Factors associated with changes in vaginal length and diameter during pelvic radiotherapy for cervical cancer

Author(s)

Martins, Jumara ^[1] ; Vaz, Ana Francisca ^[1] ; Grion, Regina Celia ^[1] ; Barros Esteves, Sergio Carlos ^[1] ; Costa-Paiva, Lucia ^[2] ; Baccaro, Luiz Francisco ^[2]

Affiliation

^[1] Univ Campinas UNICAMP, Dept Gynecol, Radiotherapy Div, Campinas, SP - Brazil

^[2] Univ Campinas UNICAMP, Dept Gynecol, Rua Alexander Fleming 101, BR-13083881 Campinas, SP - Brazil

• Document type: Journal article
• Source: ARCHIVES OF GYNECOLOGY AND OBSTETRICS; v. 296, n. 6, p. 1125-1133, DEC 2017.
• Web of Science Citations: 4

Abstract

Objectives This study reports the incidence and factors associated with vaginal stenosis and changes in vaginal dimensions after pelvic radiotherapy for cervical cancer. Methods A descriptive longitudinal study with 139 women with cervical cancer was conducted from January 2013 to November 2015. The outcome variables were vaginal stenosis assessed using the Common Terminology Criteria for Adverse Events (CTCAE v3.0) and changes in vaginal diameter and length after the end of radiotherapy. Independent variables were the characteristics of the neoplasm, clinical and sociodemographic data. Bivariate analysis was carried out using chi(2), Kruskal-Wallis and Mann-Whitney's test. Multiple analysis was carried out using Poisson regression and a generalized linear model. Results Most women (50.4%) had stage IIIB tumors. According to CTCAE v3.0 scale, 30.2% had no stenosis, 69.1% had grade 1 and 0.7% had grade 2 stenosis after radiotherapy. Regarding changes in vaginal measures, the mean variation in diameter was - 0.6 (+/- 1.7) mm and the mean variation in length was - 0.6 (+/- 1.3) cm. In the final statistical model, having tumoral invasion of the vaginal walls (coefficient + 0.73, p < 0.01) and diabetes (coefficient + 1.16; p < 0.01) were associated with lower vaginal stenosis and lower reduction of vaginal dimensions. Advanced clinical stage (coefficient + 1.44; p = 0.02) and receiving brachytherapy/teletherapy (coefficient - 1.17, p < 0.01) were associated with higher reduction of vaginal dimensions. Conclusions Most women had mild vaginal stenosis with slight reductions in both diameter and length of the vaginal canal. Women with tumoral invasion of the vagina have an increase in vaginal length soon after radiotherapy due to a reduction in tumoral volume. (AU)

• FAPESP's process: 12/09215-7 - Randomized clinical trial, with topical estrogen use, testosterone therapy and vaginal dilator in the prevention of vaginal stenosis in women with cervical carcinoma after radiation therapy
• Grantee: Luiz Francisco Cintra Baccaro
• Support Opportunities: Regular Research Grants