Department of Gynecology, University Campus Biomedico, Rome, Italy.
Department of Obstetrics and Ginecology, IRCCS San Raffaele Hospital, Milan, Lombardia, Italy.
Int J Gynecol Cancer. 2020 May;30(5):590-595. doi: 10.1136/ijgc-2019-001028. Epub 2020 Mar 27.
Many women diagnosed with gynecological cancers undergo adjuvant therapy, which may lead to transient or permanent menopause that ultimately leads to urogenital syndrome and vulvovaginal atrophy. Studies advise against the use of estrogen in women with a history of hormone-dependent cancer. One alternative is vaginal microablative fractional CO laser, which promotes tissue regeneration through the production of collagen and elastic fibers.
To evaluate the effectiveness of CO laser in the treatment of urogenital syndrome-in particular, symptomatic vulvovaginal atrophy in women who have survived gynecological cancers.
A retrospective study was carried out, including all patients with a history of gynecological cancers and vulvovaginal atrophy who underwent CO laser treatment between November 2012 and February 2018 in four Italian centers. The study was approved by the local ethics committee of each participating institution. The inclusion criteria were women aged between 18 and 75; Eastern Cooperative Oncology Group performance status <2; and history of breast, ovarian, cervical, or uterus cancer. Patients had to have vulvovaginal atrophy and at least one of the following symptoms of urogenital syndrome: vaginal dryness, dyspareunia, vaginal introitus pain, burning, or itching. Three applications were administered at baseline, 30 days, and 60 days. All patients were evaluated before the first laser session, at each session, and 4 weeks after the last session. In particular, patients were asked to indicate the intensity of symptoms before the first session and 4 weeks after the last session, using Visual Analog Scale (VAS) scoring from 0 ('no discomfort') to 10 ('maximum discomfort').
A total of 1213 patients underwent CO laser treatment and of these, 1048 were excluded because they did not meet the inclusion criteria in the analysis. Finally, a total of 165 patients were included in the study. The mean age at the time of treatment was 53 years (range 31-73). Dryness improved by 66%, dyspareunia improved by 59%, burning improved by 66%, pain at introitus improved by 54%, and itching improved by 54%. The side effects were evaluated as pain greater than VAS score 6 during and after the treatment period. No side effects were seen in any sessions.
Fractional microablative CO laser therapy offers an effective strategy in the management of the symptoms of genitourinary syndrome in post-menopausal women and in survivors of gynecological cancer.
许多被诊断患有妇科癌症的女性需要接受辅助治疗，这可能导致暂时或永久性绝经，最终导致泌尿生殖系统综合征和阴道萎缩。研究建议对有激素依赖性癌症病史的女性避免使用雌激素。另一种选择是阴道微剥脱性分数 CO 激光，它通过产生胶原蛋白和弹性纤维来促进组织再生。
评估 CO 激光治疗泌尿生殖系统综合征的有效性，特别是治疗妇科癌症存活者的症状性阴道萎缩。
进行了一项回顾性研究，包括 2012 年 11 月至 2018 年 2 月在意大利四个中心接受 CO 激光治疗的有妇科癌症和阴道萎缩病史的所有女性患者。该研究得到了每个参与机构当地伦理委员会的批准。纳入标准为年龄 18-75 岁；东部合作肿瘤组表现状态<2；有乳腺癌、卵巢癌、宫颈癌或子宫癌病史。患者必须有阴道萎缩和泌尿生殖系统综合征的至少一种以下症状：阴道干燥、性交困难、阴道入口疼痛、灼热或瘙痒。基线时、30 天和 60 天各应用 3 次。所有患者在第一次激光治疗前、每次治疗时和最后一次治疗后 4 周进行评估。特别是，患者在第一次治疗前和最后一次治疗后 4 周时被要求使用视觉模拟量表（VAS）评分从 0（“无不适”）到 10（“最大不适”）来表示症状的强度。
共有 1213 名患者接受了 CO 激光治疗，其中 1048 名因不符合分析中的纳入标准而被排除。最终，共有 165 名患者被纳入研究。治疗时的平均年龄为 53 岁（范围 31-73 岁）。干燥改善了 66%，性交困难改善了 59%，灼热改善了 66%，入口疼痛改善了 54%，瘙痒改善了 54%。副作用被评估为治疗期间和治疗后 VAS 评分大于 6 的疼痛。在任何治疗阶段都没有观察到副作用。
分数微剥脱性 CO 激光治疗为绝经后妇女和妇科癌症存活者泌尿生殖系统综合征症状的管理提供了一种有效的策略。
