Karabuga Havva, Gultekin Melis, Tulunay Gokhan, Yuce Kunter, Ayhan Ali, Yuce Deniz, Yildiz Ferah
*Department of Radiation Oncology, Ankara Ataturk Training and Research Hospital; †Department of Radiation Oncology, Hacettepe University, Faculty of Medicine; ‡Department of Gynecological Oncology, Etlik Zubeyde Hanim Training and Research Hospital; §Department of Gynecological Oncology, Hacettepe University, Faculty of Medicine; ∥Department of Gynecological Oncology, Baskent University Faculty of Medicine; and ¶Department of Preventive Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
Int J Gynecol Cancer. 2015 Oct;25(8):1526-33. doi: 10.1097/IGC.0000000000000509.
The current study evaluates long-term quality of life (QOL) and sexual function of patients with endometrial cancer who received adjuvant pelvic external beam radiotherapy (EBRT) and/or vaginal brachytherapy (BRT).
One hundred forty-four endometrial cancer survivors who were treated between January 2000 and December 2009 in our department were included in this study. Median follow-up was 79 months (range, 31-138 months). Fifty-two patients were treated with 45 to 50.4 Gy EBRT, 76 were with BRT, and 16 were with both EBRT and BRT. Brachytherapy was in the form of vaginal cuff BRT with 5 × 550 cGy high dose rate BRT, prescribed to the first 4 cm and whole wall thickness of vagina. Quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and subscales from the supplemental 24-item Cervical Cancer Module.
Vaginal BRT patients reported better physical functioning (P = 0.01), role functioning (P = 0.03), and sexual enjoyment (P = 0.01) compared to EBRT group. Symptom score (P = 0.01), lymphedema (P = 0.03), pain (P = 0.02), and diarrhea (P = 0.009) scores were also higher with EBRT. Vaginal BRT did not worsen symptom scores or sexual functions when added to EBRT. Obese patients experienced higher rates of lymphedema (P = 0.008). Cognitive and role functioning scores were significantly higher in patients with normal body mass index.
External beam radiotherapy negatively affects long-term QOL and sexual functions in endometrial cancer survivors. Vaginal BRT provides higher QOL. Patients with body mass index within normal limits have improved QOL.
本研究评估接受辅助盆腔外照射放疗(EBRT)和/或阴道近距离放疗(BRT)的子宫内膜癌患者的长期生活质量(QOL)和性功能。
本研究纳入了2000年1月至2009年12月在我科接受治疗的144例子宫内膜癌幸存者。中位随访时间为79个月(范围31 - 138个月)。52例患者接受45至50.4 Gy的EBRT治疗,76例接受BRT治疗,16例同时接受EBRT和BRT治疗。近距离放疗采用阴道袖口BRT形式,5×550 cGy高剂量率BRT,处方剂量为阴道前4 cm和全壁厚度。使用欧洲癌症研究与治疗组织生活质量问卷核心30以及补充的24项宫颈癌模块的子量表评估生活质量。
与EBRT组相比,阴道BRT患者的身体功能(P = 0.01)、角色功能(P = 0.03)和性快感(P = 0.01)报告更好。EBRT组的症状评分(P = 0.01)、淋巴水肿(P = 0.03)、疼痛(P = 0.02)和腹泻(P = 0.009)评分也更高。在EBRT基础上加用阴道BRT不会使症状评分或性功能恶化。肥胖患者淋巴水肿发生率更高(P = 0.008)。体重指数正常的患者认知和角色功能评分显著更高。
外照射放疗对子宫内膜癌幸存者的长期QOL和性功能有负面影响。阴道BRT可提供更高的QOL。体重指数在正常范围内的患者QOL有所改善。