Radiotherapy For Gynecological Cancer Research Articles

Prediction of Patients at Risk of Pelvic Insufficiency Fractures Following Pelvic Radiotherapy

<h3>Purpose/Objective(s)</h3> Radiotherapy-induced pelvic insufficiency fractures (PIFs), historically under-reported, can lead to significant morbidity. Using deep-learning techniques, this study develops a fully automated predictive tool to identify patients who are at high-risk of developing PIFs following radiotherapy for gynecological cancer. <h3>Materials/Methods</h3> Retrospective clinical, dosimetry and imaging data from 330 patients receiving pelvic radiotherapy for any primary gynecological cancer between January 2012 and January 2021 was collected (study approved by local ethical committee). Patient electronic records were reviewed; PIFs were diagnosed radiologically using computed tomography (CT) and magnetic resonance imaging (MRI). An auto-segmentation model for the sacrum and whole pelvis on CT-imaging was developed using a UNETR architecture to aid evaluation of pelvic radiotherapy dose and CT density. The model was validated by comparing the derived dose-volume histograms (DVHs) with those derived from manual contours. Chi-squared and Mann-Whitney tests were performed to determine associations between derived potential risk factors and PIF. Using Elastic Net Logistic Regression modelling a predictive tool to identify patients at risk of developing PIF was developed and internally validated. <h3>Results</h3> Among the 330 patients, the median follow-up was 36.6 months, and median age was 65 years. The PIF incidence was 10.9% and median interval from radiotherapy to PIF was 16 months. 86% of fractures occurred in the sacrum, 56% of patients had multiple fractures and 64% of patients were symptomatic. The auto-contouring tool of the sacrum and whole pelvis was clinically validated and, against gold-standard contours, achieved a mean DICE coefficient of 0.94, Average Surface Distance (ASD) of 0.65, and maximum absolute error for DVH curves of 3.1%. Univariant analysis found that site of primary disease, body mass index, prior diagnosis of osteopenia or osteoporosis, use of concurrent chemotherapy, V_55Gy (volume of the sacrum and whole pelvis receiving 55 Gy), and lower CT density were statistically associated with the development of PIF (p<0.05). The fully automated predictive tool to identify patients at risk of PIF using solely imaging and dosimetry data had similar accuracy to models including additional clinical features; both had a receiver-operating-characteristic (ROC) area-under-the-curve (AUC) of 0.761. The prediction tool has a sensitivity of 66%, specificity of 72% and a negative predictive value of 95%. <h3>Conclusion</h3> PIF is not uncommon in this setting, often symptomatic and strongly associated with low bone density on CT. Prediction and prevention of PIF would have an immense impact on patients and healthcare systems. We propose an automated predictive tool to identify patients at high risk, for whom effective prophylactic treatments are needed.

Ghosts in the machinery: Living with and beyond radiotherapy treatment for gynaecological cancer.

This paper explores post-treatment experiences of women who have had radiotherapy for gynaecological cancer. Drawing on data from a project which explored post-treatment wellbeing, conceptual metaphors of ghosts/haunting are used to engage with enduring legacies of cancer and 'neglected matters' in post-treatment trajectories. Current arrangements of care contribute to the idea that participants are 'out of the other side of cancer' once active treatment completes. Despite broader ambitions for holistic cancer rehabilitation, fragilities of body and mind persist, even when the outward representation is one of health, of looking well, of moving on. We show how neglected matters of cancer (visceral late effects, psychological suffering and lives not lived) are part of living with and beyond cancer. These 'ghosts' manifest in chronic states of unsettledness that are temporarily relieved by individualised 'fixes', such as mobilisation of 'mind over matter' discourse and mindfulness. This discourse and its associated tools are a powerful yet impoverished framing of approaches to living with and beyond cancer. We argue for the need to attend to 'neglected matters' of post-treatment trajectories differently.

Sexual Health Dysfunction After Radiotherapy for Gynecological Cancer: Role of Physical Rehabilitation Including Pelvic Floor Muscle Training.

IntroductionThe present study aims to describe: 1. How the side effects of radiotherapy (RT) could impact sexual health in women; 2. The effectiveness of physical rehabilitation including pelvic floor muscle training (PFMT) in the management of sexual dysfunction after RT.Materials and MethodsSearch keys on PubMed, Web of Science, Scopus, PEDro, and Cochrane were used to identify studies on women treated with radical or adjuvant RT and/or brachytherapy for gynecological cancers with an emphasis on vulvo-vaginal toxicities and PFMT studies on sexual dysfunction for this group of women.ResultsRegarding the first key question, we analyzed 19 studies including a total of 2,739 women who reported vaginal dryness, stenosis, and pain as the most common side effects. Reports of dosimetric risk factors and dose-effect data for vaginal and vulvar post-RT toxicities are scant. Only five studies, including three randomized controlled trials (RCTs), were found to report the effect of PFMT alone or in combination with other treatments. The results showed some evidence for the effect of training modalities including PFMT, but to date, there is insufficient evidence from high-quality studies to draw any conclusion of a possible effect.ConclusionsGynecological toxicities after RT are common, and their management is challenging. The few data available for a rehabilitative approach on post-actinic vulvo-vaginal side effects are encouraging. Large and well-designed RCTs with the long-term follow-up that investigate the effect of PFMT on vulvo-vaginal tissues and pelvic floor muscle function are needed to provide further guidance for clinical management.

A sexual rehabilitation intervention for women with gynaecological cancer receiving radiotherapy (SPARC study): design of a multicentre randomized controlled trial

BackgroundSexual problems are frequently reported after treatment with radiotherapy (RT) for gynaecological cancer (GC), in particular after combined external beam radiotherapy and brachytherapy (EBRT+BT). Studies demonstrate that psychosexual support should include cognitive behavioural interventions and involvement of the patient’s partner, if available. Therefore, we developed a nurse-led sexual rehabilitation intervention, including these key components. The intervention was previously pilot-tested and results demonstrated that this intervention improves women’s sexual functioning and increases dilator compliance. The objective of the current study is to investigate the (cost-)effectiveness of the intervention compared to optimal care as usual (CAU). We expect that women who receive the intervention will report a statistically significant greater improvement in sexual functioning and – for women who receive EBRT+BT – higher compliance with dilator use, from baseline to 12 months post-RT than women who receive optimal care as usual (CAU).Methods/designThe intervention is evaluated in the SPARC (Sexual rehabilitation Programme After Radiotherapy for gynaecological Cancer) study, a multicentre, randomized controlled trial (RCT). The primary endpoint is sexual functioning. Secondary outcomes include body image, fear of sexual activity, sexual-, treatment-related- and psychological distress, health-related quality of life and relationship satisfaction. A cost-effectiveness analysis (CEA) will be conducted in which the costs of the intervention will be related to shifts in other health care costs and the impact on patient outcome. The study sample will consist of 220 women with GC treated with RT in specialized GC treatment centres (N = 10). Participants are randomized to either the intervention- or CAU control group (1:1), and within each centre stratified by type of radiotherapy (EBRT+BT vs. EBRT only) and having a partner (yes/no). All women complete questionnaires at baseline (T1) and at 1, 3, 6, and 12 months post-RT (T2, T3, T4 and T5, respectively).DiscussionThere is a need to improve sexual functioning after RT for GC. This RCT will provide evidence about the (cost-)effectiveness of a nurse-led sexual rehabilitation intervention. If proven effective, the intervention will be a much needed addition to care offered to GC survivors and will result in improved quality of life.Trial registrationClinicalTrials.gov, NCT03611517. Registered 2 August 2018.

Dose-response relationships of intestinal organs and excessive mucus discharge after gynaecological radiotherapy.

BackgroundThe study aims to determine possible dose-volume response relationships between the rectum, sigmoid colon and small intestine and the ‘excessive mucus discharge’ syndrome after pelvic radiotherapy for gynaecological cancer.Methods and materialsFrom a larger cohort, 98 gynaecological cancer survivors were included in this study. These survivors, who were followed for 2 to 14 years, received external beam radiation therapy but not brachytherapy and not did not have stoma. Thirteen of the 98 developed excessive mucus discharge syndrome. Three self-assessed symptoms were weighted together to produce a score interpreted as ‘excessive mucus discharge’ syndrome based on the factor loadings from factor analysis. The dose-volume histograms (DVHs) for rectum, sigmoid colon, small intestine for each survivor were exported from the treatment planning systems. The dose-volume response relationships for excessive mucus discharge and each organ at risk were estimated by fitting the data to the Probit, RS, LKB and gEUD models.ResultsThe small intestine was found to have steep dose-response curves, having estimated dose-response parameters: γ50: 1.28, 1.23, 1.32, D50: 61.6, 63.1, 60.2 for Probit, RS and LKB respectively. The sigmoid colon (AUC: 0.68) and the small intestine (AUC: 0.65) had the highest AUC values. For the small intestine, the DVHs for survivors with and without excessive mucus discharge were well separated for low to intermediate doses; this was not true for the sigmoid colon. Based on all results, we interpret the results for the small intestine to reflect a relevant link.ConclusionAn association was found between the mean dose to the small intestine and the occurrence of ‘excessive mucus discharge’. When trying to reduce and even eliminate the incidence of ‘excessive mucus discharge’, it would be useful and important to separately delineate the small intestine and implement the dose-response estimations reported in the study.

Trajectory log analysis and cone-beam CT-based daily dose calculation to investigate the dosimetric accuracy of intensity-modulated radiotherapy for gynecologic cancer.

This study evaluated unexpected dosimetric errors caused by machine control accuracy, patient setup errors, and patient weight changes/internal organ deformations. Trajectory log files for 13 gynecologic plans with seven‐ or nine‐beam dynamic multileaf collimator (MLC) intensity‐modulated radiation therapy (IMRT), and differences between expected and actual MLC positions and MUs were evaluated. Effects of patient setup errors on dosimetry were estimated by in‐house software. To simulate residual patient setup errors after image‐guided patient repositioning, planned dose distributions were recalculated (blurred dose) after the positions were randomly moved in three dimensions 0–2 mm (translation) and 0°–2° (rotation) 28 times per patient. Differences between planned and blurred doses in the clinical target volume (CTV) D98% and D2% were evaluated. Daily delivered doses were calculated from cone‐beam computed tomography by the Hounsfield unit‐to‐density conversion method. Fractional and accumulated dose differences between original plans and actual delivery were evaluated by CTV D98% and D2%. The significance of accumulated doses was tested by the paired t test. Trajectory log file analysis showed that MLC positional errors were −0.01 ± 0.02 mm and MU delivery errors were 0.10 ± 0.10 MU. Differences in CTV D98% and D2% were <0.5% for simulated patient setup errors. Differences in CTV D98% and D2% were 2.4% or less between the fractional planned and delivered doses, but were 1.7% or less for the accumulated dose. Dosimetric errors were primarily caused by patient weight changes and internal organ deformation in gynecologic radiation therapy.

A study protocol of vaginal laser therapy in gynecological cancer survivors

Objectives: Sexual dysfunction and radiation cystitis are common adverse events following radiotherapy for gynecological cancer (GC). This study aims to assess the efficacy of intravaginal CO2 laser on GC survivors with dyspareunia following pelvic radiation and/or brachytherapy.Methods: This is the study protocol of a randomized double-blind placebo-controlled trial. All participants will receive five therapies (active or placebo) at monthly intervals. Outcomes will include a 10-cm visual analog scale measuring dyspareunia, vaginal dryness, and other symptom intensity, 3-day voiding diary, Day-to Day Impact of Vaginal Aging questionnaire, Female Sexual Function Index, European Organization for Research and Treatment of Cancer Quality of Life questionnaire cervical cancer module, Urogenital Distress Inventory short form, King's Health Questionnaire, International Consultation on Incontinence Questionnaire short form/female lower urinary tract symptoms, patient perception of improvement, sexual satisfaction of male partners, vaginal maturation value, and Vaginal Health Index. Differences between groups will be assessed at baseline and 1, 3, 6, 9, and 12 months following the five laser therapies.Results: As this is a study protocol, the study is ongoing with an expected end of recruitment and analysis date of 2021.Conclusion: Pelvic radiotherapy for GC increases the 5-year survival rate but with a negative impact on women’s quality of life due to sexual dysfunction and radiation cystitis onset. With this study, CO2 laser therapy will be evaluated for the first time in GC survivors treated with radiotherapy. ClinicalTrials.gov registration number: NCT03714581

A nurse-led sexual rehabilitation intervention after radiotherapy for gynecological cancer

PurposeAlthough vaginal dilator use after combined pelvic radiation therapy and brachytherapy (RT/BT) is recommended to prevent vaginal shortening and stenosis, women fail to use them and experience sexual problems. A nurse-led sexual rehabilitation intervention targeting sexual recovery and vaginal dilatation was developed. Its feasibility was investigated during a prospective, longitudinal, observational pilot study.MethodsFour oncology nurses were specifically trained to conduct the intervention. Gynecologic cancer patients treated with RT/BT were assessed using (i) questionnaires on frequency of dilator use (monthly), sexual functioning, and sexual distress (at baseline and 1, 6, and 12 months) and psychological and relational distress (at 1, 6, and 12 months); (ii) semi-structured interviews (between 6 and 12 months); and (iii) consultation recordings (a random selection of 21 % of all consults).ResultsTwenty participants were 26–71 years old (mean = 40). Eight participants discontinued participation after 3 to 9 months. At 6 months after RT, 14 out of 16 (88 %), and at 12 months 9 out of 12 (75 %), participants dilated regularly, either by having sexual intercourse or by using dilators. Sexual functioning improved between 1 and 6 months after RT, with further improvement at 12 months. Most participants reported that the intervention was helpful and the nurses reported having sufficient expertise and counseling skills.ConclusionsAccording to the pilot results, the intervention was feasible and promising for sexual rehabilitation and regular dilator use after RT. Its (cost-)effectiveness will be investigated in a randomized controlled trial.

Abstract: Laparoscopic Harvest of an Extended Right Gastroepiploic Lymph Node Flap With Double Level Inset in Patients With Extremity Lymphedema

INTRODUCTION: Lymph node flap (LNF) transfer has shown promising results and its becoming one of the mainstay treatment options for extremity lymphedema.1,2,3 However, there are concerns regarding donor site morbidity following LNF harvest.4,5 Also, some observations have been made with regards of the effect of LNF on areas of the extremity away from the transferred flap. Herein, we describe the extended right gastroepiploic lymph node flap (RGE-LNF)3 via laparoscopic approach with a double level flap inset for patients with upper and lower limb lymphedema. MATERIALS AND METHODS: Between 2012 and 2015, patients with grade II and III upper or lower extremity lymphedema were selected for LNF transfer. Preoperative and postoperative limb circumference and lymphoscintigraphy were obtained. All patients underwent laparoscopic harvest of the extended RGE-LNF. In all cases, a double inset was performed at a distal and mid-limb level of the affected limb by dissecting a single flap in two. In addition, etiology of lymphedema, OR time and complications were analyzed. RESULTS: A total of 7 patients were analyzed. The etiology was due to mastectomy and axillary lymph node dissection for breast cancer (n=4) and after hysterectomy and radiotherapy for gynecological cancer (n=3). The survival rate of the flaps after microsurgical transfer was 100%. The average operating time for flap harvest was 37 ± 4.7 minutes; The average time for flap preparation was 8.7 ± 0.8 minutes. The average total operating time including harvest and insets was 245 minutes. The average follow-up period was 14 months. The mean circumference reduction rate of the lymphedematous limb during follow-up was 43.4 ± 4.0% (range, 38.3% to 48.9%). Postoperative lymphoscintigraphy showed improvement of the lymph flow on the affected limb in all cases. No donor-site morbidity was encountered during the follow-up period. CONCLUSION: The laparoscopic harvest of the extended RGE-LNF with a double level flap inset has been showing promising results. Due to the reduction of overall limb volume and symptomatic improvement, this approach may be a new potential treatment option for patients with extremity lymphedema. In addition, minimally invasive approach achieved reduction in donor site morbidity. REFERENCES: 1. Raju A, Chang DW. Vascularized lymph node transfer for treatment of lymphedema: a comprehensive literature review. Ann Surg. 2014 Jun 19. 2. Ciudad P, Maruccia M, Socas J, Lee MH, Chung KP, Constantinescu T, Kiranantawat K, Nicoli F, Sapountzis S, Yeo MS, Chen HC., The laparoscopic right gastroepiploic lymph node flap transfer for upper and lower limb lymphedema: Technique and outcomes. Microsurgery, 2015. 3. Sapountzis S, Singhal D, Rashid A, Ciudad P, Meo D, Chen HC. Lymph node flap based onthe right transverse cervical artery as a donor site for lymph node transfer. Ann Plast Surg. 2013 Oct;73(4):398–401. 4.Vignes S, Blanchard M, Yannoutsos A, Arrault M. Complications of autologous lymph-node transplantation for limb lymphoedema. Eur J Vasc Endovasc Surg 2013;45:516–520. 5. Massey MF, Gupta DK. The incidence of donor-site morbidity after transverse cervical artery vascularized lymph node transfers: the need for a lymphatic surgery national registry. Plast Reconstr Surg. 2015 May;135(5):939e-940e.

PTU-324 Pelvic radiation disease – when do patients present to gastroenterology services?

<h3>Introduction</h3> Pelvic radiation disease (PRD) is a common condition causing gastrointestinal symptoms following radiotherapy treatment for pelvic cancer. Awareness of this patient group is increasing but there are few dedicated services in the UK at present. Patients can develop symptoms at varying times following radiotherapy. It is unclear at what point these patients tend to present to gastroenterology services. We aimed to assess the time from radiotherapy to presentation at a regional, non sub-specialised centre. <h3>Method</h3> As part of a service evaluation a database search and retrospective note analysis was used to identify 109 patients who had been reviewed by our service between 2005 and 2014. Patients were seen in clinic and direct access endoscopy services. Patients were excluded from the analysis if they did not have both a clear date of radiotherapy commencement plus a clear date of initial review by the gastroenterology service. We analysed the time from radiotherapy to review by gastroenterology in these patients. <h3>Results</h3> 67 patients were identified (36 women, 31 men). Time to event analysis was performed. 76% were initially seen in gastroenterology clinic and 24% were seen in direct access endoscopy. The median time to presentation was 2 years (95% CI 1.622 to 2.378). The Kaplan-Meier curve is shown in Figure 1. The range was 0 to 26 years. 36% (n = 24) had radiotherapy for gynaecological cancer, 37% (n = 25) for urological cancer, 24% (n = 16) for colorectal malignancies and 3% (n = 2) for secondary malignancies (non pelvic primary). There was no significant difference in time to presentation between different types of malignancy (p = 0.713). 80% of patients presented in the first 5 years following radiotherapy. <h3>Conclusion</h3> PRD usually presents within the first five years following radiotherapy, but our analysis clearly shows that delayed presentation is possible (up to 26 years in our evaluation). This time difference may lead both patients and physicians to neglect the impact the consequential effect of radiotherapy damage to the bowel can have, even several decades. As such gastroenterologists should be mindful of PRD in any patient who has previously had pelvic radiotherapy, even if it is in the distant past. <h3>Disclosure of interest</h3> None Declared.

Reduced vaginal elasticity, reduced lubrication, and deep and superficial dyspareunia in irradiated gynecological cancer survivors

Purpose. The purpose of this study was to examine whether or not vaginal elasticity or lack of lubrication is associated with deep or superficial dyspareunia. We investigated gynecological cancer survivors treated with radiation therapy.Methods. In a population-based study with 616 women answering a questionnaire (participation rate 78%) and who were treated with radiotherapy for gynecological cancer, we analyzed information from 243 women (39%) who reported that they had had intercourse during the previous six months. Analyses included log-binomial regression (relative risks) and multiple imputations by chained equations in combination with Bayesian Model Averaging, yielding a posterior probability value. Age range of this cancer recurrent-free group of women was 29–80.Results. Dyspareunia affected 164 of 243 of the women (67%). One hundred thirty-four women (55%) reported superficial pain, 97 women (40%) reported deep pain, and 87 women (36%) reported both types of dyspareunia. The relative risk (RR) of deep dyspareunia was 1.87 (CI 1.41–2.49) with impaired vaginal elasticity compared to normal vaginal elasticity. Age and lower abdominal swelling were separate risk factors for deep dyspareunia. However, effects remain after adjusting for these factors.Conclusion. The relative risk of deep dyspareunia was almost twice as high with impaired vaginal elasticity compared to normal vaginal elasticity. If we wish to treat or even prevent deep dyspareunia in women with gynecological cancer, we may use our knowledge of the pathophysiology of deep dyspareunia and increasingly provide dilators together with instructions on how to use them for stretching exercises in order to retain vaginal elasticity. Results highlight the need for studies with more precise questions distinguishing superficial from deep dyspareunia so that in the future we may be able to primarily try to avoid reduced vaginal elasticity and secondarily reduce the symptoms.

Acquired Vulvar Lymphangioma

Vulvar lymphangioma circumscriptum (LC) is an unusual benign condition, congenital or acquired, related to interference in the lymph drainage. Acquired cases are usually related to oncological surgical procedures. We report 6 cases of vulvar LC: 3 have been caused by surgery and radiotherapy for gynecologic cancer, whereas the other 3 have originated under benign conditions--Crohn disease, recurring episodes of cellulits, and lower limb lymphedema. In 3 of them, the initial clinical diagnosis was genital wart. Surgical exeresis was performed as the treatment of choice in 5 patients and there were 3 cases of recurrences. Diagnosis of this unusual condition is not always easy even after histopathologic examination. The possibility of vulvar LC should be taken into account as a possible diagnosis in patients with previous oncological surgery or genital warts refractory to the conventional treatment. In these cases, a biopsy of not only the epidermis but also the superficial dermis is recommendable to rule out inflammatory or tumoral processes. Knowledge on the features of this lesion can avoid unnecessary clinical and therapeutic procedures.

Urinary neopterin concentrations during radiotherapy for gynecological cancer

Abstract Neopterin is a biomarker of host response to neoplasia. In the present study, urinary neopterin was determined during the course of (chemo)radiation in ten patients with gynecological tumors (nine patients with cervical carcinoma and one patient with carcinoma of the vulva). Baseline urinary neopterin concentrations were, generally, above the normal range. Neopterin concentrations were relatively stable during the first 5 weeks of combined (chemo)radiation. Marked peaks of neopterin concentrations reflected the emergence of complications. Neopterin could represent a useful biomarker for the assessment of the condition of the patients during this aggressive therapy.

A population-based study of tumours of the renal pelvis and ureter: Incidence, aetiology and histopathological findings

Objective. Carcinoma of the renal pelvis and ureter are unusual tumours and our limited knowledge comes mainly from case reports and small series from large academic hospitals, as a rule without histopathological review. This study reports aetiological and demographical factors as well as clinicopathological findings of all patients in a large geographical region. Material and methods. All patients in western Sweden with a renal pelvic or ureteral tumour diagnosed between 1971 and 1998 (n = 930) were included. Untreated cases were not excluded. Demographic data and results of preoperative examinations were retrieved from the original clinical records. The histopathological slides were reviewed and tumour stage, grade, configuration, presence of carcinoma in situ and angiolymphatic invasion were determined Results. The majority of patients (80%) had invasive or high-grade tumours. Carcinoma in situ was present among 30% of patients with non-invasive high-grade tumours. Angiolymphatic invasion (62%) and solid (non-papillary) growth pattern (84%) were very common among patients with stage T2–T4 tumours. Twenty-three women out of 138 (16.7%) with ureteral carcinoma had a history of abdominal radiotherapy for gynaecological cancer 22 years (median) earlier. Forty-one patients out of 930 (4.4%) had a history of abuse of phenacetin-containing analgesics. Conclusions. This study demonstrates a very high incidence of high-grade upper tract tumours with carcinoma in situ, angiolymphatic invasion and solid (non-papillary) growth pattern, which underscores the malignant character of the disease. The possible association between pelvic radiotherapy and ureteral carcinoma warrants further study.

Quality of life and adverse events after radiotherapy in gynecologic cancer survivors: a cohort study

To evaluate quality of life (QOL) in gynecologic cancer survivors after radiotherapy (RT), investigate the frequency of adverse events and demonstrate an association between these symptoms and QOL. A prospective cohort study of 95 women aged 21-75 years undergoing RT for gynecologic cancer was carried out. QOL was assessed by the WHOQOL-BREF before, at 4 months, 1 year and 3 years after RT and adverse events were evaluated following RT by the (CTCAE) v 3.0 scale. QOL scores were assessed by the Wilcoxon signed rank test over time. Multiple linear regression analysis was used to identify predictors of QOL. The most frequent adverse events were pain (64.2%) and dyspareunia (45.9%). A significant increase in QOL scores was observed in the psychological domain, general health and overall QOL. Pain was negatively associated with the physical, psychological and social relationship domains (p < 0.01); dyspareunia with the physical and social relationship (p < 0.01); decreased sexual interest with the psychological (p < 0.01). Higher family income was positively associated with the psychological domain and general health (p < 0.01). Results suggested that QOL improved after RT in women with gynecologic cancer. Adverse events, such as pain, dyspareunia and decreased sexual interest had a negative impact on QOL.

Pilot Study of Vaginal Plethysmography in Women Treated With Radiotherapy for Gynecological Cancer

No AccessJournal of UrologyUrological Survey: ABSTRACTS: MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY1 Aug 2004Pilot Study of Vaginal Plethysmography in Women Treated With Radiotherapy for Gynecological Cancer Allen SeftelM.D. Allen SeftelAllen Seftel More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)61769-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Pilot Study of Vaginal Plethysmography in Women Treated With Radiotherapy for Gynecological Cancer." The Journal of Urology, 172(2), pp. 794–795 © 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 172Issue 2August 2004Page: 794-795 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.MetricsAuthor Information Allen Seftel More articles by this author Expand All Advertisement PDF downloadLoading ...

Long-Term Nutritional and Digestive Consequences of Pelvic Radiation

Objective: To study long-term changes in nutritional status and gastrointestinal (GI) functions of 15 women previously treated with radiotherapy for gynecological cancer. Two years prior to this research, these patients had been assessed twice: before external radiotherapy and 5 weeks later, at the completion of the external dose (45–50 Gy).Methods: Each patient was given complete clinical evaluation, consisting of dietary, physical activity and digestive symptoms questionnaires. Blood was drawn for routine clinical laboratory tests (hemoglobin, white blood cell count, creatinine, lipoproteins, glucose, total proteins, albumin, and C reactive protein). Body composition was assessed by classical anthropometric indicators and double beam X-ray absorptiometry (DEXA), while muscle strength was measured through a hand dynamometer. Resting energy expenditure (REE), obtained by indirect calorimetry, was subtracted from energy ingestion, derived from dietary records, to calculate energy balance.Results: This third evaluation included fifteen patients. A significant increase in body mass index (BMI), % body fat and waist circumference were observed in comparison to earlier evaluations. The lean compartment decreased significantly, and REE descended in parallel. Meanwhile, total energy, fat and protein intake increased, compared to previous measurements. The changes in bowel habits observed during radiotherapy persisted at this third evaluation, with the exception of diarrhea, which was less reported. Abdominal bloating and rectal symptoms were the most prevalent complaints.Conclusions: After radiation treatment for gynecological cancer, patients gained more body fat than expected in Chilean women around menopause. In spite of high protein ingestion, the loss of fat-free mass observed during radiation treatment was not recovered along with weight increase. This is probably associated with infrequent physical activity, both during and after treatment, and hyperphagia.

Early-onset sigmoid colon perforation during concurrent chemoradiation in a patient with cervical cancer

Radiation-induced colon perforation is a rare adverse effect caused by vascular and connective tissue injury to the rectosigmoid colon. It usually occurs a few months to years after radiotherapy for gynecological cancer. Herein, we present a patient who developed sigmoid colon perforation during concurrent chemoradiotherapy for cervical cancer. The patient was a 64-year-old clinical stage IIB woman who received concurrent chemoradiotherapy as a standard treatment. The chemotherapeutic protocol was cisplatin 50 mg/m2 and 5-fluorouracil 4000 mg, starting together with radiotherapy. After the completion of external beam radiation for 4500 cGy, the patient developed sigmoid colon perforation presenting with fecal peritoneum and sepsis. An emergency end ileostomy with resection of entire sigmoid colon was performed and the patient was discharged 3 months later in good condition. Clinicians must be highly suspicious of serious bowel perforation, even if the full dose of radiation has not been completed. Whether or not the chemotherapy was the trigger factor is in need of further clarification.

Late Urological Complications and Malignancies After Curative Radiotherapy for Gynecological Carcinomas: A Retrospective Analysis of 10,709 Patients

Purpose A retrospective study was done to analyze late urological complications following curative radiotherapy of primary gynecological carcinomas. All patients were treated at a single center and with the same radiotherapeutic regimen. The incidence of other carcinomas in these patients was also evaluated. Materials and Methods A total of 10,709 patients was treated using combined telebrachytherapy (dosage 67.5 Gy.) during an observation period of 22 years. Results Severe late complications were seen in 1.24% (133 of 10,709) of the patients, including irradiated bladder (65 cases, mean interval since treatment 6.7 years), ureteral stenosis (33, mean 5.7 years) and urinary fistula (35, mean 2.7 years). Complications required surgery in 118 of 133 patients with a perioperative mortality of 4.2% (5 of 118). Overall in 4.27% (457 of 10,709) of the patients another malignancy developed after (29.1%), during (26.3%) and before (44.6%) radiotherapy. Subsequent malignancies after treatment were predominantly seen in the genital region (88.4%) but they were also in the irradiated nongenital area (0.13%, 14 of 10,709). Of the latter patients 6 had urothelial bladder cancer, which represents a relative risk of 4.66 (based on the Austrian female population) to develop bladder cancer after radiotherapy for gynecological cancer. Conclusions Late urological complications after radiotherapy of the pelvis are rare but severe. Surgical therapy of irradiated tissues has a higher complication rate compared to surgery on nonirradiated tissue.

Severe late radiation enteropathy is characterized by impaired motility of proximal small intestine

Late radiation enteropathy (LRE) is a serious disorder, and therapeutic progress has thus far been hampered by insufficient understanding of the pathogenesis. This prospective study addresses whether alterations in proximal intestinal motility can predict the clinical severity of this disorder. Forty-one consecutive patients with chronic abdominal complaints after radiotherapy for gynecological cancer were examined by prolonged ambulatory manometry. Twenty-seven healthy adults served as controls. Impaired fasting motility was found in 12 of 41 patients (29%), and attenuated postprandial motor response after a liquid-solid meal was seen in 10 of 41 patients (24%). Postprandial delay of the migrating motor complex (MMC) was a good predictor of the degree of malnutrition (Cox regression, P < 0.01), and intensity of the MMC and postprandial motility index explained 69% (P < 0.001, multiple regression) of the variability in degree of malnutrition, assessed by weight loss and serum albumin level. The typical presentation of severe LRE was clinical symptoms suggesting intestinal pseudoobstruction, malnutrition, failure of a liquid-solid meal to induce postprandial motility, and delayed initiation and reduced intensity of MMC during nocturnal fasting. Prolonged ambulatory manometry was useful for detection of dysmotility in patients with symptoms of LRE and impaired motility of proximal small intestine seems to be a key factor in the pathogenesis of severe LRE.