Top Line: Should a vaginal dilator be used during treatment for anal squamous cell carcinoma?
The Study: Vaginal dilators are commonly used after pelvic radiation in women to reduce vaginal stenosis and sexual dysfunction. However, practice is much more varied when it comes to placing devices in the vagina during treatment delivery in order to reduce vaginal dose. Here’s a single institution retrospective series of 285 women who received definitive, IMRT-based chemoradiation for anal SCC with daily vaginal dilator (VD) placement. Those with bulky T4 tumors or vaginal involvement were excluded. At the time of simulation, the physician and patient selected the largest VD that fit comfortably for treatment. It was inserted with the base flush with the introitus. About half of these patients responded to a request to complete the Female Sexual Health Index (FSHI) after treatment of whom roughly half were sexually active. The authors found that an increasing anterior vaginal wall D50% was significantly associated with worse FSHI overall as well as worse desire and worse pain. They identified anterior vaginal wall D50% >48 Gy as the best predictor of sexual dysfunction after treatment. Of note, ongoing trials such as the ECOG EA2182 DECREASE trial recommend using a VD during treatment.
TBL: Using a vaginal dilator during chemoradiation for anal cancer may help reduce dose to the anterior vaginal wall. In this study, higher dose to the anterior vaginal wall was associated with worse sexual dysfunction after treatment. | Arzola, Pract Radiat Oncol 2023
The Study: Vaginal dilators are commonly used after pelvic radiation in women to reduce vaginal stenosis and sexual dysfunction. However, practice is much more varied when it comes to placing devices in the vagina during treatment delivery in order to reduce vaginal dose. Here’s a single institution retrospective series of 285 women who received definitive, IMRT-based chemoradiation for anal SCC with daily vaginal dilator (VD) placement. Those with bulky T4 tumors or vaginal involvement were excluded. At the time of simulation, the physician and patient selected the largest VD that fit comfortably for treatment. It was inserted with the base flush with the introitus. About half of these patients responded to a request to complete the Female Sexual Health Index (FSHI) after treatment of whom roughly half were sexually active. The authors found that an increasing anterior vaginal wall D50% was significantly associated with worse FSHI overall as well as worse desire and worse pain. They identified anterior vaginal wall D50% >48 Gy as the best predictor of sexual dysfunction after treatment. Of note, ongoing trials such as the ECOG EA2182 DECREASE trial recommend using a VD during treatment.
TBL: Using a vaginal dilator during chemoradiation for anal cancer may help reduce dose to the anterior vaginal wall. In this study, higher dose to the anterior vaginal wall was associated with worse sexual dysfunction after treatment. | Arzola, Pract Radiat Oncol 2023