Miles Tracie, Johnson Nick
Gynaecological Oncology, Royal United Hospital NHS Trust, Combe Park, Bath, UK, BA1 3NG.
Cochrane Database Syst Rev. 2014 Sep 8;2014(9):CD007291. doi: 10.1002/14651858.CD007291.pub3.
Vaginal dilation therapy is advocated after pelvic radiotherapy to prevent stenosis (abnormal narrowing of the vagina), but can be uncomfortable and psychologically distressing.
To assess the benefits and harms of different types of vaginal dilation methods offered to women treated by pelvic radiotherapy for cancer.
Searches included the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 5), MEDLINE (1950 to June week 2, 2013), EMBASE (1980 to 2013 week 24) and CINAHL (1982 to 2013).
Comparative data of any type, which evaluated dilation or penetration of the vagina after pelvic radiotherapy treatment for cancer.
Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. We found no trials and therefore analysed no data.
We identified no studies for inclusion in the original review or for this update. However, we felt that some studies that were excluded warranted discussion. These included one randomised trial (RCT), which showed no improvement in sexual scores associated with encouraging women to practise dilation therapy; a recent small RCT that did not show any advantage to dilation over vibration therapy during radiotherapy; two non-randomised comparative studies; and five correlation studies. One of these showed that objective measurements of vaginal elasticity and length were not linked to dilation during radiotherapy, but the study lacked power. One study showed that women who dilated tolerated a larger dilator, but the risk of objectivity and bias with historical controls was high. Another study showed that the vaginal measurements increased in length by a mean of 3 cm after dilation was introduced 6 to 10 weeks after radiotherapy, but there was no control group; another case series showed the opposite. Three recent studies showed less stenosis associated with prophylactic dilation after radiotherapy. One small case series suggested that dilation years after radiotherapy might restore the vagina to a functional length.
AUTHORS' CONCLUSIONS: There is no reliable evidence to show that routine, regular vaginal dilation during radiotherapy treatment prevents stenosis or improves quality of life. Several observational studies have examined the effect of dilation therapy after radiotherapy. They suggest that frequent dilation practice is associated with lower rates of self reported stenosis. This could be because dilation is effective or because women with a healthy vagina are more likely to comply with dilation therapy instructions compared to women with strictures. We would normally suggest that a RCT is needed to distinguish between a casual and causative link, but pilot studies highlight many reasons why RCT methodology is challenging in this area.
盆腔放疗后提倡进行阴道扩张治疗以预防狭窄（阴道异常变窄），但这种治疗可能会带来不适且造成心理困扰。
评估为接受盆腔放疗治疗癌症的女性提供的不同类型阴道扩张方法的益处和危害。
检索包括Cochrane对照试验中心注册库（CENTRAL 2013年第5期）、MEDLINE（1950年至2013年6月第2周）、EMBASE（1980年至2013年第24周）和CINAHL（1982年至2013年）。
任何类型的比较数据，其评估了癌症盆腔放疗治疗后阴道的扩张或通畅情况。
两位综述作者独立评估潜在相关研究是否符合纳入标准。我们未找到相关试验，因此未进行数据分析。
我们未找到可纳入原始综述或本次更新的研究。然而，我们认为一些被排除的研究值得讨论。这些研究包括一项随机对照试验（RCT），该试验表明鼓励女性进行扩张治疗与性功能评分改善无关；一项近期的小型RCT，该试验未显示放疗期间扩张治疗比振动治疗有任何优势；两项非随机对照研究；以及五项相关性研究。其中一项研究表明，放疗期间阴道弹性和长度的客观测量与扩张治疗无关，但该研究样本量不足。一项研究表明，进行扩张治疗的女性能够耐受更大尺寸的扩张器，但采用历史对照存在客观性和偏倚风险。另一项研究表明，放疗后6至10周开始进行扩张治疗后，阴道长度平均增加3厘米，但没有对照组；另一个病例系列则显示了相反的结果。最近的三项研究表明，放疗后预防性扩张治疗相关的狭窄较少。一项小型病例系列表明，放疗多年后进行扩张治疗可能使阴道恢复到功能长度。
没有可靠证据表明放疗期间常规、定期进行阴道扩张治疗可预防狭窄或改善生活质量。多项观察性研究考察了放疗后扩张治疗的效果。这些研究表明，频繁进行扩张治疗与自我报告的狭窄发生率较低相关。这可能是因为扩张治疗有效，或者与狭窄女性相比，阴道健康的女性更有可能遵守扩张治疗的指示。通常我们会建议需要进行一项随机对照试验来区分偶然关联和因果关联，但前期研究凸显了在该领域进行随机对照试验方法具有挑战性的诸多原因。
