Supportive therapy as prevention for iatrogenic sexual dysfunction following vaginal Brachytherapy (BRT)

Abstract

Objective: Endometrial cancer (EC) is the most common gynaecological cancer in postmenopausal women. Early stage diagnoses of EC have led to improved cancer-related survival increasing the onset of adverse events, which often negatively affect patient’s quality of life. In this regard, frequently, women treated with radiotherapy refer a sexual desire reduction and a decreased sexual intercourse frequency. In this regard, recent studies, on supportive therapies applied in association with radiotherapy in gynaecology, have reported the capability of Low-Molecular Weight Hyaluronic Acid (LMWHA) to improve patient quality of life. For this reason, a LMWHA based treatment was used in association to standard therapies, to counteract the onset of adverse events in irradiated tissues. Patients and Methods: 199 patients with EC at stage IB were enrolled, surgically treated and subsequently exposed to brachytherapy (BRT) with vaginal cylinder customized in length and diameter. Simultaneously with BRT, patients were divided in two groups and daily treated with chlorhexidine lavenders and LMWHA suppositories (Supportive therapy - SuBRT) or only with chlorhexidine lavenders (Control group – CBRT), in both cases for 15 days. To evaluate treatment effects an interview to all patients was performed by a psychologist. Results: After the treatment, 71% of patients decided to be interviewed. In SuBRT group an evident improvement of patients’ quality of life was reported thanks to limiting radiotherapy impact on sexual activity, social activities and emotional state. In this regard, an important difference about the percentages of patients reporting significant and serious effects was reported comparing SuBRT and CBRT groups (respectively 40% and 78%) in relation to sexual activity. Conclusions: As reported in this paper, thanks to LMWHA treatment, an overall improvement of patient’s QoL can be reached reducing radiotherapy impact on sexual and social life of these women.

Keywords

• endometrial cancer
• quality of life
• brachytherapy
• low-molecular weight hyaluronic acid