Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.
Strahlenther Onkol. 2019 Oct;195(10):902-912. doi: 10.1007/s00066-019-01466-1. Epub 2019 Apr 17.
Despite a lack of evidence and low compliance, current guidelines recommend the use of a vaginal dilator (VD) after pelvic radiotherapy (RT). We analyzed the effect of VD on vaginal stenosis (VS) and its influence on sexual quality of life (QoL) in women treated with adjuvant RT for endometrial cancer (EC).
Between 2014 and 2015, 56 consecutive patients were instructed to use a VD after completion of treatment. The maximum diameter of the comfortably introducible VD was measured before and at 1 year after treatment. The degree of VS was evaluated clinically, and sexual QoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) sexual functioning items before RT, during RT, at 6 weeks, and at 1 year after RT.
One year after RT, mean VD diameter had decreased by 2.7 ± 3.2 mm (p < 0.001) and 36 patients (64.3%) had clinical VS (grade I-III). A larger decrease in VD diameter correlated with a higher degree of clinical VS (p < 0.001). VD use (p = 0.81), RT modality (p = 0.68), and adjuvant ChT (p = 0.87) had no influence on VD diameter. Sexual activity decreased during RT and increased beyond pre-RT values 1 year after RT (p < 0.001). Sexual enjoyment decreased continuously during and after completion of RT (p = 0.013) and was influenced negatively by a higher degree of clinical VS (p = 0.01).
Almost two thirds of patients developed clinical VS 1 year after adjuvant RT for EC, and sexual enjoyment was substantially reduced by VS. The use of a VD after RT may not serve to prevent sexual impairments and VS.
尽管缺乏证据且患者顺应性低，当前指南仍建议在盆腔放疗（RT）后使用阴道扩张器（VD）。我们分析了 VD 对接受子宫内膜癌（EC）辅助 RT 治疗的女性阴道狭窄（VS）的影响及其对生活质量（QoL）的影响。
2014 年至 2015 年，连续 56 例患者在完成治疗后被指示使用 VD。在治疗前和治疗后 1 年测量可舒适插入的 VD 的最大直径。临床评估 VS 程度，在 RT 前、RT 期间、6 周和 RT 后 1 年使用欧洲癌症研究与治疗组织（EORTC）性功能项目评估性 QoL。
RT 后 1 年，VD 直径平均减少 2.7±3.2mm（p<0.001），36 例（64.3%）出现临床 VS（I-III 级）。VD 直径减小幅度较大与临床 VS 程度较高相关（p<0.001）。VD 使用（p=0.81）、RT 方式（p=0.68）和辅助化疗（p=0.87）对 VD 直径无影响。性活动在 RT 期间减少，并在 RT 后 1 年超过 RT 前的值（p<0.001）。性享受在 RT 期间和结束后持续下降（p=0.013），且与较高的临床 VS 程度呈负相关（p=0.01）。
EC 辅助 RT 后 1 年，近三分之二的患者出现临床 VS，VS 显著降低了性享受。RT 后使用 VD 可能无法预防性损伤和 VS。
