Author/Editor		Kirchheiner, Kathrin; Smet, Stéphanie; Jürgenliemk-Schulz, Ina Maria; Haie-Meder, Christine; Chagari, Cyrus; Lindegaard, Jacob Christian; Schmid, Maximilian; Fokdal, Lars U.; Spampinato, Sofia; Šegedin, Barbara
Title		Impact of vaginal symptoms and hormonal replacement therapy on sexual outcomes after definitive chemoradiotherapy in patients with locally advanced cervical cancer
Type		članek
Vol. and No.		Letnik 112, št. 2
Publication year		2022
Volume		str. 400-413
ISSN		0360-3016 - International journal of radiation oncology, biology, physics
Language		eng
Abstract		To evaluate patient-reported sexual outcomes after chemoradiation therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer in the observational, prospective, multicenter EMBRACE-I study. Methods and materials: Sexual outcomes were assessed prospectively with the European Organization for Research and Treatment of Cancer Qualify of Life Questionnaire (EORTC-QLQ-CX24) at baseline and follow-up. Crude incidence and prevalence rates of sexual activity, vaginal functioning problems (dryness, shortening, tightening, pain during intercourse), and sexual enjoyment were evaluated. Associations between pain during intercourse and vaginal functioning problems or sexual enjoyment were calculated, pooling observations over all follow-ups (Spearman correlation coefficient). In patients who were frequently sexually active (s50% of follow-ups), the effects of regular hormonal replacement therapy (HRT) on vaginal functioning problems were evaluated (Pearson χ2). Results: The analysis involved 1045 patients with a median follow-up of 50 months. Sexual activity was reported by 22% of patients at baseline and by 40% to 47% of patients during follow-up (prevalence rates). Vaginal functioning problems in follow-up were dryness (18%-21%), shortening (15%-22%), tightening (16%-22%), pain during intercourse (9%-21%), and compromised enjoyment (37%-47%). Pain during intercourse was significantly associated with vaginal tightening (r = 0.544), shortening (r = 0.532), and dryness (r = 0.408) and negatively correlated with sexual enjoyment (r = -0.407). Regular HRT was associated with significantly less vaginal dryness (P = .015), shortening (P = .024), pain during intercourse (P = .003), and borderline higher sexual enjoyment (P = .062). Conclusions: Vaginal functioning problems are associated with pain and compromised sexual enjoyment. Further effort is required for the primary prevention of vaginal morbidity with dose optimization and adaptation. Secondary prevention strategies, including HRT for vaginal and sexual health after radiation therapy in locally advanced cervical cancer, should be considered and sexual rehabilitation programs should be developed further.
Keywords		rak materničnega vratu lokalno napredovali rak radioterapija brahiterapija cervical cancer locally advanced cancer radiotherapy brachytherapy