Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):667-73. doi: 10.1016/j.ijrobp.2010.10.071. Epub 2011 Feb 6.
The objective of this study was to determine the patient- and treatment-related prognostic factors associated with vaginal toxicity in patients who received intravaginal high dose rate (HDR) brachytherapy alone as adjuvant treatment for endometrial cancer. Secondary goals of this study included a quantitative assessment of optimal dilator use frequency and a crude assessment of clinical predictors for compliant dilator use.
We retrospectively reviewed the charts of 100 patients with histologically confirmed endometrial cancer who underwent total hysterectomy and bilateral salpingo-oophorectomy with or without lymph node dissection and adjuvant intravaginal brachytherapy between 1995 and 2009 at the Hospital of the University of Pennsylvania. The most common treatment regimen used was 21 Gy in three fractions (71 patients). Symptoms of vaginal mucosal toxicity were taken from the history and physical exams noted in the patients' charts and were graded according to the Common Toxicity Criteria for Adverse Events v. 4.02.
The incidence of Grade 1 or asymptomatic vaginal toxicity was 33% and Grade 2-3 or symptomatic vaginal toxicity was 14%. Multivariate analysis of age, active length, and dilator use two to three times a week revealed odds ratios of 0.93 (p = 0.013), 3.96 (p = 0.008), and 0.17 (p = 0.032) respectively.
Increasing age, vaginal dilator use of at least two to three times a week, and shorter active length were found to be significantly associated with a decreased risk of vaginal stenosis. Future prospective studies are necessary to validate our findings.
本研究旨在确定接受阴道内高剂量率（HDR）近距离放疗作为子宫内膜癌辅助治疗的患者中与阴道毒性相关的患者和治疗相关的预后因素。本研究的次要目标包括对最佳扩张器使用频率进行定量评估，并对扩张器使用依从性的临床预测因素进行粗略评估。
我们回顾性分析了 1995 年至 2009 年间在宾夕法尼亚大学医院接受全子宫切除术和双侧输卵管卵巢切除术（伴或不伴淋巴结清扫术）以及辅助阴道近距离放疗的 100 例组织学证实为子宫内膜癌患者的病历。最常用的治疗方案是 21Gy，分 3 次给予（71 例）。阴道黏膜毒性的症状来自于患者病历中的病史和体格检查，并根据不良事件通用毒性标准 v.4.02 进行分级。
1 级或无症状阴道毒性的发生率为 33%，2-3 级或有症状阴道毒性的发生率为 14%。对年龄、活动长度和每周使用阴道扩张器 2-3 次进行多变量分析，发现比值比分别为 0.93（p=0.013）、3.96（p=0.008）和 0.17（p=0.032）。
发现年龄增长、每周至少使用阴道扩张器 2-3 次以及活动长度缩短与阴道狭窄风险降低显著相关。未来有必要进行前瞻性研究来验证我们的发现。
