Guidelines for the Prevention of Vaginal Stenosis in Women with Gynecological Cancer after Pelvic Brachytherapy in Radiotherapy Services in Brazil
DOI:
https://doi.org/10.32635/2176-9745.RBC.2024v70n2.4705Keywords:
Genital Neoplasms, Female/Radiotherapy, Constriction, Pathologic/radiotherapy, BrachytherapyAbstract
Introduction: Vaginal stenosis can occur after pelvic brachytherapy, leading to sexual dysfunction that makes gynecological examinations for cancer follow-up difficult or impossible. Objective: To evaluate measures to prevent vaginal stenosis after brachytherapy for gynecological cancers in radiotherapy centers in Brazil. Method: Observational cross-sectional study with data collection between June and December 2022, through a Google Forms questionnaire sent to public, philanthropic and private radiotherapy services in Brazil by e-mail. Results: A total of 43 responses were obtained, where 34 (79%) institutions reported performing pelvic brachytherapy and 33 (77%) reported advising patients on stenosis prevention. The main guidelines provided were the use of vaginal dilators (32-97%), stimulation of sexual activity with penetration (27-82%), pelvic physiotherapy (22-66%) and use of topical solutions (16-48%). In most radiotherapy centers, guidance is given at the first radiotherapy appointment, with the most frequent indication being the use of dilators, starting two weeks after the end of brachytherapy, continuing for more than 36 months, without discontinuation, three times a week, once a day, for 10 to 15 minutes. Conclusion: Most radiotherapy services in Brazil that carry out brachytherapy and took part in the study provide patients with guidance on preventing vaginal stenosis and the most common measure is use of vaginal dilators, in addition to stimulation of sexual activity with penetration, use of topical solutions and pelvic physiotherapy.
Downloads
References
Instituto Nacional de Câncer. Estimativa 2023. incidência de câncer no Brasil. Rio de Janeiro: INCA; 2022
Paulino E, Melo AC, Silva-Filho AL, et al. Panorama of gynecologic cancer in Brazil. JCO Glob Oncol. 2020;6:1617-30. doi: https://doi.org/10.1200/GO.20.00099 DOI: https://doi.org/10.1200/GO.20.00099
Lopes VAS, Ribero JM. Fatores limitadores e facilitadores para o controle do câncer de colo de útero: uma revisão de literatura. Ciênc saúde coletiva. 2018;24(9):3431-42. doi: http://dx.doi.org/10.1590/1413-81232018249.32592017 DOI: https://doi.org/10.1590/1413-81232018249.32592017
Bhatla N, Aoki D, Sharma DN, et al. Cancer of the cervix uteri published correction appears in Int J Gynaecol Obstet. 2024;164(3):1229-30. Int J Gynaecol Obstet. 2018;143(Supl 2):22-36. doi: https://doi.org/10.1002/ijgo.12611 DOI: https://doi.org/10.1002/ijgo.12611
Laganà AS, Garzon S, Raffaelli R, et al. Vaginal stenosis after cervical cancer treatments: challenges for reconstructive surgery. J Invest Surg. 2021;34(7):754-5. doi: http://dx.doi.org/10.1080/08941939.2019.16 95987 DOI: https://doi.org/10.1080/08941939.2019.1695987
Hymel R, Jones GC, Simone CB. Whole pelvic intensity-modulated radiotherapy for gynecological malignancies: a review of the literature. Crit Rev Oncol Hematol. 2015;94(3):371-9. doi: http://dx.doi.org/10.1016/j.critrevonc.2014.12.015 DOI: https://doi.org/10.1016/j.critrevonc.2014.12.015
Brand AH, Bull CA, Cakir B. Vaginal stenosis in patients treated with radiotherapy for carcinoma of the cervix. Int J Gynecol Cancer. 2006;16(1):288-93. doi: http://dx.doi.org/10.1111/j.1525-1438.2006.00348.x DOI: https://doi.org/10.1111/j.1525-1438.2006.00348.x
Esteves SC, Oliveira ACZ, Feijó LFA. Braquiterapia de alta taxa de dose no Brasil. Radiol Bras. 2004;37(5):337-41. doi: http://dx.doi.org/10.1590/s0100-39842004000500007 DOI: https://doi.org/10.1590/S0100-39842004000500007
Tanderup K, Ménard C, Polgar C, et al. Advancements in brachytherapy. Adv Drug Deliv Rev. 2017;109:15-25. doi: http://dx.doi.org/10.1016/j.addr.2016.09.002 DOI: https://doi.org/10.1016/j.addr.2016.09.002
Viswanathan AN, Lee LJ, Eswara JR, et al. Complications of pelvic radiation in patients treated for gynecologic malignancies. Cancer. 2014;120(24):3870-83. doi: http://dx.doi.org/10.1002/cncr.28849 DOI: https://doi.org/10.1002/cncr.28849
Stahl JM, Qian JM, Tien CJ, et al. Extended duration of dilator use beyond 1 year may reduce vaginal stenosis after intravaginal high-dose-rate brachytherapy. Support Care Cancer. 2019;27(4):1425-33. doi: http://dx.doi.org/10.1007/s00520-018-4441-5 DOI: https://doi.org/10.1007/s00520-018-4441-5
Sociedade Brasileira de Radioterapia [Internet]. São Paulo: SBRT; 2024. Serviços de Radioterapia; 2024. [acesso 2024 jan 20]. Disponível em: https://sbradioterapia.com.br/category/servicos-radioterapia.
Conselho Nacional de Saúde (BR). Resolução n° 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União, Brasília, DF. 2013 jun 13; Seção I:59.
Jamovi [Internet]. Versão 2.4.14. Sydney: projeto Jamovi; 2024. [acesso 2024 jan 23]. Disponível em: https://www. jamovi.org/
Summerfield J, Leong A. Management of radiation therapy-induced vaginal adhesions and stenosis: a new zealand survey of current practice. J Med Radiat Sci. 2020;67(2):128-33. doi: http://dx.doi.org/10.1002/jmrs.386 DOI: https://doi.org/10.1002/jmrs.386
Matos SRL, Cunha MLR, Podgaec S, et al. Consensus for vaginal stenosis prevention in patients submitted to pelvic radiotherapy. PLoS One. 2019;14(8):e0221054. doi: http://dx.doi.org/10.1371/journal.pone.0221054 DOI: https://doi.org/10.1371/journal.pone.0221054
Bakker RM, ter Kuile MM, Vermeer WM, et al. Sexual rehabilitation after pelvic radiotherapy and vaginal dilator use: consensus using the Delphi method. Int J Gynecol Cancer. 2014;24(8):1499-506. dois: http://dx.doi.org/10.1097/igc.0000000000000253 DOI: https://doi.org/10.1097/IGC.0000000000000253
Pikula D, Fabicz S, Carmo RL, et al. Estenose Vaginal pós-braquiterapia: ocorrências e repercussões em mulheres com câncer ginecológico. Cogit Enferm. 2021;26:e75694. doi: http://dx.doi.org/10.5380/ce.v26i0.75694 DOI: https://doi.org/10.5380/ce.v26i0.75694
Law E, Kelvin JF, Thom B, et al. Prospective study of vaginal dilator use adherence and efficacy following radiotherapy. Radiother Oncol. 2015;116(1):149-55. doi: http://dx.doi.org/10.1016/j.radonc.2015.06.018 DOI: https://doi.org/10.1016/j.radonc.2015.06.018
Charatsi D, Vanakara P, Evaggelopoulou E, et al. Vaginal dilator use to promote sexual wellbeing after radiotherapy in gynecological cancer survivors. Medicine (Baltimore). 2022;101(4):e28705. doi: http://dx.doi.org/10.1097/md.0000000000028705 DOI: https://doi.org/10.1097/MD.0000000000028705
Haddad NC, Brollo LCS, Oliveira MAP, et al. Diagnostic methods for vaginal stenosis and compliance to vaginal dilator use: a systematic review. J Sex Med. 2021;18(3):493-514. doi: http://dx.doi.org/10.1016/j.jsxm.2020.12.013 DOI: https://doi.org/10.1016/j.jsxm.2020.12.013
Bonner C, Nattress K, Anderson C, et al. Chore or priority? Barriers and facilitators affecting dilator use after pelvic radiotherapy for gynaecological cancer. Support Care Cancer. 2012;20(10):2305-13. doi: http://dx.doi.org/10.1007/s00520-011-1337-z DOI: https://doi.org/10.1007/s00520-011-1337-z
Huffman LB, Hartenbach EM, Carter J, et al. Maintaining sexual health throughout gynecologic cancer survivorship: a comprehensive review and clinical guide. Gynecol Oncol. 2016;140(2):359-68. doi: http://dx.doi.org/10.1016/j.ygyno.2015.11.010 DOI: https://doi.org/10.1016/j.ygyno.2015.11.010
Brennen R, Lin KY, Denehy L, et al. The effect of pelvic floor muscle interventions on pelvic floor dysfunction after gynecological cancer treatment: a systematic review. Phys Ther. 2020;100(8):1357-71. doi: http://dx.doi.org/10.1093/ptj/pzaa081 DOI: https://doi.org/10.1093/ptj/pzaa081
Hanlon A, Small W Jr, Strauss J, et al. Dilator use after vaginal brachytherapy for endometrial cancer: a randomized feasibility and adherence study. Cancer Nurs. 2018;41(3):200-09. doi: http://dx.doi.org/10.1097/ncc.0000000000000500 DOI: https://doi.org/10.1097/NCC.0000000000000500
Brand AH, Do V, Stenlake A. Can an educational intervention improve compliance with vaginal dilator use in patients treated with radiation for a gynecological malignancy? Int J Gynecol Cancer. 2012;22(5):897-904. doi: http://dx.doi.org/10.1097/igc.0b013e31824d7243 DOI: https://doi.org/10.1097/IGC.0b013e31824d7243
Bakker RM, Vermeer WM, Creutzberg CL, et al. Qualitative accounts of patients’ determinants of vaginal dilator use after pelvic radiotherapy. J Sex Med. 2015;12(3):764-73. doi: http://dx.doi.org/10.1111/jsm.127 DOI: https://doi.org/10.1111/jsm.12776
Downloads
Published
How to Cite
Issue
Section
License
Os direitos morais e intelectuais dos artigos pertencem aos respectivos autores, que concedem à RBC o direito de publicação.
This work is licensed under a Creative Commons Attribution 4.0 International License.
