030, USA.
- Department of Pediatric Surgery, Texas Children's Hospital, Houston, TX, 77030, USA.
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de Morais Siqueira T, Derchain S, Juliato CRT, Pinto E Silva MP, Machado HC, Brito LGO. Vaginal stenosis in women with cervical or endometrial cancer after pelvic radiotherapy: a cross-sectional study of vaginal measurements, risk for sexual dysfunction and quality of life. Int Urogynecol J 2021; 33:637-649. [PMID: 33891152 DOI: 10.1007/s00192-021-04798-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/09/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Radiotherapy (RT) for cervical (CC) and endometrial cancer (EC) is known to lead to vaginal stenosis (VS), but the comparison between vaginal anatomical measurements and the risk of sexual dysfunction presents a wide variety of results among the literature. Thus, we sought to assess the prevalence of VS, vaginal measurements, sexual dysfunction and QOL in women with CC and EC submitted to pelvic RT with or without previous surgery. METHODS Cross-sectional study that included 61 women with CC and 69 with EC. VS was classified by the Common Terminology Criteria for Adverse Effects version 5.0 (CTCAE v5.0), sexual function by the validated Female Sexual Function Index (FSFI) and QOL by the validated World Health Organization questionnaire (WHOQOL-BREF). Acrylic cylinders were used for vaginal measurements. Uni-/multivariate analyses to address factors associated with VC in both groups were performed. RESULTS The prevalence of VS was 79% and 67% within patients with CC and EC, respectively. Vagina length was decreased in both groups without statistical difference (7.2 ± 1.7 vs. 6.6 ± 1.8;p = 0.072). Vaginal diameter was significantly higher (p = 0.047) in women with EC (25.4 ± 6.3) than in those with CC (23.1 ± 5.7). Sexual dysfunction was highly prevalent for both CC and EC (88% vs. 91%; p = 0.598). There was no difference in all WHOQOL-BREF domains between women with CC and EC. CONCLUSIONS VS is highly prevalent in CC and EC patients, with vaginal length decreased in both groups but with a higher vaginal diameter in those with EC. Nevertheless, sexual dysfunction is highly prevalent in both groups.
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Affiliation(s)
- Thaís de Morais Siqueira
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Rua Alexander Fleming 101, Cidade Universitária, Campinas, SP, 13083-881, Brazil
| | - Sophie Derchain
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Rua Alexander Fleming 101, Cidade Universitária, Campinas, SP, 13083-881, Brazil
| | - Cassia Raquel Teatin Juliato
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Rua Alexander Fleming 101, Cidade Universitária, Campinas, SP, 13083-881, Brazil
| | - Marcela Ponzio Pinto E Silva
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Rua Alexander Fleming 101, Cidade Universitária, Campinas, SP, 13083-881, Brazil
| | - Helymar Costa Machado
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Rua Alexander Fleming 101, Cidade Universitária, Campinas, SP, 13083-881, Brazil
| | - Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Rua Alexander Fleming 101, Cidade Universitária, Campinas, SP, 13083-881, Brazil.
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Vaginal cuff brachytherapy practice in endometrial cancer patients: a report from the Turkish Oncology Group. J Contemp Brachytherapy 2021; 13:152-157. [PMID: 33897788 PMCID: PMC8060958 DOI: 10.5114/jcb.2021.105282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose The American Brachytherapy Association is attempting to develop standards for delivering brachytherapy, although differences in practice have been reported in the literature. This study evaluated vaginal cuff brachytherapy (VBT) practice and quality of life-related recommendations among Turkish radiation oncologists. Material and methods A nationwide web-based 17-item survey was distributed to the members of the Turkish Society for Radiation Oncology. These members received e-mail notifications, and a link was posted on the Turkish Society for Radiation Oncology internet site to solicit voluntary responses The survey addressed the simulation processes, target volume, prescribed dose, delivery schedules, and recommendations related to vaginal side effects. Results Fifty-seven radiation oncologists responded to the survey. The most used dose fraction schemes for adjuvant VBT were 7 Gy × 3 fractions (30%), 5.5 Gy × 5 fractions (26%), and 6 Gy × 5 fractions (28%). The preferred VBT scheme was 5 Gy × 3 fractions (50%) when the external beam radiotherapy (EBRT) dose was 45 Gy external radiotherapy, while the preferred schemes were 6 Gy × 3 fractions (30%) or 5 Gy × 3 fractions (32%) when the external radiotherapy dose was increased to 50.4 Gy. One-half of the respondents delivered VBT twice a week, and the dose was prescribed to 0.5 cm from vaginal mucosa by 86% of the respondents. There was no common definition for the dose prescription length, which was defined as 3 cm from the vaginal cuff in 33% of responses and as 4 cm in 35% of responses. For serous and clear cell histological types, 38% of the respondents targeted "full cylinder length". To prevent vaginal side effects, 78% of the respondents recommended using a vaginal dilator and/or sexual intercourse after VBT. Conclusions This survey revealed variations in the clinical practice of VBT among Turkish radiation oncologists, which suggests that standardization is necessary.
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Pelvic Radiation Therapy Induced Vaginal Stenosis: A Review of Current Modalities and Recent Treatment Advances. ACTA ACUST UNITED AC 2021; 57:medicina57040336. [PMID: 33915994 PMCID: PMC8066324 DOI: 10.3390/medicina57040336] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/03/2022]
Abstract
Radiation-induced vaginal stenosis (VS) is a common side effect of pelvic radiotherapy (RT). RT-induced VS may have various negative effects on women’s quality of life, in particular dyspareunia, decreased vaginal lubrication and difficulties in sexual intercourse. This narrative review provides the aspects of RT-induced VS pathogenesis, incidence, evaluation and associated risk factors. Available treatment modalities are discussed in the article, putting the focus on preliminary, although promising, experience in the use of hyaluronic acid and laser therapy in cancer survivors after pelvic RT.
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Abdelsalam SI, Velasco-Hernández JX, Zaher AZ. Electro-magnetically modulated self-propulsion of swimming sperms via cervical canal. Biomech Model Mechanobiol 2021; 20:861-878. [PMID: 33791911 DOI: 10.1007/s10237-020-01407-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/26/2020] [Indexed: 12/11/2022]
Abstract
The purpose of this study is to theoretically investigate the electro-magneto-biomechanics of the swimming of sperms through cervical canal in the female reproductive system. During sexual intercourse, millions of sperms migrate into the cervix in large groups, hence we can approximately model their movement activity by a swimming sheet through the electrically-conducting biofluid. The Eyring-Powell fluid model is considered as the base fluid to simulate male's semen with self-propulsive sperms. An external magnetic field is applied on the flow in transverse direction. The governing partial differential system of equations is analytically solved. Creeping flow regimen is employed throughout the channel due to self-propulsion of swimmers along with long wavelength approximation. Solutions for the stream function, velocity profile, and pressure gradient (above and below the swimming sheet) are obtained and plotted with the pertinent parameters. The prominent features of pumping characteristics are also investigated. Results indicate that the propulsive velocity is reduced with an increase in the electric field which is an important feature that can be used in controlling the transport of spermatozoa inside the cervical canal. Not only is the present analysis valid for living micro-organisms, but also valid for artificially designed electro-magnetic micro-swimmers which is further utilized in electro-magnetic therapy taking place in female's lubricous cervical canal filled with mucus.
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Affiliation(s)
- Sara I Abdelsalam
- Instituto de Matemáticas - Juriquilla, Universidad Nacional Autónoma de México, Blvd. Juriquilla 3001, 76230, Querétaro, Mexico. .,Basic Science, Faculty of Engineering, The British University in Egypt, Al-Shorouk City, Cairo, 11837, Egypt.
| | - Jorge X Velasco-Hernández
- Instituto de Matemáticas - Juriquilla, Universidad Nacional Autónoma de México, Blvd. Juriquilla 3001, 76230, Querétaro, Mexico
| | - A Z Zaher
- Engineering Mathematics and Physics Department, Faculty of Engineering, Shubra-Benha University, Cairo, Egypt
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Diagnostic Methods for Vaginal Stenosis and Compliance to Vaginal Dilator Use: A Systematic Review. J Sex Med 2021; 18:493-514. [PMID: 33526400 DOI: 10.1016/j.jsxm.2020.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 12/10/2020] [Accepted: 12/25/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Vaginal stenosis (VS) is a common side effect of pelvic radiotherapy for gynecological cancer in women. It has a high incidence variability, likely due to unstandardized and subjective assessment methods. Furthermore, even though the worldwide standard treatment for VS is vaginal dilation, low compliance rates have been noted. AIM To evaluate the parameters used to diagnose VS and to assess whether the lack of an objective measure of VS hampers vaginal dilator use. METHODS A systematic review in accordance with the PRISMA reporting guidelines was conducted. PubMed, EMBASE, and Web of Science databases were searched. Randomized trials and prospective, retrospective, and cross-sectional studies published from January 2011 to February 2020 were included. OUTCOMES The main outcome of this study was a review of the published literature on assessment methods for VS and compliance to vaginal dilator use. RESULTS Of the 28 articles obtained, only 7 used objective methods to measure the vaginal volume. 3 studies have demonstrated patient's concern with VS development and showed a high compliance to dilator use, whereas others reported several barriers to dilator use. CLINICAL IMPLICATIONS Lack of an objective assessment method can be a predisposing factor for uncertain VS incidence rates and impair compliance to vaginal dilator therapy, leading to long-term VS and sexual dysfunction. STRENGTHS & LIMITATIONS This is the first systematic review on the heterogeneity of VS evaluation methods and compliance to vaginal dilator use. All studies were comprehensively evaluated by 2 reviewers. The limitations included the heterogeneity of the study designs and the unstandardized criteria used to classify stenosis or to evaluate compliance to dilator use. Although 3 well-known databases were used, the inclusion of more data sources could have increased the number of publications included in this review. CONCLUSION VS is frequently diagnosed using subjective parameters. Few unstandardized objective methods are used to evaluate this condition. Regarding compliance to vaginal dilator use, there was a high dropout rate during follow-up and no consensus on starting time or ideal usage. Haddad NC, Soares Brollo LC, Pinho Oliveira MA, et al. Diagnostic Methods for Vaginal Stenosis and Compliance to Vaginal Dilator Use: A Systematic Review. J Sex Med 2021;18:493-514.
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When Love Hurts: Evaluation and Management of Painful Intercourse in Women. CURRENT SEXUAL HEALTH REPORTS 2021. [DOI: 10.1007/s11930-020-00300-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hatta S, Woon LSC, Nik Sumayyah NMN, Mohamad Nasir S. Psychosocial Determinants of Marital Satisfaction Among Gynecologic Cancer Survivors in Malaysia. Front Psychiatry 2021; 12:744922. [PMID: 34650458 PMCID: PMC8509300 DOI: 10.3389/fpsyt.2021.744922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Marital issues among gynecologic cancer survivors are common but complex. This study aimed to investigate the relationship between sociodemographic and clinical factors, including sexual dysfunction and marital satisfaction among Malaysian gynecologic cancer survivors. Methods: A cross-sectional survey of married women with gynecologic cancers was conducted at a Malaysian university hospital. Sociodemographic and clinical data were gathered. Sexual dysfunction was measured using the Malay Version Female Sexual Function Index (MVFSFI), while marital satisfaction was evaluated with the Malay Version Golombok Rust Inventory for Marital Satisfaction (MVGRIMS). Results: A total of 116 patients participated in this study. The median age was 59.0 years (Interquartile range, IQR: 49.0-67.0 years); the median duration of marriage was 32 years (IQR: 20.0-40.8 years). 80.2% had a secondary and lower level of education. 37.9% of study subjects (n = 44) reported poor-and below-levels of marital satisfaction, which was equivalent to MVGRIMS transformed scores of >5. The median FSFI total score was 49.9 (IQR: 2.0-63.0). MVGRIMS transformed score correlated significantly with all MVFSFI sub-scores. In logistic regression, lower educational levels were associated with poor marital satisfaction [primary, (adjusted Odds Ratio) aOR = 12.67, 95% CI: 1.40-114.87; secondary: aOR = 11.52, 95% CI: 1.39-95.72], while higher MVFSFI total score reduced the likelihood of poor marital satisfaction (aOR = 0.979, 95% CI: 0.964-0.994). Conclusion: Both sexual dysfunction and low education level may affect marital satisfaction among gynecologic cancer survivors. Targeted efforts focusing on sex education for patients may help to improve marital satisfaction.
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Affiliation(s)
- Sidi Hatta
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Luke Sy-Cherng Woon
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nik Mohd Nor Nik Sumayyah
- Department of Obstetrics and Gynecology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Shafiee Mohamad Nasir
- Department of Obstetrics and Gynecology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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Zhang Y, Fornes B, Gómez G, Bentoldrà I, Carmona C, Herreros A, Sabater S, Nicolás I, Li Y, Sánchez J, Biete A, Torné A, Ascaso C, Rovirosa Á. EQD2 Analyses of Vaginal Complications in Exclusive Brachytherapy for Postoperative Endometrial Carcinoma. Cancers (Basel) 2020; 12:E3059. [PMID: 33092163 PMCID: PMC7589275 DOI: 10.3390/cancers12103059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/08/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022] Open
Abstract
Background: To evaluate whether EQD2(α/β = 3Gy) at 2 cm3 of the most exposed area of the vagina is related to late vaginal toxicity in postoperative endometrial cancer (PEC) patients (p) treated with exclusive brachytherapy (BT). Methods: From 2014 to 2017, 43p were included in this study. BT was administered: 3-fractions of 6Gy in 37p and 2-fractions of 7.5Gy in 6p. The dose was prescribed at a depth of 5 mm from the applicator surface with dose-point optimization based on distance. The active treatment length was 2.5 cm. CTV-D90 and the dose to the most exposed 2 cm3 of the vagina was calculated for each patient. Late toxicity of the bladder and rectum was assessed using Radiation Therapy Oncology Group (RTOG) criteria, and vaginal toxicity by objective Late Effects Normal Tissue Task Force (LENT)-Subjective, Objective, Management, Analytic (SOMA) (LENT-SOMA) criteria. Statistics: frequency tables, mean, median, range, standard deviation, and box plot. Results: The median follow-up was 51 months (12-68). 20 p (46.5%) and 2 p (4.7%) developed G1 and G2 vaginal complications, respectively. Only 1/2 p-G2 receiving EQD2(α/β = 3Gy) at 2 cm3 >68Gy presented vaginal shortening and 18/20 p-G1 received doses < 68Gy. Conclusions: PECp receiving exclusive brachytherapy with doses < 68Gy EQD2(α/β = 3Gy) at 2 cm2 of the vagina presented only G0-G1 vaginal toxicity, except for one with bleeding telangiectasias. Larger prospective studies are necessary to confirm the present results.
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Affiliation(s)
- Yaowen Zhang
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
- Radiation Oncology Department, Hospital Clínic Universitari, 08036 Barcelona, Spain
| | - Balbino Fornes
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
| | - Gabriela Gómez
- Radiation Oncology Department, Hospital Ángeles Chihuahua, 31217 Chihuahua, Mexico;
| | - Irene Bentoldrà
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
| | - Clara Carmona
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
| | - Antonio Herreros
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
- Radiation Oncology Department, Hospital Clínic Universitari, 08036 Barcelona, Spain
| | - Sebastià Sabater
- Radiation Oncology Department, Hospital General Universitario de Albacete, 02006 Albacete, Spain;
| | - Inmaculada Nicolás
- Gynecologic Cancer Unit, Hospital Clínic Unversitari, 08036 Barcelona, Spain; (I.N.); (A.T.)
| | - Yan Li
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
| | - Joan Sánchez
- Economics Department, Hospital Clínic Universitari, 08036 Barcelona, Spain;
| | - Albert Biete
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
- Radiation Oncology Department, Hospital Clínic Universitari, 08036 Barcelona, Spain
- Gynecologic Cancer Unit, Hospital Clínic Unversitari, 08036 Barcelona, Spain; (I.N.); (A.T.)
| | - Aureli Torné
- Gynecologic Cancer Unit, Hospital Clínic Unversitari, 08036 Barcelona, Spain; (I.N.); (A.T.)
| | - Carlos Ascaso
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
| | - Ángeles Rovirosa
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
- Radiation Oncology Department, Hospital Clínic Universitari, 08036 Barcelona, Spain
- Gynecologic Cancer Unit, Hospital Clínic Unversitari, 08036 Barcelona, Spain; (I.N.); (A.T.)
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Comparison of catheter reconstruction techniques for the lunar ovoid channels of the Venezia TM applicator. J Contemp Brachytherapy 2020; 12:383-392. [PMID: 33293978 PMCID: PMC7690228 DOI: 10.5114/jcb.2020.98119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose The aim of this study was to compare catheter reconstruction methods for lunar ovoid channels of the VeneziaTM advanced gynecological applicator (Elekta, Sweden). Material and methods Three available lunar ovoid sizes (22, 26, and 30 mm effective diameter) were evaluated. Computed tomography (CT) scans were performed with a dummy wire inserted and with the Flexitron® source position simulator (SPS) at step sizes of 5 mm from the most distal dwell position. Treatment plans were generated in Oncentra® (version 4.5.3) with different catheter reconstruction techniques: centerline reconstruction, tracing a CT dummy wire, using a source path model provided by Elekta, and using the SPS at each planning dwell position. Source position agreement was assessed in registered CT images, and dose differences were calculated with the SPS-based treatment plan as a reference. Finally, dose-volume histogram (DVH) parameters were evaluated for clinical plans with the VeneziaTM applicator. Results For the most distal dwell position, the manufacturer’s model had the closest agreement with the SPS at 0.6 ±0.3 mm across applicator sizes. Relative to the SPS, maximal dose differences outside of the applicator were between 16-39% for a 0.1 cm3 volume and 3.6-9.1% for a 2.0 cm3 volume. For two clinical plans, volume-based DVH parameters agreed ≤ 3.9%, while deviations ≤ 5.3% were seen for point metrics. Conclusions Relative to the SPS-based plan, large local dose discrepancies were reduced, but not eliminated, using the manufacturer’s source path model. The choice of reconstruction technique was found to have relatively limited impact on DVH parameters for regions outside of the vaginal mucosa.
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Results of a Phase I-II Study on Laser Therapy for Vaginal Side Effects after Radiotherapy for Cancer of Uterine Cervix or Endometrium. Cancers (Basel) 2020; 12:cancers12061639. [PMID: 32575821 PMCID: PMC7352893 DOI: 10.3390/cancers12061639] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023] Open
Abstract
Women who have previously received radiotherapy (RT) for gynecologic cancer often suffer from vaginal fibrosis and stenosis. The success of “non-ablative” laser therapy for postmenopausal vaginal atrophy has led to the idea of testing the laser in patients submitted to RT. In this prospective observational study, we selected patients who underwent pelvic RT followed by vaginal laser treatment. We scheduled three treatment sessions (at T0–T1–T2) and three controls (at T1–T2–T3) one month apart. The follow-up (at T4) was carried out six months after the last treatment. Vaginal Health Index (VHI) and vaginal length were evaluated. Sexual function was assessed through Female Sexual Function Index (FSFI). Overall, 43 patients with severe vaginal shortening, atrophy and stenosis was enrolled and treated with intravaginal non-ablative CO2 laser. We observed a progressive increase in vaginal length of 9% (p = 0.03) at T2 and 28% (p < 0.0001) at T3; effects were maintained at T4 (p < 0.0001). After the first application VHI showed a significant improvement of 57% at T3 (p < 0.0001). The results were maintained at T4 (p < 0.0001). No changes were found in FSFI. All procedures were well tolerated. In conclusion, laser therapy improved vaginal length and VHI in women undergoing pelvic RT; prospective studies are needed.
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Summerfield J, Leong A. Management of radiation therapy-induced vaginal adhesions and stenosis: A New Zealand survey of current practice. J Med Radiat Sci 2020; 67:128-133. [PMID: 32267099 PMCID: PMC7276182 DOI: 10.1002/jmrs.386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Vaginal dilation is often indicated as an intervention for the management of radiation therapy-induced vaginal adhesions and stenosis (RTVAS). However, limited research exists underpinning this intervention and diversity in patient recommendations internationally are reported. In the absence of New Zealand (NZ) national guidelines regarding the management of RTVAS, a survey of NZ radiation therapy departments was conducted to gain an overview of current practice. METHODS A two-section online survey was developed to capture RTVAS education and management overview across NZ. Section one focused on departmental resourcing and section two on local standard practice regarding vaginal dilator usage. One RTVAS education representative from each department was invited to complete the survey. RESULTS Eight of nine NZ departments completed the survey. Consistent treatment indications were identified for RTVAS patient education with the involvement of diverse staffing groups at various time-points throughout the treatment process. Protocols for RTVAS management existed in each RT department with staff commonly trained by informal peer observation. Dilator usage was recommended regardless of patient sexual activity. Agreement was shown regarding the recommended start time of dilator usage and frequency. The recommended duration of dilator use post-treatment varied from 6 months to greater than 36 months. CONCLUSIONS This work illustrates both concordance and diversity in practice and contributes to the limited body of literature available. Further research is warranted to explore patterns of practice between departmental protocols and individual practitioners in further detail.
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Affiliation(s)
- Janeane Summerfield
- Department of Radiation TherapyWellington Blood and Cancer CentreWellingtonNew Zealand
| | - Aidan Leong
- Department of Radiation TherapyUniversity of OtagoWellingtonNew Zealand
- Bowen Icon Cancer CentreWellingtonNew Zealand
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Morris L, Tharmalingam H. The physical and psychological sexual well-being of women with pelvic malignancy: how can we understand and improve our practice? J Med Radiat Sci 2020; 67:100-101. [PMID: 32452091 PMCID: PMC7276181 DOI: 10.1002/jmrs.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/09/2022] Open
Abstract
How can we better understand and improve our practice around the physical and psychological well-being of women treated with radiation therapy for pelvic malignancy? In this issue, Summerfield et al report the results of a nationwide survey capturing practices around the management of radiation therapy-induced vaginal adhesions and stenosis (RTVAS) across New Zealand. This study highlights the need for oncologists to improve care around a challenging but critically important aspect of women's health beyond a cancer diagnosis.
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Affiliation(s)
- Lucinda Morris
- St George Cancer Care Centre ‐ Radiation OncologySydneyNSWAustralia
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Łaniewski P, Ilhan ZE, Herbst-Kralovetz MM. The microbiome and gynaecological cancer development, prevention and therapy. Nat Rev Urol 2020; 17:232-250. [PMID: 32071434 PMCID: PMC9977514 DOI: 10.1038/s41585-020-0286-z] [Citation(s) in RCA: 188] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 12/16/2022]
Abstract
The female reproductive tract (FRT), similar to other mucosal sites, harbours a site-specific microbiome, which has an essential role in maintaining health and homeostasis. In the majority of women of reproductive age, the microbiota of the lower FRT (vagina and cervix) microenvironment is dominated by Lactobacillus species, which benefit the host through symbiotic relationships. By contrast, the upper FRT (uterus, Fallopian tubes and ovaries) might be sterile in healthy individuals or contain a low-biomass microbiome with a diverse mixture of microorganisms. When dysbiosis occurs, altered immune and metabolic signalling can affect hallmarks of cancer, including chronic inflammation, epithelial barrier breach, changes in cellular proliferation and apoptosis, genome instability, angiogenesis and metabolic dysregulation. These pathophysiological changes might lead to gynaecological cancer. Emerging evidence shows that genital dysbiosis and/or specific bacteria might have an active role in the development and/or progression and metastasis of gynaecological malignancies, such as cervical, endometrial and ovarian cancers, through direct and indirect mechanisms, including modulation of oestrogen metabolism. Cancer therapies might also alter microbiota at sites throughout the body. Reciprocally, microbiota composition can influence the efficacy and toxic effects of cancer therapies, as well as quality of life following cancer treatment. Modulation of the microbiome via probiotics or microbiota transplant might prove useful in improving responsiveness to cancer treatment and quality of life. Elucidating these complex host-microbiome interactions, including the crosstalk between distal and local sites, will translate into interventions for prevention, therapeutic efficacy and toxic effects to enhance health outcomes for women with gynaecological cancers.
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Affiliation(s)
- Paweł Łaniewski
- Department of Basic Medical Sciences, College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Zehra Esra Ilhan
- Department of Obstetrics and Gynecology, College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Melissa M. Herbst-Kralovetz
- Department of Basic Medical Sciences, College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA,Department of Obstetrics and Gynecology, College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA,UA Cancer Center, University of Arizona, Phoenix/Tucson, AZ, USA,Correspondence:
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Dilalla V, Chaput G, Williams T, Sultanem K. Radiotherapy side effects: integrating a survivorship clinical lens to better serve patients. Curr Oncol 2020; 27:107-112. [PMID: 32489253 PMCID: PMC7253739 DOI: 10.3747/co.27.6233] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The Canadian Cancer Society estimated that 220,400 new cases of cancer would be diagnosed in 2019. Of the affected patients, more than 60% will survive for 5 years or longer after their cancer diagnosis. Furthermore, nearly 40% will receive at least 1 course of radiotherapy (rt). Radiotherapy is used with both curative and palliative intent: to treat early-stage or locally advanced tumours (curative) and for symptom management in advanced disease (palliative). It can be delivered systemically (external-beam rt) or internally (brachytherapy). Although technique improvements have drastically reduced the occurrence of rt-related toxicity, most patients still experience burdensome rt side effects (seffs). Radiotherapy seffs are local or locoregional, and manifest in tissues or organs that were irradiated. Side effects manifesting within weeks after rt completion are termed "early seffs," and those occurring months or years after treatment are termed "late seffs." In addition to radiation oncologists, general practitioners in oncology and primary care providers are involved in survivorship care and management of rt seffs. Here, we present an overview of common seffs and their respective management: anxiety, depression, fatigue, and effects related to the head-and-neck, thoracic, and pelvic treatment sites.
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Affiliation(s)
- V Dilalla
- Division of Radiation Oncology, McGill University, Montreal, QC
| | - G Chaput
- Department of Family Medicine (Secondary Care), Division of Supportive and Palliative Medicine, McGill University Health Centre, and McGill University, Montreal, QC
| | - T Williams
- Cancer Care Mission Patients' Committee, McGill University Health Centre, Montreal, QC
| | - K Sultanem
- Department of Oncology, Division of Radiation Oncology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
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Miccò M, Campitelli M, Sbarra M, Carra N, Barone R, Gui B, Gambacorta MA, Valentini V, Manfredi R. DW-MRI predictive factors for radiation-induced vaginal stenosis in patients with cervical cancer. Clin Radiol 2019; 75:216-223. [PMID: 31806362 DOI: 10.1016/j.crad.2019.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022]
Abstract
AIM To find diffusion-weighted (DW) magnetic resonance imaging (MRI) parameters predictive for radiation-induced vaginal stenosis (VS) in locally advanced cervical cancer (LACC) treated with neoadjuvant chemoradiation therapy (CRT). MATERIALS AND METHODS Retrospective analysis of 43 patients with LACC who underwent 1.5 T DW-MRI before (baseline), after 2 weeks (early), and at the end of CRT (final). At MRI, vaginal length, thickness, width, and cervical tumour volume (TV) were measured. Vaginal signal intensity at DW-MRI was analysed at final MRI. CRT-induced VS was graded using Common Terminology Criteria for Adverse Events (CTCAE) v4.03. Correlations between DW-MRI and clinical data were made using Wilcoxon's test, Mann-Whitney test, Fisher's exact test, or chi-squared test as appropriate. Receiver operating characteristic (ROC) curves were generated for variables to evaluate diagnostic ability to predict CRT-induced VS using a logistic regression model. RESULTS Asymptomatic vaginal toxicity (CTCAE Grade 1) was observed in 14 patients and symptomatic CRT-induced VS (CTCAE Grade ≥2) was detected in 29 patients. Baseline TV was higher in Grade 1 than in Grade ≥2 (p=0.013). Median vaginal length, thickness, and width decreased between baseline and final MRI in all patients (p<0.0001) without significant variances between CTCAE grades. Significant differences were observed in DW-MRI patterns (p<0.0001). In Grade ≥2, DWI showed signal loss of vaginal mucosa in 17 patients (63%) and diffuse restricted diffusion of vaginal wall in eight patients (30%). AUC was 0.938 (coefficient=4.72; p<0.001) for DWI and 0.712 (coefficient=-2.623×10 -5; p=0.004) for TV. CONCLUSIONS This is the first study using DW-MRI for predicting CRT-induced VS. DWI is useful tool in patients with LACC after CRT for early prevention and management strategies for VS.
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Affiliation(s)
- M Miccò
- Radiologia Diagnostica e Interventistica Generale, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy
| | - M Campitelli
- Radioterapia Oncologica, Area Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy
| | - M Sbarra
- Radiologia Diagnostica e Interventistica Generale, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, 00168, Italy.
| | - N Carra
- Radioterapia Oncologica, Area Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, 00168, Italy
| | - R Barone
- RADIUS S.r.l., Budrio (BO), Italy
| | - B Gui
- Radiologia Diagnostica e Interventistica Generale, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy
| | - M A Gambacorta
- Radioterapia Oncologica, Area Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, 00168, Italy
| | - V Valentini
- Radioterapia Oncologica, Area Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, 00168, Italy
| | - R Manfredi
- Radiologia Diagnostica e Interventistica Generale, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, 00168, Italy
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de Meric de Bellefon M, Lemanski C, Castan F, Samalin E, Mazard T, Lenglet A, Demontoy S, Riou O, Llacer-Moscardo C, Fenoglietto P, Aillères N, Thezenas S, Debrigode C, Vieillot S, Gourgou S, Azria D. Long-term follow-up experience in anal canal cancer treated with Intensity-Modulated Radiation Therapy: Clinical outcomes, patterns of relapse and predictors of failure. Radiother Oncol 2019; 144:141-147. [PMID: 31809980 DOI: 10.1016/j.radonc.2019.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/02/2019] [Accepted: 11/14/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE To assess the long-term outcomes of patients with squamous cell carcinoma of the anal canal (SCCAC) treated with Intensity-Modulated Radiation Therapy (IMRT). MATERIAL AND METHODS From 2007 to 2015, 193 patients were treated by IMRT for SCCAC. Radiotherapy delivered 45 Gy in 1.8 Gy daily-fractions to the primary tumor and elective nodal areas, immediately followed by a boost of 14.4-20 Gy to the primary tumor and involved nodes. Concurrent chemotherapy with 5-FU-mitomycin (MMC) or cisplatin was added for locally advanced tumors. Survivals were estimated by Kaplan-Meier method. Locoregional (LR) relapses were precisely assessed. Prognostic factors were evaluated by uni- and multivariate analyses. Late toxicity was scored according to the Common Toxicity Criteria for Adverse Events v4.0. RESULTS Median follow-up was 70 months (range, 1-131). Forty-nine men (25%) and 144 women (75%) were analyzed. Median age was 62 years. Tumor stages were I, II, III and IV in 7%, 24%, 63% and 6% of cases, respectively. Chemotherapy was delivered in 167 patients (87%), mainly MMC (80%). Five-year OS, DFS, CFS and LR control rates were 74%, 68%, 66% and 85%, respectively. Forty-one patients (21%) had a relapse: 22 were LR, mostly in-field (68%). Predictors for LR failure were exclusive radiotherapy, chemotherapy lacking MMC and treatment breaks >3 days. Overall late toxicity ≥grade 2 occurred in 43% of patients, with 24% grade 3 and one case of grade 4 (hematuria). CONCLUSION CRT with IMRT assures excellent local control in locally advanced SCCAC with manageable long-term toxicity. Multicentric prospective trials are required to reinforce those results.
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Affiliation(s)
- Maïlys de Meric de Bellefon
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France.
| | - Claire Lemanski
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Florence Castan
- Biometrics Unit ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Emmanuelle Samalin
- Department of Medical Oncology, ICM, Montpellier Cancer Institute - University of Montpellier, INSERM U1194, IRCM, France
| | - Thibault Mazard
- Department of Medical Oncology, ICM, Montpellier Cancer Institute - University of Montpellier, INSERM U1194, IRCM, France
| | - Alexis Lenglet
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Sylvain Demontoy
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Olivier Riou
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Carmen Llacer-Moscardo
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Pascal Fenoglietto
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Norbert Aillères
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Simon Thezenas
- Biometrics Unit ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Charles Debrigode
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, CHU Nîmes, France
| | - Sabine Vieillot
- Department of Radiation Oncology, Catalan Oncology Center, Perpignan, France
| | - Sophie Gourgou
- Biometrics Unit ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - David Azria
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
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Dias MTPM, Bilhar APM, Rios LC, Costa BA, Duete ÚR, Lima Júnior EM, Alves APNN, Bruno ZV, de Moraes Filho MO, Bezerra LRPS. Neovaginoplasty for radiation-induced vaginal stenosis using Nile Tilapia Fish Skin as a biological graft. J Surg Case Rep 2019; 2019:rjz311. [PMID: 31768241 PMCID: PMC6865336 DOI: 10.1093/jscr/rjz311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/01/2019] [Indexed: 12/24/2022] Open
Abstract
Tilapia skin showed good results when used as a biological graft for surgical management of Mayer-Rokitansky-Küster-Hauser syndrome. Thus, our researchers considered the use of this biomaterial for neovaginoplasty in radiation-induced vaginal stenosis. We report the case of a 41-year-old female patient with a total occlusion of the vaginal canal after radiotherapy for vaginal cancer. McIndoe neovaginoplasty using tilapia skin as a scaffold for proliferation of new vaginal epithelium was performed. Initially, laparoscopic dissection of the rectovaginal septum and vesicovaginal space spaces was conducted. In the vaginal surgical time, a transverse transmural incision was made in the scarred vaginal reminiscent followed by blunt dissection and insertion of an acrylic mold covered with tilapia skin. Good anatomical and functional outcomes were noted. Vaginal reconstruction with tilapia skin seems to be an excellent option for patients with radiation-induced vaginal stenosis due to its wide availability, easy application and high effectiveness.
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Affiliation(s)
| | | | - Livia Cunha Rios
- Maternity School Assis Chateaubriand (MEAC), Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | - Bruno Almeida Costa
- Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | - Úlima Rates Duete
- Maternity School Assis Chateaubriand (MEAC), Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | | | | | - Zenilda Vieira Bruno
- Maternity School Assis Chateaubriand (MEAC), Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
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Savoie MB, Laffan A, Brickman C, Daniels B, Levin A, Rowen T, Smith J, Van Blarigan EL, Hope TA, Berry-Lawhorn JM, Anwar M, Van Loon K. A multi-disciplinary model of survivorship care following definitive chemoradiation for anal cancer. BMC Cancer 2019; 19:906. [PMID: 31510960 PMCID: PMC6737598 DOI: 10.1186/s12885-019-6053-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/19/2019] [Indexed: 12/13/2022] Open
Abstract
Following definitive chemoradiation for anal squamous cell carcinoma (ASCC), patients face a variety of chronic issues including: bowel dysfunction, accelerated bone loss, sexual dysfunction, and psychosocial distress. The increasing incidence of this disease, high cure rates, and significant long-term sequelae warrant increased focus on optimal survivorship care following definitive chemoradiation. In order to establish our survivorship care model for ASCC patients, a multi-disciplinary team of experts performed a comprehensive literature review and summarized best practices for the multi-disciplinary management of this unique patient population. We reviewed principle domains of our survivorship approach: (1) management of chronic toxicities; (2) sexual health; (3) HIV management in affected patients; (4) psychosocial wellbeing; and (5) surveillance for disease recurrence and survivorship care delivery. We provide recommendations for the optimization of survivorship care for ASCC patients can through a multi-disciplinary approach that supports physical and psychological wellness.
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Affiliation(s)
- Marissa B Savoie
- School of Medicine, University of California, San Francisco, USA
| | - Angela Laffan
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
| | - Cristina Brickman
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, USA
| | - Bevin Daniels
- Department of Physical Therapy, University of California, San Francisco, USA
| | - Anna Levin
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
- Department of Psycho-Oncology, University of California, San Francisco, USA
| | - Tami Rowen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - James Smith
- Department of Urology, University of California, San Francisco, USA
| | - Erin L Van Blarigan
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
- Department of Urology, University of California, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Thomas A Hope
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - J Michael Berry-Lawhorn
- Department of Medicine, Division of Hematology/Oncology, University of California, San Francisco, USA
| | - Mekhail Anwar
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
- Department of Radiation Oncology, University of California, San Francisco, USA
| | - Katherine Van Loon
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA.
- Department of Medicine, Division of Hematology/Oncology, University of California, San Francisco, USA.
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Athanasiou S, Pitsouni E, Grigoriadis T, Michailidis G, Tsiveleka A, Rodolakis A, Loutradis D. A study protocol of vaginal laser therapy in gynecological cancer survivors. Climacteric 2019; 23:53-58. [DOI: 10.1080/13697137.2019.1646720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- S. Athanasiou
- Urogynaecology Unit, 1st Department of Obstetrics and Gynecology, ‘Alexandra’ Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E. Pitsouni
- Urogynaecology Unit, 1st Department of Obstetrics and Gynecology, ‘Alexandra’ Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - T. Grigoriadis
- Urogynaecology Unit, 1st Department of Obstetrics and Gynecology, ‘Alexandra’ Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - G. Michailidis
- Department of Radiation Oncology, ’Alexandra’ Hospital, Athens, Greece
| | - A. Tsiveleka
- Cytological Department, ’Alexandra’ Hospital, Athens, Greece
| | - A. Rodolakis
- Oncologic Unit, 1st Department of Obstetrics and Gynecology, ‘Alexandra’ Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - D. Loutradis
- 1st Department of Obstetrics and Gynecology, ’Alexandra’ Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Cerentini TM, Schlöttgen J, Viana da Rosa P, La Rosa VL, Vitale SG, Giampaolino P, Valenti G, Cianci S, Macagnan FE. Clinical and Psychological Outcomes of the Use of Vaginal Dilators After Gynaecological Brachytherapy: a Randomized Clinical Trial. Adv Ther 2019; 36:1936-1949. [PMID: 31209699 PMCID: PMC6822871 DOI: 10.1007/s12325-019-01006-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the dimensions of the vaginal canal in patients undergoing gynaecological brachytherapy and the effect of the use of vaginal dilators (VD) used in the follow-up of pelvic physiotherapy. METHODS A total of 88 patients were randomly allocated to the control group (CG) and intervention group (IG). Three evaluations were performed: pre-brachytherapy, post-brachytherapy and follow-up of 3 months. The CG received standard guidance from the health team while the IG was instructed to use VD for 3 months. The dimensions of the vaginal canal (main outcome) were defined by the length of the vagina (centimetres), width (number of full clockwise turns of the opening thread of a gynaecological speculum) and area (defined by the size of the VD). Quality of life and pelvic floor (PF) functionality were also evaluated. RESULTS There was no effect of the VD on vaginal length, width and area among the intention-to-treat (ITT) population. However, in the analysis stratified by adhesion, the CG had a significant decrease in the vaginal area. PF was predominantly hypoactive throughout the follow-up. Quality of life improved in both groups, but the reduction of constipation, vaginal dryness and stress urinary incontinence manifested only in the IG. CONCLUSION The use of VD did not alter the dimensions of the vaginal canal within the first 3 months after the end of radiotherapy treatment. However, there was a large sample loss during follow-up so studies with a larger sample number and longer follow-up time need to be conducted. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03090217.
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Affiliation(s)
| | - Júlia Schlöttgen
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | | | | | - Salvatore Giovanni Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy.
| | - Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Stefano Cianci
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Damast S, Jeffery DD, Son CH, Hasan Y, Carter J, Lindau ST, Jhingran A. Literature Review of Vaginal Stenosis and Dilator Use in Radiation Oncology. Pract Radiat Oncol 2019. [PMID: 31302301 DOI: 10.1016/j.prro.2019.07.001.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
PURPOSE Guidelines for the care of women undergoing pelvic radiation therapy (RT) recommend vaginal dilator therapy (VDT) to prevent radiation-induced vaginal stenosis (VS); however, no standard protocol exists. This review seeks to update our current state of knowledge concerning VS and VDT in radiation oncology. METHODS AND MATERIALS A comprehensive literature review (1972-2017) was conducted using search terms "vaginal stenosis," "radiation," and "vaginal dilator." Information was organized by key concepts including VS definition, time course, pathophysiology, risk factors, and interventions. RESULTS VS is a well-described consequence of pelvic RT, with early manifestations and late changes evolving over several years. Strong risk factors for VS include RT dose and volume of vagina irradiated. Resultant vaginal changes can interfere with sexual function and correlational studies support the use of preventive VDT. The complexity of factors that drive noncompliance with VDT is well recognized. There are no prospective data to guide optimal duration of VDT, and the consistency with which radiation oncologists monitor VS and manage its consequences is unknown. CONCLUSIONS This review provides information concerning VS definition, pathophysiology, and risk factors and identifies domains of VDT practice that are understudied. Prospective efforts to monitor and measure outcomes of patients who are prescribed VDT are needed to guide practice.
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Affiliation(s)
- Shari Damast
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut.
| | - Diana D Jeffery
- Department of Defense, Defense Health Agency, Falls Church, Virginia
| | - Christina H Son
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Yasmin Hasan
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Jeanne Carter
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois; Department of Medicine-Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois; Comprehensive Cancer Center, University of Chicago, Chicago, Illinois
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Damast S, Jeffery DD, Son CH, Hasan Y, Carter J, Lindau ST, Jhingran A. Literature Review of Vaginal Stenosis and Dilator Use in Radiation Oncology. Pract Radiat Oncol 2019; 9:479-491. [PMID: 31302301 DOI: 10.1016/j.prro.2019.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/03/2019] [Accepted: 07/01/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Guidelines for the care of women undergoing pelvic radiation therapy (RT) recommend vaginal dilator therapy (VDT) to prevent radiation-induced vaginal stenosis (VS); however, no standard protocol exists. This review seeks to update our current state of knowledge concerning VS and VDT in radiation oncology. METHODS AND MATERIALS A comprehensive literature review (1972-2017) was conducted using search terms "vaginal stenosis," "radiation," and "vaginal dilator." Information was organized by key concepts including VS definition, time course, pathophysiology, risk factors, and interventions. RESULTS VS is a well-described consequence of pelvic RT, with early manifestations and late changes evolving over several years. Strong risk factors for VS include RT dose and volume of vagina irradiated. Resultant vaginal changes can interfere with sexual function and correlational studies support the use of preventive VDT. The complexity of factors that drive noncompliance with VDT is well recognized. There are no prospective data to guide optimal duration of VDT, and the consistency with which radiation oncologists monitor VS and manage its consequences is unknown. CONCLUSIONS This review provides information concerning VS definition, pathophysiology, and risk factors and identifies domains of VDT practice that are understudied. Prospective efforts to monitor and measure outcomes of patients who are prescribed VDT are needed to guide practice.
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Affiliation(s)
- Shari Damast
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut.
| | - Diana D Jeffery
- Department of Defense, Defense Health Agency, Falls Church, Virginia
| | - Christina H Son
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Yasmin Hasan
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Jeanne Carter
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois; Department of Medicine-Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois; Comprehensive Cancer Center, University of Chicago, Chicago, Illinois
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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