DOSIMETRIC PREDICTORS OF SEXUAL TOXICITY IN CERVICAL CANCER PATIENTS TREATED WITH DEFINITIVE CHEMORADIATION AND MRI-GUIDED BRACHYTHERAPY

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-01 DOI:10.1016/S0167-8140(25)04684-5

Stephanie Gulstene , Elizabeth Chuk , Jessica L. Conway , Jennifer Hanuschak , Kathy Han , Michael Milosevic , Helena Lukovic , Nauman Malik , Sarah E. Ferguson , Ailya Salman , Anna T. Santiago , Alexandra Rink , Jennifer Croke

{"title":"DOSIMETRIC PREDICTORS OF SEXUAL TOXICITY IN CERVICAL CANCER PATIENTS TREATED WITH DEFINITIVE CHEMORADIATION AND MRI-GUIDED BRACHYTHERAPY","authors":"Stephanie Gulstene , Elizabeth Chuk , Jessica L. Conway , Jennifer Hanuschak , Kathy Han , Michael Milosevic , Helena Lukovic , Nauman Malik , Sarah E. Ferguson , Ailya Salman , Anna T. Santiago , Alexandra Rink , Jennifer Croke","doi":"10.1016/S0167-8140(25)04684-5","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose:</h3><div>Definitive radiotherapy for cervical cancer results in significant vaginal and sexual toxicity. Prior work has investigated dosimetric predictors of vaginal toxicity; however, sexual health outcomes are lacking. We assessed dosimetric predictors of sexual toxicity in cervical cancer patients treated with definitive radiation.</div></div><div><h3>Materials and Methods:</h3><div>Stage IB-IVA cervical cancer patients treated with definitive chemoradiation and MR-guided brachytherapy were enrolled in a prospective, cross-sectional study. Sexual toxicity was assessed using 2 validated patient reported outcome measures (PROMs): Female Sexual Function Index (FSFI) (scores >11 indicating distress) and Female Sexual Distress Scale-Revised (FSDS-R) (scores <26 indicating dysfunction). Clinical and treatment data were collected by chart review. Vaginal dosimetry was abstracted from individual treatment plans including cumulative dose (EQD2) and maximum dose per fraction for vaginal D2cc, ICRU recto-vaginal point (RV point), vaginal lateral point (5mm from applicator), posterior-inferior border of symphysis (PIBS), and PIBS±2cm. Vaginal Total Reference Air Kerma (TRAK) assessed dose loading within the vagina. Descriptive statistics summarized the data and correlations were evaluated using logistic regression analyses.</div></div><div><h3>Results:</h3><div>Between August 2018 and April 2022, 73 patients were eligible for analysis. Median age at diagnosis was 50 (range: 23-80), median Stage was IIB (49%), 61% had vaginal involvement at diagnosis, and 33% had involvement at brachytherapy. Mean EQD2 for vaginal D2cc, ICRU RV point, lateral point, PIBS+2cm, PIBS, and PIBS-2cm were 78.3 Gy (SD±13.7), 63.5Gy (±10.1), 118.5 Gy (±98.4), 55.7 Gy (±22.5), 28.4 Gy (±19.6), and 5.5 Gy (±6.9), respectively. Patients completed PROMs a median of 19 months (range 3–63) after treatment. Criteria for sexual dysfunction and distress was met in 85% and 55% of participants, respectively. Cumulative ICRU RV point dose >65 Gy (p=0.012) and vaginal TRAK (p=0.003) were associated with increased sexual distress on multivariable analysis.</div></div><div><h3>Conclusions:</h3><div>Sexual health following radiotherapy for cervical cancer is an important and multifactorial issue. Here we highlight the importance of vaginal dosimetry in post-treatment sexual health. Attention to and evaluation of vaginal doses could improve our understanding of sexual health outcomes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Pages S12-S13"},"PeriodicalIF":5.3000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiotherapy and Oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0167814025046845","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose:

Definitive radiotherapy for cervical cancer results in significant vaginal and sexual toxicity. Prior work has investigated dosimetric predictors of vaginal toxicity; however, sexual health outcomes are lacking. We assessed dosimetric predictors of sexual toxicity in cervical cancer patients treated with definitive radiation.

Materials and Methods:

Stage IB-IVA cervical cancer patients treated with definitive chemoradiation and MR-guided brachytherapy were enrolled in a prospective, cross-sectional study. Sexual toxicity was assessed using 2 validated patient reported outcome measures (PROMs): Female Sexual Function Index (FSFI) (scores >11 indicating distress) and Female Sexual Distress Scale-Revised (FSDS-R) (scores <26 indicating dysfunction). Clinical and treatment data were collected by chart review. Vaginal dosimetry was abstracted from individual treatment plans including cumulative dose (EQD2) and maximum dose per fraction for vaginal D2cc, ICRU recto-vaginal point (RV point), vaginal lateral point (5mm from applicator), posterior-inferior border of symphysis (PIBS), and PIBS±2cm. Vaginal Total Reference Air Kerma (TRAK) assessed dose loading within the vagina. Descriptive statistics summarized the data and correlations were evaluated using logistic regression analyses.

Results:

Between August 2018 and April 2022, 73 patients were eligible for analysis. Median age at diagnosis was 50 (range: 23-80), median Stage was IIB (49%), 61% had vaginal involvement at diagnosis, and 33% had involvement at brachytherapy. Mean EQD2 for vaginal D2cc, ICRU RV point, lateral point, PIBS+2cm, PIBS, and PIBS-2cm were 78.3 Gy (SD±13.7), 63.5Gy (±10.1), 118.5 Gy (±98.4), 55.7 Gy (±22.5), 28.4 Gy (±19.6), and 5.5 Gy (±6.9), respectively. Patients completed PROMs a median of 19 months (range 3–63) after treatment. Criteria for sexual dysfunction and distress was met in 85% and 55% of participants, respectively. Cumulative ICRU RV point dose >65 Gy (p=0.012) and vaginal TRAK (p=0.003) were associated with increased sexual distress on multivariable analysis.

Conclusions:

Sexual health following radiotherapy for cervical cancer is an important and multifactorial issue. Here we highlight the importance of vaginal dosimetry in post-treatment sexual health. Attention to and evaluation of vaginal doses could improve our understanding of sexual health outcomes.

查看原文本刊更多论文

明确放化疗和mri引导下近距离放疗宫颈癌患者性毒性的剂量学预测因子

目的：宫颈癌的最终放射治疗导致明显的阴道和性毒性。先前的工作研究了阴道毒性的剂量学预测因子；然而，缺乏性健康结果。我们评估了接受明确放射治疗的宫颈癌患者性毒性的剂量学预测因子。材料和方法：IB-IVA期宫颈癌患者接受了明确的放化疗和mr引导近距离放疗，纳入了一项前瞻性横断面研究。性毒性评估采用两种经过验证的患者报告结果测量（PROMs）：女性性功能指数（FSFI）（得分<； 11表示焦虑）和女性性焦虑量表-修订版（FSDS-R）（得分<；26表示功能障碍）。通过图表复习收集临床和治疗资料。阴道剂量测定从个体治疗方案中提取，包括阴道D2cc、ICRU直肠阴道点（RV点）、阴道侧边点（距涂抹器5mm）、联合后下边界（PIBS）和PIBS±2cm的累积剂量（EQD2）和每分数最大剂量。阴道总参考空气克尔玛（TRAK）评估阴道内的剂量负荷。描述性统计总结了数据，并使用逻辑回归分析评估相关性。结果：2018年8月至2022年4月，73例患者符合分析条件。诊断时的中位年龄为50岁（范围：23-80岁），中位分期为IIB(49%)， 61%在诊断时有阴道受累，33%在近距离治疗时受累。阴道D2cc、ICRU RV点、侧侧点、PIBS+2cm、PIBS、PIBS-2cm的平均EQD2分别为78.3 Gy （SD±13.7）、63.5Gy（±10.1）、118.5 Gy（±98.4）、55.7 Gy（±22.5）、28.4 Gy（±19.6）、5.5 Gy（±6.9）。患者在治疗后完成PROMs的中位时间为19个月（范围3-63）。分别有85%和55%的参与者达到了性功能障碍和焦虑的标准。多变量分析显示，累积ICRU RV点剂量>；65 Gy （p=0.012）和阴道TRAK （p=0.003）与性痛苦增加相关。结论：宫颈癌放疗后的性健康是一个重要的多因素问题。在这里，我们强调阴道剂量测定在治疗后性健康中的重要性。关注和评估阴道剂量可以提高我们对性健康结果的理解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.