Martins Jumara, Vaz Ana Francisca, Grion Regina Celia, Esteves Sérgio Carlos Barros, Costa-Paiva Lúcia, Baccaro Luiz Francisco
Radiotherapy Division, Department of Gynecology, University of Campinas (UNICAMP), Campinas, SP, Brazil.
Department of Gynecology, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil.
Arch Gynecol Obstet. 2017 Dec;296(6):1125-1133. doi: 10.1007/s00404-017-4553-z. Epub 2017 Oct 3.
This study reports the incidence and factors associated with vaginal stenosis and changes in vaginal dimensions after pelvic radiotherapy for cervical cancer.
A descriptive longitudinal study with 139 women with cervical cancer was conducted from January 2013 to November 2015. The outcome variables were vaginal stenosis assessed using the Common Terminology Criteria for Adverse Events (CTCAE v3.0) and changes in vaginal diameter and length after the end of radiotherapy. Independent variables were the characteristics of the neoplasm, clinical and sociodemographic data. Bivariate analysis was carried out using χ , Kruskal-Wallis and Mann-Whitney's test. Multiple analysis was carried out using Poisson regression and a generalized linear model.
Most women (50.4%) had stage IIIB tumors. According to CTCAE v3.0 scale, 30.2% had no stenosis, 69.1% had grade 1 and 0.7% had grade 2 stenosis after radiotherapy. Regarding changes in vaginal measures, the mean variation in diameter was - 0.6 (± 1.7) mm and the mean variation in length was - 0.6 (± 1.3) cm. In the final statistical model, having tumoral invasion of the vaginal walls (coefficient + 0.73, p < 0.01) and diabetes (coefficient + 1.16; p < 0.01) were associated with lower vaginal stenosis and lower reduction of vaginal dimensions. Advanced clinical stage (coefficient + 1.44; p = 0.02) and receiving brachytherapy/teletherapy (coefficient - 1.17, p < 0.01) were associated with higher reduction of vaginal dimensions.
Most women had mild vaginal stenosis with slight reductions in both diameter and length of the vaginal canal. Women with tumoral invasion of the vagina have an increase in vaginal length soon after radiotherapy due to a reduction in tumoral volume.
本研究报告了宫颈癌盆腔放疗后阴道狭窄的发生率、相关因素以及阴道尺寸的变化。
2013年1月至2015年11月对139例宫颈癌患者进行了一项描述性纵向研究。观察变量为采用不良事件通用术语标准（CTCAE v3.0）评估的阴道狭窄情况以及放疗结束后阴道直径和长度的变化。自变量为肿瘤特征、临床和社会人口统计学数据。采用χ²检验、Kruskal-Wallis检验和Mann-Whitney检验进行双变量分析。采用泊松回归和广义线性模型进行多变量分析。
大多数女性（50.4%）患有IIIB期肿瘤。根据CTCAE v3.0量表，放疗后30.2%无狭窄，69.1%有1级狭窄，0.7%有2级狭窄。关于阴道尺寸的变化，直径的平均变化为-0.6（±1.7）mm，长度的平均变化为-0.6（±1.3）cm。在最终统计模型中，阴道壁受肿瘤侵犯（系数+0.73，p<0.01）和糖尿病（系数+1.16；p<0.01）与较低的阴道狭窄和较小的阴道尺寸减小相关。临床晚期（系数+1.44；p=0.02）和接受近距离放疗/远距离放疗（系数-1.17，p<0.01）与较大的阴道尺寸减小相关。
大多数女性有轻度阴道狭窄，阴道管直径和长度均略有减小。阴道受肿瘤侵犯的女性在放疗后不久由于肿瘤体积减小，阴道长度会增加。
