Patient-Reported Sexual Health After Definitive Chemoradiation Therapy and MR-Guided Brachytherapy for Cervical Cancer

Abstract

Concurrent chemo-radiotherapy followed by brachytherapy (BT) is the standard curative treatment for patients with locally advanced cervix cancer. Vaginal toxicity and associated sexual dysfunction are under-reported and negatively impact long-term quality of life for this patient population. The purpose of this pilot, prospective study was to evaluate doses to the vagina during MR-guided BT and patient-reported sexual health after treatment in women with locally advanced cervical cancer, and whether an association exists between these two factors. Consenting patients with biopsy-proven FIGO IB-IVA carcinoma of the cervix treated with curative intent with chemo-radiotherapy followed by MR-guided BT were enrolled into a prospective study. One substudy evaluated sexual health. The vaginal wall (3mm) was contoured on all MR scans during BT for all patients. The EQD2 ICRU recto-vaginal point was calculated as a surrogate for vaginal toxicity. Patients completed the validated Sexual Adjustment Questionnaire (SAQ), which measures sexuality over time (domains: desire, relationship, activity, arousal, orgasm, techniques, satisfaction; score 0-115). The SAQ was completed at baseline, 3 months post-treatment, and 15 months post-treatment. The associations between SAQ and covariates were analyzed using a mixed model. Thirty-one patients participated in the substudy and 22 completed the SAQ at baseline (71%), 20 at 3 months follow-up (65%) and 14 at 15 months follow-up (45%). The median age of the patient cohort was 51 years (31-64). Seventy-three percent had FIGO IB-IIA disease. There were no local failures. There were no grade 3-4 CTCAE v4 physician reported vaginal toxicities. The median ICRU recto-vaginal point was 69.9 Gy (56.6-87.6). The mean SAQ scores improved from baseline (45.9) to 3 months (50.2) and 15 months (57.1) post-treatment. The difference between 15 months and baseline reached borderline significance (P = 0.055). There was no correlation between total SAQ scores and ICRU recto-vaginal dose. Age and stage did not significantly correlate with sexual health. This is the first study to correlate vaginal dose and patient-reported sexual health. The treatment of cervical cancer is associated with measureable changes in patient reported sexual adjustment that improve but persist after treatment. Prospective collection of patient-reported outcomes in this patient population is recommended to provide patient-centered care and interventions as needed.