Results of a Phase I-II Study on Laser Therapy for Vaginal Side Effects after Radiotherapy for Cancer of Uterine Cervix or Endometrium

Perrone, Anna Myriam; Tesei, Marco; Ferioli, Martina; Terlizzi, Francesca de; Gatta, Anna Nunzia Della; Boussedra, Safia; Dondi, Giulia; Galuppi, Andrea; Morganti, Alessio Giuseppe; Iaco, Pierandrea De

doi:10.3390/cancers12061639

Cited by 27 publications

(17 citation statements)

References 43 publications

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“…Intravaginal laser therapy is a novel non-pharmacological technique, which alleviates symptoms associated with menopausal genital atrophy [ 60 ]. Perrone et al [ 61 ] reported a progressive increase in vaginal length following intravaginal non-ablative CO 2 laser comparing to baseline. Furthermore, to reduce the radiation related vaginal stenosis, vaginal dilators might be recommended.…”

Section: Discussionmentioning

confidence: 99%

Interventions Preventing Vaginitis, Vaginal Atrophy after Brachytherapy or Radiotherapy Due to Malignant Tumors of the Female Reproductive Organs—A Systematic Review

Wierzbicka

Mańkowska-Wierzbicka

Cieślewicz

et al. 2021

IJERPH

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Background: Radiotherapy, as a method of treatment of cervical and uterine cancers, may induce severe late-onset vaginal side effects. Unfortunately, little evidence on the management of adverse effects has been presented. This study aimed to evaluate the available interventions which reduce symptoms of vaginitis and vaginal atrophy by improving dyspareunia, mucosal inflammation, vaginal pH and vaginal dryness in women who have undergone brachytherapy or radiotherapy due to uterine or cervical malignancies. Materials and methods: A comprehensive literature search was performed following PRISMA guidelines. The systematic search was conducted using electronic databases, namely Scopus, Web of Science and PubMed, between October and November 2020 to identify randomized controlled trials (RCT) and, prospective randomized studies (PRS). Results: The analyzed population consists of 376 patients with uterine or cervical cancer, treated with hyaluronic acid, vitamin A, vitamin E, alpha-tocopherol acetate and dienestrol. Intervention with HA along with vitamin A and vitamin E revealed advantage in endpoints such as reduced dyspareunia, vaginal mucosal inflammation, vaginal dryness, bleeding, fibrosis and cellular atypia. Administration of alpha-tocopherol acetate reduced vaginal mucosal inflammation and improved vaginal acanthosis, whereas dienestrol resulted in reduced dyspareunia, vaginal caliber and bleeding. Conclusions: Vaginal suppositories were found to be clinically effective at the management of late-onset vulvovaginal side effects after radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Interventions Preventing Vaginitis, Vaginal Atrophy after Brachytherapy or Radiotherapy Due to Malignant Tumors of the Female Reproductive Organs—A Systematic Review

Wierzbicka

Mańkowska-Wierzbicka

Cieślewicz

et al. 2021

IJERPH

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“…Besides physiological changes, the unfavorable effect of radiation used to treat cervical cancer also influences vaginal health [ 33 , 34 ]. The use of laser treatment to revert the adverse effect of radical surgeries or radiotherapy for gynecological malignancy is also under active investigation [ 35 ]. The number of publications still rising, although the FDA has not approved vaginal laser treatment for those indications.…”

Section: Discussionmentioning

confidence: 99%

Fractional CO2 laser treatment effect on cervicovaginal lavage zinc and copper levels: a prospective cohort study

Sipos

Pákozdy

Jäger³

et al. 2021

BMC Women's Health

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Background The basic principle of vaginal laser therapy is the rejuvenation of the affected tissue. Zinc and copper are essential nutritional trace elements and have a key role in connective tissue homeostasis. We aimed to investigate the effect of vaginal, fractional CO2 laser treatment on cervicovaginal lavage (CVL) zinc and copper levels. Methods Twenty-nine postmenopausal women with symptoms of vaginal dryness were enrolled in our prospective cohort study. Three treatments with MonaLisa Touch CO2 laser system were performed four weeks apart. At each treatment CVL was collected, Vaginal Health Index (VHI) was obtained, and Visual Analog Scale (VAS) for vaginal dryness was assigned by patients. Zinc and copper concentrations were measured with optical emission spectrometry before each treatment and six weeks after the 3rd treatment. Results The VHI scores significantly improved after each laser treatment (mean ± SD VHI score, 13.03 ± 4.49 before vs. 15.55 ± 4.35 after the 1st, 17.79 ± 4.57 after the 2nd and 19.38 ± 4.39 after the 3rd treatment, P < 0.01). Similarly, VAS scores reflected improvement (mean ± SD VAS score 6.59 ± 2.86 before vs. 4.17 ± 2.86 after the 1st, 2.45 ± 2.43 after the 2nd and 1.41 ± 1.94 after the 3rd treatment, P < 0.01). CVL zinc levels were significantly higher compared to copper levels (0.06 ± 0.04 vs. 0.006 ± 0.006 mg/L, P < 0.01) at baseline. While copper levels remained the same through treatments, the CVL zinc level was significantly higher after the second laser treatment compared to the baseline. Conclusions Fractional CO2 laser treatment of the vagina impacts CVL zinc and copper levels differently. While CVL copper levels were not different after each laser treatment, zinc levels were significantly higher after the second treatment before returning to baseline values.

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“…Perrone et al [40] conducted a prospective cohort study in which (N=43) patients suffering from vaginal shorting, atrophy, and stenosis following radiation therapy for gynecologic cancers received treatment with CO 2 laser therapy which showed improvement in vaginal length and VHI [40]. Moreover, Pieralli et al [7] reported in a prospective cohort study improvement in VHI and VAS in patients (N=50) with a history of breast cancer and with resultant oncologic menopause following treatment with vaginal CO 2 laser therapy [7].…”

Section: Co 2 Lasermentioning

confidence: 99%

Energy-Based Devices for Functional Vaginal Problems: Issues and Answers

Bujnak

Crowder

Krychman

2021

Curr Sex Health Rep

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Vaginal rejuvenation is a marketing term that encompasses surgical and medical treatments for functional vaginal/vulvar problems including but not limited to genitourinary syndrome of menopause (GSM), sexual dysfunction, vaginal laxity, and stress urinary incontinence (SUI) and for esthetic concerns including dissatisfaction with vulvovaginal appearance. Multiple treatment options have become available for indications of functional vaginal problems. Noninvasive management options including the use of more novel treatments such as energy-based devices have gained interest. Previously, studies regarding the efficacy and safety of the energy-based devices for functional vaginal problems were mostly limited to cohort studies without sham treatment, control groups, randomization, or double blinding. As a result of this insufficient data in 2018, the FDA released a statement of warning against the use of energy-based devices in the treatment of functional vaginal problems or vaginal cosmetic procedures (Https://Www.Fda.Gov/Medical-Devices/Safety-Communications/Fda-Warns-Against-Use-Energy-Based-Devices-Perform-Vaginal-Rejuvenation-or-Vaginal-Cosmetic. 1–4, 2018). Purpose of Review This article reviews the most current treatment modalities in the realm of vaginal rejuvenation therapy with an emphasis on the efficacy and safety of the energy-based devices. Recent Findings In the most recent literature, there have been studies with improvements in study design that support the efficacy and the short-term safety of the energy-based devices. Summary More recent studies with improved study design evidence that the use of energy-based devices results in improvements in functional vaginal problems and that serious adverse events appear to be rare. The availability of these devices as treatment options for functional vaginal problems has the potential to impact patient by improving their symptoms and quality of life. Caution still remains however regarding their safety following a longer period of time after their use.

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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

Cited by 27 publications

References 43 publications

Interventions Preventing Vaginitis, Vaginal Atrophy after Brachytherapy or Radiotherapy Due to Malignant Tumors of the Female Reproductive Organs—A Systematic Review

Interventions Preventing Vaginitis, Vaginal Atrophy after Brachytherapy or Radiotherapy Due to Malignant Tumors of the Female Reproductive Organs—A Systematic Review

Fractional CO2 laser treatment effect on cervicovaginal lavage zinc and copper levels: a prospective cohort study

Energy-Based Devices for Functional Vaginal Problems: Issues and Answers

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