Efficacy of preoperative brachytherapy for controlling vaginal bleeding in early-stage cervical cancer: a retrospective study

Abstract

Background: In our clinical study, 11% of the patients with early-stage cervical cancers had different degrees of vaginal bleeding, which required a preoperative intervention. We set to assess the efficacy and safety of preoperative high-dose rate vaginal ovoid brachytherapy (HDR-VOBT) for the treatment of vaginal bleeding in women with early cervical cancer.Methods: We retrospectively identified and reviewed patients with vaginal bleeding and early-stage cervical carcinoma, treated between January 2011 and December 2014 (median follow-up of 69 months).Of the 116 patients, 59 received preoperative HDR-VOBT (a dose of 8 Gy at 0.5 cm from the tumor surface), and 57 received traditional vaginal packing with gauze alone, followed by radical hysterectomy and lymphadenectomy. Analysis of the clinical parameters was performed using the chi-square test. The outcome measures were the 3-and 5-year survival and the complication rate.Results: From the 116 patients, 25 had stage IB1, 49 had stage IB2, and 42 had stage IIA1 cervical cancer.No differences were observed regarding the 5-year overall survival (OS) (91.5% vs. 91.2%) and diseasefree survival (DFS) (76.3% vs. 86%) between the preoperative HDR-VOBT group and the vaginal packing with gauze group. The mean volume of blood loss due to vaginal bleeding after treatment was 83.4 (range: 30-150) mL: 56.8 (range: 30-80) mL in the preoperative HDR-VOBT group and 111.1 (range: 80-150) mL in the gauze packing group (P<0.001). The mean time to achieve hemostasis was 3.5 h in the preoperative HDR-VOBT group and 8.1 h in the vaginal packing with gauze group (P<0.001). There was no significant difference in postoperative risk factors, complications, and survival between the two groups.

The management of vaginal bleeding in advanced cervical cancer

“…These include initiating sexual activity under the age of 16 years, having multiple sexual partners and infrequent condom use, prolonged use (more than 5 years) of oral contraceptive pills, having a weakened immune system (including being HIV positive), low socioeconomic status, and smoking [13]. In addition to these risk factors, it is valid to note that some researchers reported a massive gap in knowledge about the risk factors in the general population [14,15], which may result in delayed diagnosis and treatment because women are unaware of how the disease presents itself [16] or whether they are at risk.…”

“…Because the severity of pain increases as the development of cancer progresses, these women often reported experiencing pain in more than 2 areas of the body with an overall score of 4 on a pain scale of 0-5 (0 being no pain; 5 being severe pain) and required the administration of opioids. As time progressed, a consequent study that was conducted in 2021 revealed that vaginal bleeding was also commonly reported, with a high prevalence of 89% [16]. Although intermenstrual and post-coital bleedings are common symptoms of cervical cancer, they may also be associated with benign conditions such as polyps, uterine fibroids, ovulatory or endometrialrelated disorders, birth control, sexually transmitted infections, or trauma [22,23].…”

“…Simple rolled gauze, haemostatic gauze, or haemostatic cellulose sponges should be tightly packed into the upper part of the vagina to apply even local pressure, halting the bleeding [9]. Sedation or short-acting general anaesthesia for the vaginal tamponade procedure should be considered [9,16]. It is significant to note that the vaginal packing should be removed within 24-36 hours.…”

“…Because the urethra lies close to the distal vagina, to some extent, this vaginal packing applies pressure to the urethra as well, resulting in difficulties in urination and even urinary retention. Therefore, the placement of a tamponade is an indication of bladder catheterization [9,16]. In addition, patients' mobility should be restricted to enhance the efficacy of the packing.…”

Intensity-Modulated Radiotherapy and Three-Dimensional Conformal Radiotherapy Combined with Intracavitary Posterior Radiotherapy for the Treatment of Medium-Term and Advanced Cervical Cancer: Efficacy, Safety and Prognostic Factors

“…At present, external irradiation combined with intracavitary posterior radiotherapy and concurrent chemotherapy is the standard method for the treatment of medium-term and advanced cervical cancer. Traditional radiotherapy methods such as four-field box-type and front-to-back penetrating irradiation have been used earlier and are widely used, but their damage to the digestive tract, urinary tract and hematopoietic systems is relatively serious ( 2 , 3 ). Intensity modulated radiation therapy (IMRT) and three dimensional conformal radiation therapy (3D-CRT) are new radiotherapy techniques, and there is no unified understanding on the specific effects of these two techniques.…”