Department of Gynaecological Oncology, Westmead Hospital, Westmead Hospital, NSW, Australia.
Int J Gynecol Cancer. 2012 Jun;22(5):897-904. doi: 10.1097/IGC.0b013e31824d7243.
To investigate whether an educational intervention would facilitate compliance with vaginal dilators and potentially reduce stenosis in women receiving radiotherapy as treatment for a gynecological malignancy.
From 2002 to 2009, all patients undergoing pelvic radiotherapy (either external beam radiotherapy or brachytherapy) at our center for treatment of gynecological malignancies were educated about the use of vaginal dilators. Sixty patients agreed to participate in a prospective 12-month study to evaluate use. The patients had a structured educational intervention regarding dilator use. Assessment was prospectively performed via questionnaires at baseline, 3, 6, 9, and 12 months after completion of radiotherapy. Data collected included patients' demographics, treatment, incidence of stenosis, and usage of and attitudes toward dilator use.
The median age of the patients was 60 years. Primary disease site was the uterus (56.6%) and cervix (40.0%). At 12 months, 52% of patients were still using the dilators, and 35% were using the dilators at least 2 to 3 times per week. Frequency of dilator use was greater in those patients older than 50 years (P = 0.005), even after adjusting for sexual frequency, and in those experiencing pain on vaginal examination (P < 0.001). It was less frequent in those patients who were sexually active (P = 0.035). At 12 months, 11% of the patients had flimsy adhesions and 6.5% had partial stenosis. No patients had complete stenosis. The only independent predictor of stenosis was the treatment group with a hazard ratio of 0.200 (95% confidence interval, 0.059-0.685), favoring surgery and any radiotherapy reducing the risk of stenosis compared to definitive radiation therapy alone.
Our educational intervention facilitates compliance with vaginal dilators. Surgery and adjuvant radiation therapy (with or without cisplatin as a radiation sensitizer) may predict a lower risk of vaginal stenosis compared to definitive radiation therapy alone.
探讨教育干预是否有助于接受放射治疗的妇科恶性肿瘤患者遵医嘱使用阴道扩张器，并可能降低狭窄的发生率。
2002 年至 2009 年，在我院接受盆腔放射治疗（外照射或近距离放射治疗）的所有妇科恶性肿瘤患者均接受了阴道扩张器使用方面的教育。60 名患者同意参加一项为期 12 个月的前瞻性研究，以评估其使用情况。这些患者接受了关于阴道扩张器使用的结构化教育干预。在放射治疗完成后 3、6、9 和 12 个月，通过问卷调查进行前瞻性评估。收集的数据包括患者的人口统计学、治疗情况、狭窄发生率以及对扩张器使用的态度和使用情况。
患者的中位年龄为 60 岁。主要疾病部位为子宫（56.6%）和宫颈（40.0%）。在 12 个月时，52%的患者仍在使用扩张器，35%的患者每周至少使用扩张器 2-3 次。年龄大于 50 岁的患者（P=0.005）、阴道检查时有疼痛的患者（P<0.001）扩张器使用频率更高。而性活跃的患者（P=0.035）使用频率较低。在 12 个月时，11%的患者有脆弱的粘连，6.5%的患者有部分狭窄。没有患者出现完全狭窄。狭窄的唯一独立预测因素是治疗组，其危险比为 0.200（95%置信区间，0.059-0.685），与单纯放疗相比，手术和任何辅助放疗均降低了狭窄的风险。
我们的教育干预措施有助于患者遵医嘱使用阴道扩张器。与单纯放疗相比，手术和辅助放疗（含或不含顺铂作为放射增敏剂）可能降低阴道狭窄的风险。
