Brachytherapy In Cervical Cancer Patients Research Articles

Prospective Application of an Artificial Intelligence Decision Support Tool for Applicator and Needle Selection in High-Dose-Rate Brachytherapy for Cervical Cancer Patients

To assess the performance of an artificial intelligence (AI)-based decision support tool under differing thresholds to determine optimal applicator selection in a prospective clinical setting. Cervical cancer patients scheduled for high-dose-rate brachytherapy implants with intracavitary tandem and ring (IC) or interstitial tandem and ring (IC/IS) implants in a single tertiary cancer center were eligible for enrollment. Prior to the first brachytherapy implant, a diagnostic MRI was acquired. The clinical target volume and the expected inserted position of the intrauterine tandem and ring were identified and contoured on the T2-MRI. An in-house artificial intelligence-based predicted the need for an IC or IC/IS implant, based on target volume geometric features. For IC/IS implants, an optimal needle arrangement for target coverage was also predicted. Blinded to the AI outcome, a clinical determination was made by the clinician reviewing the MR image. AI algorithm prediction provided a confidence level associated with each decision. The algorithm performance for different confidence thresholds using the IC applicator of 50%, 60%, and 80% was investigated. Performance metrics of the initial clinical determination and the AI prediction were calculated based on the consensus optimal applicator determined from an assessment of planning dosimetry in the first fraction and clinical use for the final brachytherapy implants and fractions. The performance metrics were accuracy, precision, and recall. A total of 10 eligible patients were accrued between December 2020 and October 2022. Table 1 shows the initial clinical determination and consensus applicator AI predictions that were made with different confidence thresholds. The optimal confidence threshold (60%) yielded performance scores of 80%, 83.3%, and 83.3% for the accuracy, precision, and recall, respectively. The performance metrics were equivalent for the optimal confidence threshold and the initial clinical decision. The AI-based decision support tool shows strong predictive results for a clinical brachytherapy application that is important to patient outcome. This prospective study demonstrates that the algorithm's utility is a critical step in using AI-based tools clinically. Further work to determine the optimal brachytherapy applicator, based on treatment planning dosimetry, is required.

Racial disparities in receipt of radiation and brachytherapy in cervical cancer patients and impact on survival outcomes: Do they exist in a SEER-Medicare population? (2124)

Racial disparities in receipt of radiation and brachytherapy in cervical cancer patients and impact on survival outcomes: Do they exist in a SEER-Medicare population? (2124)

Identifying disparities in brachytherapy delivery for locally advanced cervical cancer

IntroductionThe standard of care for locally advanced cervical cancer is concurrent chemotherapy and external beam radiation therapy (EBRT) followed by a brachytherapy boost. Some studies show a decreased usage of brachytherapy in cervical cancer patients despite the standard of care and known survival advantage. This study aims to characterize the utilization of brachytherapy in Oregon and identify where disparities in treatment may exist. MethodsThe Oregon State Cancer Registry database was used to identify patients diagnosed with FIGO Stage IB2-IVB cervical cancer between 2007 and 2016. Patients who received initial EBRT were categorized by whether they received brachytherapy boost or not. Age at diagnosis, county of patient residence, rural-urban status of the county, race/ethnicity, and insurance payer were studied using multivariable logistic regression to identify possible underserved populations. Survival data was compared using a Cox proportional hazard survival model. Results401 patients who received primary EBRT for FIGO stage IB2-IVB cervical cancer were identified in the 10-year span. Breakdown by stage is: 16% stage IB2, 23.9% stage II, 37.4% stage III, and 22.7% stage IV. Of those, 154 (38.4%) received brachytherapy boost treatment, 75 (18.7%) received a different boost modality, and 42.9% received no boost. Stage IV (p = 0.001) and uninsured patients (p = 0.04) were significantly less likely to receive brachytherapy. Older age was also associated with decreased brachytherapy usage, as each additional year of life decreased brachytherapy receipt by 1.8% (p = 0.04). Native American and Pacific Islander patients were the only group significantly more likely to receive brachytherapy (p=0.003). There was no significant difference in the rate of brachytherapy boost identified based on urban/rural status of the county (p = 0.63 to 0.69), other racial/ethnic categories (p = 0.66 to 0.80), or among the other stages (p=0.45 to 0.63). In Cox proportional hazard survival analysis, patients that received brachytherapy showed a 42% reduction in risk of cancer specific mortality, though this did not reach the predetermined level of statistical significance (p = 0.057). ConclusionsThe brachytherapy boost rate among locally advanced cervical cancer patients was 38.4%. The data also indicated a likely reduction in cancer specific mortality in patients receiving brachytherapy. Older patients, stage IV patients, and uninsured patients were less likely to receive brachytherapy. Given the low overall brachytherapy usage, these data indicate access and delivery of brachytherapy care needs to be improved across the state. The increased brachytherapy use in the American Indian and Pacific Islander patient population should be further studied to identify facilitators to treatment completion and potentially extrapolate to other groups.

Initial tumor volume as an important predictor for indication of intra-cavitary brachytherapy, intra-cavitary/interstitial brachytherapy, and multi-catheter sole interstitial brachytherapy in cervical cancer patients treated with chemoradiotherapy.

Advances in three-dimensional image-guided brachytherapy technique allow for using intra-cavitary and interstitial brachytherapy (ICIS-BT), and sole interstitial brachytherapy (ISBT) in addition to conventional intra-cavitary brachytherapy (ICBT). However, no consensus has been reached regarding the choice of these techniques. The aim of this study was to propose the size criteria for indication of interstitial techniques. We examined initial gross tumor volume (GTV) at presentation and at each brachytherapy session. Also, dose volume histogram parameters for each modality were compared in 112 patients with cervical cancer treated with brachytherapy (ICBT, 54; ICIS-BT, 11; and ISBT, 47). The average GTV at diagnosis was 80.9 cm3 (range, 4.4-343.2 cm3), which shrank to 20.6 cm3 (25.5% of initial volume, range, 0.0-124.8 cm3) at initial brachytherapy. GTV > 30 cm3 at brachytherapy and high-risk clinical target volume > 40 cm3 were good threshold values for indication of interstitial technique, and tumors with initial GTV > 150 cm3 could be candidates for ISBT. An ISBT dose of 89.10 Gy can be prescribed in equivalent dose in 2 Gy fractions (range, 65.5-107.6 Gy), which was higher than those of ICIS (73.94 Gy, range, 71.44-82.50 Gy) and ICBT (72.83 Gy, range, 62.50-82.27 Gy) (p < 0.0001). Initial tumor volume is an important predictor for indication of ICBT and ICIS-BT. ISBT or at least an interstitial technique is recommended for initial GTV > 150 cm3.

GSOR15 Presentation Time: 11:40 AM: Underutilization of Brachytherapy: A Retrospective State Level Analysis of Brachytherapy Delivery in Locally Advanced Cervical Cancer

<h3>Purpose</h3> The standard of care for locally advanced cervical cancer is concurrent chemotherapy and external beam radiation therapy (EBRT) followed by a brachytherapy boost. Decreased rate of brachytherapy in cervical cancer patients has shown a declining survival for these patients. This study aims to characterize the utilization of brachytherapy in Oregon in order to better understand how care delivery can be improved. <h3>Materials and Methods</h3> The Oregon State Cancer Registry database was used to identify patients diagnosed with FIGO 2008 Stage IB2-IVB cervical cancer between 2007 and 2016. Patients who received initial EBRT were categorized by whether they received brachytherapy boost or not. Age at diagnosis, county, rural/urban status of the county, race/ethnicity, and insurance payer were studied using multivariable logistic regression to identify possible underserved populations. Survival data was compared using a Cox proportional hazard survival model. Changes in brachytherapy use over time were also examined by grouping patients by year of diagnosis and comparing the rates of brachytherapy utilization over the duration of the study. <h3>Results</h3> 401 patients who received primary EBRT for FIGO stage IB2-IVB cervical cancer were identified in the 10-year span. Breakdown by stage is: 16% stage IB2, 23.9% stage II, 37.4% stage III, and 22.7% stage IV. Of those, 154 (38.4%) received brachytherapy boost treatment, 75 (18.7%) received a different boost modality, and 172 (42.9%) received no boost. Stage IV (p=0.001) and uninsured patients (p=0.04) were significantly less likely to receive brachytherapy. Older age was also associated with decreased brachytherapy usage, as each additional year of life correlated with a decreased likelihood of brachytherapy receipt of 1.8% (p=0.04). Native American and Pacific Islander patients were the only group significantly more likely to receive brachytherapy (p=0.003). There was no significant difference in the rate of brachytherapy boost based on urban/rural status of the county (p=0.63 to 0.69), other racial/ethnic categories (p=0.66 to 0.80), or among the other stages (p=0.45 to 0.63). In Cox proportional hazard survival analysis, patients that received brachytherapy showed a 42% reduction in risk of cancer specific mortality, though this did not reach the level of statistical significance (p=0.057). In terms of brachytherapy utilization by year, no definitive trend was shown. Yearly rates varied from 25% to 52%, with a dip in utilization in 2013 and 2014 at around 30% before a jump in utilization in 2015 and 2016 to around 50%. <h3>Conclusions</h3> The brachytherapy boost rates among locally advanced cervical cancer patients were 38.4%. Though not statistically significant, a reduction in cancer specific mortality in patients receiving brachytherapy by 42% was seen. Older patients, stage IV patients, and uninsured patients were less likely to receive brachytherapy. Given the low overall brachytherapy usage, these data may indicate barriers to access and delivery of brachytherapy care. The increased brachytherapy use in the American Indian and Pacific Islander patient population should be further studied to identify facilitators to treatment completion and potentially extrapolate to other groups.

Identifying Disparities in Cervical Cancer Brachytherapy Delivery

<h3>Purpose/Objective(s)</h3> The standard of care for locally advanced cervical cancer is concurrent chemotherapy and external beam radiation therapy (EBRT) followed by a brachytherapy boost. Some studies show a decreased usage of brachytherapy in cervical cancer patients despite the standard of care and known survival advantage. This study aims to characterize the utilization of brachytherapy in Oregon and identify where disparities in treatment may exist. <h3>Materials/Methods</h3> The Oregon State Cancer Registry database was used to identify patients diagnosed with FIGO Stage IB2-IVB cervical cancer between 2007 and 2016. Patients who received initial EBRT were categorized by whether they received brachytherapy boost or not. Age at diagnosis, county, rural/urban status of the county, race/ethnicity, and insurance payer were studied using multivariable logistic regression to identify possible underserved populations. Survival data was compared using a Cox proportional hazard survival model. <h3>Results</h3> 401 patients who received primary EBRT for FIGO stage IB2-IVB cervical cancer were identified in the 10-year span. Breakdown by stage is: 16% Stage IB2, 23.9% stage II, 37.4% stage III, and 22.7% stage IV. Of those, 154 (38.4%) received brachytherapy boost treatment, 75 (18.7%) received a different boost modality, and 42.9% received no boost. Stage IV (p=0.001) and uninsured patients (p=0.04) were significantly less likely to receive brachytherapy. Older age was also associated with decreased brachytherapy usage, as each additional year of life decreased brachytherapy receipt by 1.8% (p=0.04). Native American and Pacific Islander patients were the only group significantly more likely to receive brachytherapy (p=0.003). There was no significant difference in the rate of brachytherapy boost identified based on urban/rural status of the county (p=0.63 to 0.69), other racial/ethnic categories (p=0.66 to 0.80), or among the other stages (p=0.45 to 0.63). In Cox proportional hazard survival analysis, patients that received brachytherapy showed a 42% reduction in risk of cancer specific mortality, though this did not reach the level of statistical significance (p=0.057). <h3>Conclusion</h3> The brachytherapy boost rates among locally advanced cervical cancer patients were 38.4%, similar to national averages. Though not statistically significant, data also showed a reduction in cancer specific mortality in patients receiving brachytherapy. Older patients, stage IV patients, and uninsured patients were less likely to receive brachytherapy. Given the low overall brachytherapy usage, these data indicate access and delivery of brachytherapy care needs to be improved across the state. The increased brachytherapy use in the American Indian and Pacific Islander patient population should be further studied to identify facilitators to treatment completion and potentially extrapolate to other groups.

Contemporary image-guided cervical cancer brachytherapy: Consensus imaging recommendations from the Society of Abdominal Radiology and the American Brachytherapy Society

To present recommendations for the use of imaging for evaluation and procedural guidance of brachytherapy for cervical cancer patients. An expert panel comprised of members of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease Focused Panel and the American Brachytherapy Society jointly assessed the existing literature and provide data-driven guidance on imaging protocol development, interpretation, and reporting. Image-guidance during applicator implantation reduces rates of uterine perforation by the tandem. Postimplant images may be acquired with radiography, computed tomography (CT), or magnetic resonance imaging (MRI), and CT or MRI are preferred due to a decrease in severe complications. Pre-brachytherapy T2-weighted MRI may be used as a reference for contouring the high-risk clinical target volume (HR-CTV) when CT is used for treatment planning. Reference CT and MRI protocols are provided for reference. Image-guided brachytherapy in locally advanced cervical cancer is essential for optimal patient management. Various imaging modalities, including orthogonal radiographs, ultrasound, computed tomography, and magnetic resonance imaging, remain integral to the successful execution of image-guided brachytherapy.

Usefulness of Metal Artifact-reduced Reconstruction for Image-guided Brachytherapy for Cervical Cancer

To evaluate the usefulness of single-energy metal artifact reduction (SEMAR) for target delineation in brachytherapy for cervical cancer patients with metal hip implants. A series of four definitive brachytherapy sessions in the same patient was analyzed. At each brachytherapy session, the identical set of computed tomography images was subjected with or without SEMAR treatment. For both SEMAR-treated and -untreated sets, five radiation oncologists delineated the high-risk clinical target volume (HR-CTV), bladder, and rectum, for which the volume, Dice coefficient, and the dose volume parameters were compared between SEMAR-treated and -untreated datasets. The bladder volume was significantly greater in the SEMAR-treated datasets compared with the SEMAR-untreated datasets. Importantly, for the bladder, Dice coefficient among five radiation oncologists was significantly higher for the SEMAR-treated datasets compared with the SEMAR-untreated datasets. These effects of SEMAR treatment were not evident for HR-CTV and the rectum. These data indicate that SEMAR treatment contributes to improve delineation of the bladder in brachytherapy for cervical cancer patients with metal hip implants.

Comparison of treatment outcomes of pelvis external radiotherapy with and without vaginal brachytherapy for cervical cancer patients with positive or close vaginal resected margins.

We evaluated whether there is a difference in the local recurrence and survival after pelvic external radiotherapy (ERT) with and without boost vaginal brachytherapy (VB) in cervical cancer patients with positive or close vaginal resected margins (RM). We retrospectively reviewed FIGO stage IA-IIB cervical cancer patients treated with postoperative ERT between 1997 and 2018. The sixty patients showing close (safety margin < 5mm) or positive vaginal RM were included. ERT was delivered with median 50.4Gy in 28 fractions to the pelvis and VB with median 30Gy in 6 fractions. The median follow-up duration was 46months. Five out of 30 patients treated with ERT alone experienced vaginal recurrence within 2years after surgery. The 5-year local control (LC) was 100% in patients receiving ERT + VB compared with 81.3% in patients receiving ERT alone (log rank p = 0.022). The 5-year pelvic control (PC) was 95.8% for patients receiving ERT + VB and 76.8% for ERT alone (p = 0.041). The 5-year overall survival and recurrence-free survival (RFS) were not significantly different between treatment groups. In multivariate analysis, perineural invasion was a significant risk factor for PC (p = 0.024). Parametrial involvement (p = 0.044) and vascular invasion (p = 0.032) were unfavorable prognostic factors for RFS. Late toxicity occurrences were not significant in both groups. VB after ERT improved LC and PC in cervical cancer patients with close or positive RM after hysterectomy. The toxicities were not increased after VB was added to ERT.

PO-1278 Uterine Perforation During Image-Guided Adaptive Brachytherapy in Cervical Cancer Patients

PO-1278 Uterine Perforation During Image-Guided Adaptive Brachytherapy in Cervical Cancer Patients

The Case Selection for Vaginal Cuff Brachytherapy in Cervical Cancer Patients After Radical Hysterectomy and External Beam Radiation Therapy.

ObjectiveTo explore the suitable cases for vaginal cuff brachytherapy (VCB) combined with external beam radiation therapy (EBRT) in the postoperative treatment of cervical cancer.MethodsWe retrospectively analyzed the clinical data of 214 postoperative cervical cancer patients who received radiotherapy from January 2008 to December 2015. Among them, 146 patients received postoperative EBRT, 68 received EBRT plus VCB. There was no statistical difference in clinical and pathological characteristics between these two groups. Those who with negative vaginal cuff underwent supplemented 12–18 Gy/2–3 Fx VCB. Survival analyses were performed using Kaplan–Meier method, and Cox model was used to analyze prognostic factors.ResultsThe median follow-up was 52 months (9–136 months), and 4-year RFS (recurrence-free survival) was 77%. Among them, 58 patients (27.10%) had local or distant recurrences, 29 (13.55%) in pelvis, six (2.80%) with metastases to para-aortic, 19 (8.88%) with distant metastases (including inguinal lymph nodes) and four (1.87%) with both local and distant recurrences. The postoperative brachytherapy boost did not improve RFS or OS (overall survival) among the investigated subjects, P = 0.77, P = 0.99, respectively. Neither it decreased the local relapse in the pelvis or vaginal cuff, P = 0.56, P = 0.59. Subgroup analyses showed that brachytherapy boost improved RFS in patients who had bulky mass (>4 cm) as well as 1) with deep stromal invasion (>50% stromal invasion), P = 0.012 or 2) received low EBRT dose (≤45 Gy), P = 0.033, and in patients with deep stromal invasion as well as received low EBRT dose (P = 0.018).ConclusionsWe first proposed the case selection model for postoperative EBRT plus VCB. Brachytherapy boost were considered in the setting of postoperative radiotherapy if the patients had at least two out of these following factors: bulky mass, deep stromal invasion and low EBRT dose.

GSOR09 Presentation Time: 3:10 PM: Case Report and Literature Review on Ultrasound - MRI Hybrid Adaptive External Beam Radiotherapy and Brachytherapy for Cervical Cancer Patients

Purpose: Existing studies confirmed role of ultrasound to guide applicator insertion in cervix cancer brachytherapy. This study introduces important role in ultrasound features and serial changes combining with MR Adaptive radiotherapy and MR guided brachytherapy.

GSOR09 Presentation Time: 3:10 PM: Case Report and Literature Review on Ultrasound - MRI Hybrid Adaptive External Beam Radiotherapy and Brachytherapy for Cervical Cancer Patients

GSOR09 Presentation Time: 3:10 PM: Case Report and Literature Review on Ultrasound - MRI Hybrid Adaptive External Beam Radiotherapy and Brachytherapy for Cervical Cancer Patients

Quantitative and qualitative application of clinical drawings for image-guided brachytherapy in cervical cancer patients.

PurposeClinical drawings are integral part of image-guided adaptive brachytherapy (IGABT) of cervical cancer. It was used in EMBRACE study protocol as a useful tool. In our study clinical drawings from EMBRACE study were modified to include scales in all the dimensions for more accurate representation of various tumor related volumes. The aim of the present study was to understand patterns of tumor regression and relationship between gross tumor at diagnosis (GTVD) and high-risk clinical target volume (CTV-THR)/intermediate-risk clinical target volume (CTV-TIR) in brachytherapy (BRT), using modified clinical drawings.Material and methods42 cervical cancer patients, staged as FIGO IIB-IIIB according to EMBRACE study, were enrolled. Advanced schematic 3D mapping diagram (3D-MD) in axial, coronal, and sagittal orientations, with a measurement scale (grid with 10 mm distance) for precise assessment and documentation was applied (through MRI at diagnosis and during brachytherapy). Dimensions, including height, width, and thickness as well as volumes (GTVD, CTV-THR and CTV-TIR) were compared both qualitatively and quantitatively.Results and conclusionsWe found qualitative and quantitative correlation of the dimensions of final CTV-THR with initial GTVD. Meticulous mapping of tumor volumes can provide useful insights to CTV-THR volume during brachytherapy.

Therapeutic Benefit of Intracavitary-interstitial Brachytherapy in Cervical Cancer Patients with Small and Large High-risk Clinical Target Volume

Therapeutic Benefit of Intracavitary-interstitial Brachytherapy in Cervical Cancer Patients with Small and Large High-risk Clinical Target Volume

SP-0516: Describing and characterizing the effect of brachytherapy in cervical cancer patients from radiomic feature dynamics

SP-0516: Describing and characterizing the effect of brachytherapy in cervical cancer patients from radiomic feature dynamics

Quantitative analysis of intra-fractional variation in CT-based image guided brachytherapy for cervical cancer patients

We quantified intra-fractional dose variation and organ movement during CT-based 3D-image guided brachytherapy (3D-IGBT) in cervical cancer patients. Fifteen patients who underwent CT-based 3D-IGBT were studied. For all patients, pre-delivery CT for treatment planning after applicator insertion and post-delivery CT after dose delivery without changing the applicator position were acquired. Pre- and post-delivery CT were rigidly fused by matching the inserted applicator and planned dose on pre-delivery CT (pre-delivery dose) was mapped on post-delivery CT (post-delivery dose). D2, D1, and D0.1 cm3 of the rectum and bladder were compared between pre- and post-delivery doses with contours on each CT image. Organ movement and deformation was evaluated using deformation vector fields calculated by deformable image registration between pre- and post-delivery CT. We also evaluated dose variation and DVF between with and without a catheter to control filling. Differences in all DVH parameters were <±3% in physical dose and ± 5% in EQD2. However, a > 15% dose difference was found in 13.8% of the fractions in rectum D2 cm3 and in 11.1% of those in bladder D2 cm3. The mean value of DVF for bladder was larger than that of rectum, especially for the superior-inferior (S-I) direction. Insertion catheters in bladder reduced mean dose and DVF variation compared with that of without catheters. In fraction groups with large dose increasing, DVF in the S-I direction was significantly larger than that of other fraction groups. Our results indicated that preparation is needed to reduce changes in the S-I direction affect dose variation.

Interstitial high-dose-rate brachytherapy using cobalt-60 source for cervical cancer: dosimetric and clinical outcomes from a single institute.

PurposeTo record and report dosimetric and clinical outcomes of interstitial brachytherapy using cobalt-60 (60Co) source in cervical cancer.Material and methodsSeventy patients who underwent external beam radiotherapy with dose of 45 Gy in 25 fractions, followed by interstitial brachytherapy (ISBT) 6.5 Gy × 4 fractions were included into this study. The ISBT applicators were inserted under combined spinal and epidural anesthesia. Computed tomography (CT) simulation was performed and axial CT images were transferred to treatment planning system. High-risk clinical target volume (CTVHR) and organs at risks (OARs) were contoured. Four fractions of 6.5 Gy were prescribed to CTVHR using inverse planning technique. Patients were followed-up for 3 years. Dosimetric parameters and clinical outcomes were recorded and compared with available literature.ResultsSeventy patients with FIGO stage IIB-IVA were included in the study. The median EQD2 of 2 cm3 of bladder, rectum, sigmoid and D90 CTVHR were 70 Gy (53-75 Gy), 64 Gy (51-71 Gy), 48 Gy (44-72 Gy), and 77 Gy (70-86 Gy), and dose homogeneity index (DHI), dose non-uniformity ratio (DNR), coverage index (CI), overdose volume index (OI), and conformal index (COIN) were 0.58 (0.39-0.78), 0.42 (0.22-0.61), 0.87 (0.59-0.97), 0.19 (0.09-0.30) and 0.74 (0.52-0.85), respectively. Local control rate at 2 years was 87.14%. Eight patients had local recurrence and one patient had lung metastasis. Also, two patients with local recurrence had recto-vaginal fistula. Two patients had grade 2 proctitis (2.8%) and one patient developed grade 3 proctitis (1.4%). There was no grade 2 or higher bladder toxicity.ConclusionsThe dosimetric parameters, local control and toxicities of high-dose-rate interstitial brachytherapy in cervical cancer patients treated by 60Co radioactive source are similar, compared to available literature using iridium-192 (192Ir) source.

CN119 - Vaginal moisturizing post PDR-pulse dose rate brachytherapy

BackgroundPDR (Pulsed Dose Rate) Brachytherapy is one of the treatments of choice for cervical cancer. Main side-effects are vaginal dryness, dyspareunia, pain, stenosis and sexual dysfunction that impacts on the patient’s well-being and on quality of life. To evaluate the efficacy of vaginal moisture to reduce dryness and pain associated with PDR Brachytherapy in cervical cancer patients treated at Catalan Institute of Oncology-Barcelona. MethodsA quasi-experimental randomized study. From 2016 to 2018 all women were assessed by nurses 4 times: basal at discharge, 1st, 3rd and 6th month post-treatment. Experimental intervention with moisturizing versus standard care. Inclusion criteria; women diagnosed of cervical cancer receiving PDR. Probabilistic sampling of patients assigned 42 to control group CG and 47 to experimental group (EG). Variables: vaginal hydration, pain, age, ethnicity, comfort perceived, socio-demographic, tobacco, sexual relationship and couples. Instruments: LENT/SOMA to assess vaginal toxicity and visual numeric for pain. ResultsOf the 96 eligible, some excluded for relapse, or study failure. N=89 women. Mean age: 52.78+12.8 (range 24-83) years old. Ethnicity; 63.8% white, Latina 3.1%, Arabic and Asiatic 0.8% each and gypsies 1.6%. Education; 3.1% illiteracy, primary 32.2%, secondary 25.2% and university 7.2%. Smokers 29.2%. For variable pain was 15-15-17-15 in CG and 20-17-15-13 in EG for consecutive points. Dyspareunia was present in 0-4-8-7 patients and 3-0-2-2 in EG. Dryness was 1-9-13-12 in CG and 6-1-8-10 in EG. Bleeding was 17-5-5-7 in CG and 16-10-0-6 in EG. Only significance differences on dryness variable. A total of 48.31% women avoid sexual intercourse, 22 (24.71%) in CG and 21 (23.59%). No significance differences. ConclusionsAn early vaginal moisturizing post-brachytherapy decreases the appearance of dyspareunia, allows start sexual relationships and improves the quality of life and sense of well-being. However some patients do not give the necessary importance to sexuality and it is something that they put aside during the treatment. Nursing education for patients at discharge helps to facilitate a healthy sexuality. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

The Case Selection for Brachytherapy in Cervical Cancer Patients after Radical Hysterectomy

The Case Selection for Brachytherapy in Cervical Cancer Patients after Radical Hysterectomy