Abstract
PURPOSE
Endometrial Cancer (EC) is the most common gynecologic malignancy in the United States.
Standard treatment is TAH/BSO with radiation therapy (RT) and chemotherapy given based
on risk. Treatment can cause significant vaginal changes, including shortening, narrowing,
loss of elasticity, atrophy, and dryness. These are not life threatening, but affect
a woman's physical, psychological, and social functioning. Adjuvant vaginal dilator
use is often advised, but there are inconsistent recommendations on use. This prospective
study compared vaginal length changes and sexual function in women compliant with
dilation versus not after surgery and RT.
METHODS AND MATERIALS
Enrolled patients underwent surgery for Stage I-IIIC EC ±RT. Vaginal dilator use was
recommended for women receiving RT (external beam or brachytherapy). Vaginal length
was measured with a vaginal sound and the Female Sexual Function Index (FSFI) was
used to assess sexual function.
RESULTS
Forty-one enrolled patients had sufficient data for analysis. Dilation significantly
increased FSFI scores (p = 0.02) while RT without dilation showed a significant decrease (p = 0.04). Dilation helped maintain vaginal length for all patients (0 cm vs. 1.8 cm
loss (p = 0.03)). Individual arms did not show statistically significant changes in length
with dilation, though the trend showed RT without dilation had an average loss of
2.3 cm as compared to only 0.2 cm for regular dilation. Notably, there was no difference
in length change with dilation for surgery alone versus surgery and RT (p = 0.14).
CONCLUSION
This data provides novel, prospective evidence of the benefit of vaginal dilation
for maintaining vaginal length and improving sexual health after any pelvic treatment
for EC. This evidence also supports that the addition of RT after surgery does not
appear to significantly worsen vaginal shortening. This study has important implications
for providing a strong foundation for future studies and helping to establish solid
clinical management criteria for the prevention of vaginal stenosis and promotion
of female sexual health.
Keywords
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Article info
Publication history
Published online: February 25, 2023
Accepted:
January 18,
2023
Received in revised form:
January 10,
2023
Received:
September 21,
2022
Publication stage
In Press Corrected ProofFootnotes
Disclosures: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Services and products in support of the research project were generated by the VCU Massey Cancer Center Shared Resource, supported, in part, with funding from NIHNCI Cancer Center Support Grant P30 CA016059
Identification
Copyright
© 2023 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
