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Abstract
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.
Highlights
Up to 50–60% of women experience symptoms of vulvovaginal atrophy [1].The clinical signs associated with these lesions are diverse and incorporate recurrent urinary tract infections, dryness, dyspareunia and irritation
Research interest has progressively increased towards the drastic changes in the vaginal health in endometrial and cervical cancer survivors treated with radiation therapy [28]
The application of hyaluronic acid, vitamin A, vitamin E or dienestrol can be considered a positive supplement to gynecological cancer survivors
Summary
Up to 50–60% of women experience symptoms of vulvovaginal atrophy [1].The clinical signs associated with these lesions are diverse and incorporate recurrent urinary tract infections, dryness, dyspareunia and irritation. Vaginitis is defined as “any condition with symptoms of abnormal vaginal discharge, odor, irritation, itching, or burning” [2] and vaginal atrophy as “a condition in which the tissues lining the inside of the vagina (birth canal) become thin, dry, and inflamed” [3]. All these manifestations when they have a chronic progressive course may significantly impact women’s health and quality of life (QoL). 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. 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
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