Tahseen Rabia, Ahmed Yumna, Tariq Maria, Abrar Sehrish, Ali Nasir
Section of Radiation Oncology, Department of Oncology, Aga Khan University, Karachi 74800, Pakistan.
Ecancermedicalscience. 2023 May 4;17:1545. doi: 10.3332/ecancer.2023.1545. eCollection 2023.
To investigate the compliance and clinical efficacy of vaginal dilators (VDs) as an educational intervention in patients receiving pelvic radiation therapy (RT) for endometrial and cervical malignancies.
This is a single institution, retrospective chart review. Patients undergoing pelvic RT for endometrial or cervical cancer at our center were educated about the use of a VD starting 1 month after completion of RT. The patients were assessed after 3 months of prescribing VD. The demographic details and physical examination findings were extracted from medical records.
We identified 54 female patients at our institution during the 6-month duration. The median mean age of patients was 54 ± 9.9 years. Twenty-four (44.4%) had endometrial cancers and 30 (55.6%) were diagnosed with cervical cancers. All patients received external beam RT, 38 (70.4%) received a dose of 45 Gy, and 16 (29.6%) patients received 50.4 Gy. Brachytherapy was also received by all patients, 28 (51.9%) received 5 Gy × 2 fractions, 4 (7.4%) received 7 Gy × 3 fractions and 22 (40.7%) received 8 Gy × 3 fractions. The compliance with VD use was 36 (66.6%) patients. Twenty-two (40.7%) used 2-3 times a week, 8 (14.8%) used <2 times per week and 6 (11.9%) used only once a month, and 18 (33.3%) did not use the VD post-treatment. Per vaginal (PV) examination findings of the patient's vagina with normal mucosa were evaluated in 32 (59.3%) and adhesions were found in 20 (37.0%) and 2 (3.7%) were unable to examine due to dense adhesions. During examination 12 (22.2%) had bleeding PV, however, the majority of the patients, 42 (77.8%) experienced no bleeding PV. Out of the 36 patients who used a VD, it was found to be efficacious in 29 (80.6%) of patients. Upon stratification of efficacy with a frequency of VD, 72.4% ( = 21) efficacy was seen in patients using frequent VD as prescribed 2-3 times per week.
The compliance and efficacy of VD use after radiation to pelvic in cervical and endometrial cancers at 3 months follow-up were found to be 66.6% and 80.6%, respectively. This shows that VD therapy is an effective interventional tool and patients should receive specialist education about vaginal stenosis as toxicity at the outset of treatment.
探讨阴道扩张器作为一种教育干预手段，在接受盆腔放疗（RT）的子宫内膜癌和宫颈癌患者中的依从性及临床疗效。
这是一项单机构回顾性病历审查。在我们中心接受子宫内膜癌或宫颈癌盆腔放疗的患者，在放疗结束后1个月开始接受阴道扩张器使用的教育。在开具阴道扩张器3个月后对患者进行评估。从病历中提取人口统计学细节和体格检查结果。
在6个月期间，我们机构共确定了54名女性患者。患者的中位平均年龄为54±9.9岁。24例（44.4%）患有子宫内膜癌，30例（55.6%）被诊断为宫颈癌。所有患者均接受了外照射放疗，38例（70.4%）接受了45 Gy的剂量，16例（29.6%）患者接受了50.4 Gy。所有患者也接受了近距离放疗，28例（51.9%）接受了5 Gy×2次分割，4例（7.4%）接受了7 Gy×3次分割，22例（40.7%）接受了8 Gy×3次分割。阴道扩张器的使用依从性为36例（66.6%）患者。22例（40.7%）每周使用2 - 3次，8例（14.8%）每周使用<2次，6例（11.9%）每月仅使用1次，18例（33.3%）在治疗后未使用阴道扩张器。对32例（59.3%）患者的阴道进行了阴道内（PV）检查，发现黏膜正常，20例（37.0%）发现粘连，2例（3.7%）因粘连严重无法检查。检查期间，12例（22.2%）有PV出血，然而，大多数患者，42例（77.8%）没有PV出血。在使用阴道扩张器的36例患者中，发现29例（80.6%）患者有效。根据阴道扩张器使用频率对疗效进行分层后，每周按规定使用2 - 3次的频繁使用阴道扩张器的患者中，疗效为72.4%（n = 21）。
在3个月的随访中，宫颈癌和子宫内膜癌盆腔放疗后使用阴道扩张器的依从性和疗效分别为66.6%和80.6%。这表明阴道扩张器治疗是一种有效的干预工具，患者在治疗开始时应接受关于阴道狭窄作为毒性反应的专科教育。
