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

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

doi:10.3390/cancers12061639

Anna Myriam Perrone, Alessio Giuseppe Morganti + Show 8 more

Open Access

https://doi.org/10.3390/cancers12061639

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Abstract

Women who have previously received radiotherapy (RT) for gynecologic cancer often suffer from vaginal fibrosis and stenosis. The success of “non-ablative” laser therapy for postmenopausal vaginal atrophy has led to the idea of testing the laser in patients submitted to RT. In this prospective observational study, we selected patients who underwent pelvic RT followed by vaginal laser treatment. We scheduled three treatment sessions (at T0–T1–T2) and three controls (at T1–T2–T3) one month apart. The follow-up (at T4) was carried out six months after the last treatment. Vaginal Health Index (VHI) and vaginal length were evaluated. Sexual function was assessed through Female Sexual Function Index (FSFI). Overall, 43 patients with severe vaginal shortening, atrophy and stenosis was enrolled and treated with intravaginal non-ablative CO2 laser. We observed a progressive increase in vaginal length of 9% (p = 0.03) at T2 and 28% (p < 0.0001) at T3; effects were maintained at T4 (p < 0.0001). After the first application VHI showed a significant improvement of 57% at T3 (p < 0.0001). The results were maintained at T4 (p < 0.0001). No changes were found in FSFI. All procedures were well tolerated. In conclusion, laser therapy improved vaginal length and VHI in women undergoing pelvic RT; prospective studies are needed.

Highlights

Radiotherapy (RT) represents a cornerstone in the treatment of gynecological tumors and, in cases of advanced cervical cancers, it is the only available therapy with curative intent [1,2,3,4,5,6]
We offered laser therapy to 121 women followed up in our outpatient clinic and that met the inclusion criteria
We found that laser treatment was less effective in cervical cancers than endometrial tumors and that the resulting efficacy rate was affected by the radiation therapy doses

Summary

Introduction

Radiotherapy (RT) represents a cornerstone in the treatment of gynecological tumors and, in cases of advanced cervical cancers, it is the only available therapy with curative intent [1,2,3,4,5,6]. Some side effects affecting sexual function are well known. Brachytherapy (BT) on reproductive organs and sexual activity depends on several factors: age, irradiated volumes, dose and fractionation and treatment technique and duration [7,8,9]. RT, alone or combined with other cancer treatments such as surgery and chemotherapy, induces early menopause and worsens the genitourinary symptoms. The vaginal walls become atrophic, inelastic, narrow, short and lastly stenotic which may make sexual intercourse painful or uncomfortable and, in cases of complete stenosis, impossible [11,12,13,14].

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