Pelvic Radiation Therapy Induced Vaginal Stenosis: A Review of Current Modalities and Recent Treatment Advances

Varytė, Guoda; Bartkevičienė, Daiva

doi:10.3390/medicina57040336

Cited by 24 publications

(22 citation statements)

References 54 publications

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“…Dyspareunia occurs in up to 80% of patients with a relevant negative impact on sexuality, mainly due to pain during vaginal intercourse, while sexual satisfaction seems not to be significantly impaired [ 20 , 21 , 26 ]. Despite the relevant impairment in quality of life, only 10–28% of cervical cancer patients received information about the onset of this kind of acute and, above all, late vaginal toxicity [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Interventions for vaginal toxicities prevention are based on limited scientific evidence and, even in the international context, there is no standard strategy guiding prevention of this condition. Only recently, some practical recommendations are beginning to focus on the vaginal/sexual morbidity aspect [ 20 , 21 , 27 , 32 , 33 , 34 , 35 , 36 ]. First of all, attention has been focused to consider the vagina as an organ at risk, according to ICRU89 and EMBRACE I indications, although a consensus has still not been reached for contouring and for reporting the dose to the vagina [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…For the vagina, these toxicities historically included necrosis, vescico/rectovaginal fistula, while, in the past decade, vaginal stenosis and, above all, dyspareunia were the most frequently experienced symptoms in LACC patients who had undergone exclusive (chemo)radiotherapy and IRT. In fact, vaginal stenosis was recorded for from 21% to 38% of LACC patients, while dyspareunia ranged from 50–60% to 80% of the patients [ 18 , 20 , 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

“…Prevention strategies may include vaginal dilatation, topical therapies, and laser therapy, but consensus is not reached due to the paucity of high-level evidence regarding the prevention and management of vaginal stenosis/dyspareunia [ 20 , 21 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2023

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

et al. 2023

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“…Combining HA and vitamins E and C reduces vaginal damage from radiotherapy and improves vaginal atrophy and related symptoms [31,32].…”

Section: Other Alternativesmentioning

confidence: 99%

Treatment of Female Sexual Dysfunction Due to Dyspareunia with Solid-State Vaginal Laser and Recombinant Platelet-Derived Epidermal Growth Factors: A Viable Possibility?

Mendoza¹,

Quereda²

2023

Clin. Exp. Obstet. Gynecol.

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To examine the efficacy and safety of non-pharmacological and non-ablative options (or a combination of these) for postmenopausal dyspareunia. Mechanism: Narrative review on non-pharmacological and non-ablative options (or a combination of these) for postmenopausal dyspareunia. Findings in Brief: Dyspareunia is the most bothersome symptom of the genitourinary syndrome of menopause, often complicated by decreased sexual interest and arousal. Solid-state vaginal laser (SSVL) and recombinant plateletderived epidermal growth factors (RGFs) are new alternatives are new alternatives that improve female sexual dysfunction resulting from dyspareunia. Conclusions: SSVL is a new alternative the treatment of postmenopausal dyspareunia either alone or in combination with other alternatives with efficacy and safety similar to the classical options.

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Brazilian Society of Surgical Oncology: Guidelines for the management of anal canal cancer

Valadão

Riechelmann

Silva

et al. 2023

Journal of Surgical Oncology

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BackgroundAnal canal squamous cell carcinoma (SCC) is a relatively uncommon neoplasia, and it is mostly a local‐regional cancer, of low metastatic potential (only 15%), resulting in cure in most cases treated with definitive chemoradiation. On the other hand, its incidence has been steadily increasing over the last decades, which makes it an important public health problem. In an effort to provide surgeons and oncologists who treat patients with anal cancer with the most updated information based on the best scientific evidence, the Brazilian Society of Surgical Oncology (SBCO) has produced the present guideline for the management of anal canal SCC, focused on the main topics related to daily clinical practice.ObjectivesThe SBCO developed the present guidelines to provide recommendations on the main topics related to the management of anal canal squamous cell carcinoma (SCC) based on current scientific evidence.MethodsBetween October 2022 and January 2023, 14 experts met to develop the guidelines for the management of anal canal cancer. A total of 30 relevant topics were distributed among the participants. The methodological quality of a final list with 121 sources was evaluated, all the evidence was examined and revised, and the management guidelines were formulated by the 14‐expert committee. To reach a final consensus, all the topics were reviewed in a meeting that was attended by all the experts.ResultsThe proposed guidelines contained 30 topics considered to be highly relevant in the management of anal canal cancer, covering subjects related to screening recommendations, preventive measures, tests required for diagnosing and staging, treatment strategies, response assessment after chemoradiotherapy, surgical technique‐related aspects, and follow‐up recommendations. In addition, screening and response assessment algorithms, and a checklist were proposed to summarize the important information and offer an updated tool to assist surgeons and oncologists who treat anal canal cancer and in providing the best care to their patients.ConclusionThese guidelines summarize recommendations based on the most current scientific evidence on relevant aspects of anal canal cancer management and are a practical guide to help surgeons and oncologists who treat anal canal cancer make the best therapeutic decisions.

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Pelvic Radiation Therapy Induced Vaginal Stenosis: A Review of Current Modalities and Recent Treatment Advances

Cited by 24 publications

References 54 publications

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

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

Treatment of Female Sexual Dysfunction Due to Dyspareunia with Solid-State Vaginal Laser and Recombinant Platelet-Derived Epidermal Growth Factors: A Viable Possibility?

Brazilian Society of Surgical Oncology: Guidelines for the management of anal canal cancer

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