来自整形和重建外科伤口专家在放射治疗后处理复杂阴道和外阴毒性的见解

IF 1.3 Q3 OBSTETRICS & GYNECOLOGY

Gynecologic Oncology Reports Pub Date : 2025-10-01 DOI:10.1016/j.gore.2025.101966

Ovya Ganesan , Stephanie M. Mueller , Diana Miao , M Aiven Dyer , Natalie Cain , Colleen M. Feltmate , Dennis P. Orgill

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引用次数: 0

摘要

目的放射治疗是治疗阴道和外阴癌的必要手段，但放射治疗可引起慢性疼痛、性功能障碍、感染和伤口愈合延迟。这些并发症深刻地影响了幸存者的生活质量，并可能阻碍复发性疾病的癌症定向治疗。我们描述了一种涉及整形和重建外科，妇科肿瘤学和放射肿瘤学的多学科方法来处理复杂的辐射引起的伤口。方法回顾性分析在三级伤口护理中心治疗的2例严重阴道/外阴放射伤患者。结果病例1:1例71岁女性外阴鳞状细胞癌（VSCC）行外阴切除术和辅助放化疗，并发急性放射性皮炎。复发的VSCC需要进一步手术，重建时伤口坏死，用清创、四分之一强度的次氯酸钠和高级敷料治疗。第三次外阴切除术后再次复发，伤口愈合受损。尽管进行了持续的治疗，癌症仍然存在。病例2:73岁女性局部晚期子宫内膜腺癌患者，行化疗、外置放疗、近距离放疗、双侧输卵管卵巢切除术、立体定向放疗治疗骨转移。放疗后两年，患者出现阴道坏死，经次氯酸溶液、急剧清创和高压氧治疗。她最近参加了一项针对持续性癌症的临床试验。在这两种情况下，伤口并发症延迟了最佳的癌症定向治疗。结论这些病例强调了多学科治疗严重放射性阴道/外阴损伤的重要性。考虑到疾病的复杂性，以疼痛控制、减少气味和优化伤口环境为重点的护理往往是姑息性的，这强调了平衡伤口愈合与正在进行的癌症治疗的挑战。

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Insights from plastic and reconstructive surgery wound specialists in managing complex vaginal and vulvar toxicities following radiation therapy

Objective

Radiation therapy is essential for treating vaginal and vulvar cancers but can cause chronic pain, sexual dysfunction, infections, and delayed wound healing. These complications profoundly impact survivors’ quality of life and may impede cancer-directed treatment in recurrent disease. We describe a multidisciplinary approach involving Plastic and Reconstructive Surgery, Gynecologic Oncology, and Radiation Oncology for managing complex radiation-induced wounds.

Methods

We retrospectively reviewed two patients with severe vaginal/vulvar radiation wounds treated at a tertiary wound care center.

Results

Case 1: A 71-year-old woman with vulvar squamous cell carcinoma (VSCC) underwent vulvectomy and adjuvant chemoradiation, developing acute radiation dermatitis. Recurrent VSCC required further surgery, and reconstruction was complicated by wound necrosis, which was treated with debridement, quarter-strength sodium hypochlorite and advanced dressings. Following a third vulvectomy for further recurrence, she again demonstrated impaired wound healing. Despite ongoing management, cancer persists.

Case 2: A 73-year-old woman with locally advanced endometrial adenocarcinoma received chemotherapy, external radiation, brachytherapy, hysterectomy with bilateral salpingo-oophorectomy, and stereotactic radiation for bone metastasis. Two years post-radiation, she developed vaginal necrosis, which was managed with hypochlorous acid solution, sharp debridement, and hyperbaric oxygen therapy. She recently enrolled in a clinical trial for persistent cancer.

In both cases, wound complications delayed optimal cancer-directed therapy.

Conclusion

These cases highlight the importance of a multidisciplinary strategy to manage severe radiation-induced vaginal/vulvar wounds. Focused on pain control, odor reduction, and optimizing the wound environment, care is often palliative given disease complexity, underscoring the challenges in balancing wound healing with ongoing cancer treatment.

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来源期刊

Gynecologic Oncology Reports OBSTETRICS & GYNECOLOGY-

CiteScore

2.00

自引率

0.00%

发文量

183

审稿时长

41 days

期刊介绍： Gynecologic Oncology Reports is an online-only, open access journal devoted to the rapid publication of narrative review articles, survey articles, case reports, case series, letters to the editor regarding previously published manuscripts and other short communications in the field of gynecologic oncology. The journal will consider papers that concern tumors of the female reproductive tract, with originality, quality, and clarity the chief criteria of acceptance.