2867 - Clinical Factors that Affect Patient-Reported Outcomes of Vaginal Stenosis after Pelvic Radiation Treatment for Cervical Cancer

A. C. Norman¹, A. K. Yoder², X. Yu¹, C. Godfrey¹, E. Dong³, J. R. Montealegre⁴, J. Hakim⁵, and M. S. Ludwig⁶; ¹School of Medicine, Baylor College of Medicine, Houston, TX, ²The University of Texas MD Anderson Cancer Center, Houston, TX, ³Department of Pediatrics, Stanford Medicine, Palo Alto, CA, ⁴Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, ⁵Division of Pediatric Adolescent Gynecology, Baylor College of Medicine, Houston, TX, ⁶Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX

Purpose/Objective(s): Vaginal stenosis (VS) is a common sequela of pelvic radiotherapy (RT). Cellular injury results in shortening and/or narrowing of the vaginal canal and can lead to significant quality of life (QoL) deficits. Studies have shown that the development of VS is impacted by many factors, and interventions to reduce VS including dilator use and hormonal vaginal cream have yielded mixed outcomes. This is a secondary analysis of a previously published prospective study that aims to better characterize risk factors for VS based on patient-reported outcomes. Materials/

Methods: This secondary analysis studied data collected from patients undergoing RT for cervical cancer at an urban safety net health center. The Functional Assessment of Cancer Therapy-Cervical Cancer Version 4 was used to assess QoL before and during RT and at follow-up appointments. Patients who responded to the prompt “My vagina feels too narrow or short” with a 3 out of 5 or greater were considered to have VS. Adult patients were eligible to participate in the study if they were undergoing definitive or adjuvant chemoradiation for cervical cancer and were able to read and complete the survey. Patients who did not answer the VS survey prompt or received vaginal cuff radiation were excluded. Information was retrospectively collected from the medical record about risk factors for VS. Binary and multivariable logistic regression was performed to assess for the association between risk factors and VS.
Results: There were 93 patients enrolled in the study. Of these, 73 patients met the criteria to be included in this analysis. Median time from end of radiation to follow-up survey was 4 months. VS occurred in 14 (19.2%) patients. In the VS group, 3 (21.4%) patients used hormone cream and 7 (50%) used dilator at follow up as compared to 18 (30.5%) patients who used hormone cream and 23 (39.0%) that used dilator in the non-stenosis (NS) group (p=0.523, p=0.649; respectively). Similarly, in the VS group, 9 (64.3%) of patients were sexually active at follow up vs 23 (39%) in the NS group (p=0.072). Median total radiation dose was 58.8 Gy in the cohort that developed VS as compared to 59.8 Gy in the NS cohort. Lower total radiation dose was associated with VS in a univariate analysis only (p=0.037). Higher D2cc to the rectum was also found to be associated with VS (VS 70.85 Gy, NS 65.5 Gy; p=0.025). On multivariable analysis, both rectal radiation dose and sexual activity at follow-up appointment were associated with an increased risk of VS (p=0.018, p=0.046; respectively).
Conclusion: Almost 20% of our cohort developed VS at just 4 months follow-up time. D2cc to the rectum and sexual activity at follow-up were significantly associated with VS development. Use of interventions to reduce VS were not associated with VS presentation in this cohort. More efficacious medical interventions are needed to decrease patient-reported VS.