Kirchheiner Dr. Kathrin, Zaharie Dr. Alexandru, Smet Dr. Stéphanie, Spampinato Dr. Sofia, Pötter Dr. Richard, Kirisits Dr. Christian, Schmid Dr. Maximilian, Tanderup Dr. Kari, De Leeuw Dr. Astrid A, Jürgenliemk-Schulz Dr. Ina M, Nout Dr. Remi A

(233) REGULAR DILATION AND SEXUAL ACTIVITY SHOW LESS RISK FOR VAGINAL NARROWING AND SHORTENING AFTER RADIOCHEMOTHERAPY FOR LOCALLY ADVANCED CERVICAL CANCER

  • Urology
  • Reproductive Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Psychiatry and Mental health
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Abstract Objectives Radiochemotherapy for cervical cancer has a substantial risk to cause long-term vaginal stenosis (shortening/narrowing), due to irreversible fibrotic changes and can cause dyspareunia in many cancer survivors. Clinical recommendations for aftercare include vaginal dilation with cylinders; sexually active patients with partners are encouraged to engage in intercourse involving penetration. However, the evidence for prevention is limited. Aim of this report is to evaluate the association between regular vaginal dilation, sexual activity and vaginal stenosis in locally advanced cervical cancer patients after definitive radiochemotherapy and image-guided adaptive brachytherapy from the prospective, international, longitudinal EMBRACE I study (www.embracestudy.dk). Methods Physician-assessed vaginal stenosis (CTCAE v.3), vaginal dilation and patient-reported sexual activity (EORTC QLQ CX24) were assessed at baseline, every 3 months in the 1st year, every 6 months in the 2nd and 3rd year and yearly thereafter. For this longitudinal analysis, a subgroup of patients was selected with at least 3 follow-ups with information on vaginal dilation and sexual activity. Regular dilation was defined if reported in ≥50%, irregular/no dilation if reported in <50% of follow-ups. The same method was applied to sexual activity. Actuarial estimates of vaginal stenosis G≥2 were calculated with Kaplan-Meier method; group comparisons evaluated with the log-rank test. Results The EMBRACE I study recruited 1416 patients overall (2008-2015); the subgroup of patients for this longitudinal evaluation included 821 patients, with a median follow-up of 61 months. Of those, 296 (36%) reported regular dilation; this was associated with a significantly lower risk of vaginal stenosis G≥2 at 5 years, p=0.023 (figure A). 381 patients (46%) reported regular sexual activity; this was associated with a significantly lower risk of vaginal stenosis G≥2 at 5 years, p≤0.001 (figure B). Conclusions These long-term data support clinical recommendations for regular dilation and/or sexual activity after radiotherapy. Conflicts of Interest The authors have no conflict of interest to declare.

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