Sexual Function in Surviving Women with Endometrial Carcinoma after Hysterectomy and Adjuvant Radiation Therapy

PurposeFor women with endometrial cancer who underwent hysterectomy and adjuvant therapy without any tumor recurrences, limited data is available on how treatment for endometrial cancer alters sexual function. In this study, our goal is to assess the impact of adjuvant treatment on sexual function in this population.Materials and MethodsIn this IRB-approved study, we retrospectively reviewed charts of surviving, recurrence-free and sexually active women with endometrial carcinoma FIGO stage I-II who underwent surgical staging and adjuvant radiation treatment (RT) alone or with chemotherapy. We collected patient demographics, treatment information and sexual dysfunction data (i.e., dyspareunia, vaginal dryness, vaginal bleeding and vaginal narrowing). Using Common Terminology Criteria for Adverse Events v3.0, these symptoms were graded from grade 0 (none) to 3. For data analysis, the degree of symptoms was grouped into low grade (0 - 1) and high grade (2 - 3).ResultsThirty-six patients were analyzed - median age 59 years, 75% endometrioid carcinoma. Median followup was 26 months. All patients reported using vaginal dilators routinely for at least 6 months after RT. RT consisted of HDR brachytherapy alone (27 patients, 75%) or in combination with pelvic external beam RT (9 patients, 25%). The prescribed brachytherapy surface dose ranged from 18 - 37.5 Gy in 3 - 5 fractions. The median vaginal length treated with brachytherapy was 4 cm (range 3-7 cm). Seven patients (19%) received adjuvant chemotherapy with RT. High grade symptoms were experienced, as follows: dyspareunia (9 patients, 25%), vaginal dryness (10, 28%), vaginal bleeding (7, 19%) and vaginal narrowing (9, 25%). Neither pelvic external beam nor chemotherapy was associated with worse sexual functions. Treated vaginal length of 6 cm or greater was a significant predictor for worse sexual dysfunction (p <0.001).ConclusionsIn this study, we observed a significantly higher risk of sexual dysfunction in women receiving HDR brachytherapy to a vaginal length of 6 cm or greater. Further evaluation in a prospective study is indicated to determine the impact of adjuvant treatment on sexual function in women with endometrial carcinoma. PurposeFor women with endometrial cancer who underwent hysterectomy and adjuvant therapy without any tumor recurrences, limited data is available on how treatment for endometrial cancer alters sexual function. In this study, our goal is to assess the impact of adjuvant treatment on sexual function in this population. For women with endometrial cancer who underwent hysterectomy and adjuvant therapy without any tumor recurrences, limited data is available on how treatment for endometrial cancer alters sexual function. In this study, our goal is to assess the impact of adjuvant treatment on sexual function in this population. Materials and MethodsIn this IRB-approved study, we retrospectively reviewed charts of surviving, recurrence-free and sexually active women with endometrial carcinoma FIGO stage I-II who underwent surgical staging and adjuvant radiation treatment (RT) alone or with chemotherapy. We collected patient demographics, treatment information and sexual dysfunction data (i.e., dyspareunia, vaginal dryness, vaginal bleeding and vaginal narrowing). Using Common Terminology Criteria for Adverse Events v3.0, these symptoms were graded from grade 0 (none) to 3. For data analysis, the degree of symptoms was grouped into low grade (0 - 1) and high grade (2 - 3). In this IRB-approved study, we retrospectively reviewed charts of surviving, recurrence-free and sexually active women with endometrial carcinoma FIGO stage I-II who underwent surgical staging and adjuvant radiation treatment (RT) alone or with chemotherapy. We collected patient demographics, treatment information and sexual dysfunction data (i.e., dyspareunia, vaginal dryness, vaginal bleeding and vaginal narrowing). Using Common Terminology Criteria for Adverse Events v3.0, these symptoms were graded from grade 0 (none) to 3. For data analysis, the degree of symptoms was grouped into low grade (0 - 1) and high grade (2 - 3). ResultsThirty-six patients were analyzed - median age 59 years, 75% endometrioid carcinoma. Median followup was 26 months. All patients reported using vaginal dilators routinely for at least 6 months after RT. RT consisted of HDR brachytherapy alone (27 patients, 75%) or in combination with pelvic external beam RT (9 patients, 25%). The prescribed brachytherapy surface dose ranged from 18 - 37.5 Gy in 3 - 5 fractions. The median vaginal length treated with brachytherapy was 4 cm (range 3-7 cm). Seven patients (19%) received adjuvant chemotherapy with RT. High grade symptoms were experienced, as follows: dyspareunia (9 patients, 25%), vaginal dryness (10, 28%), vaginal bleeding (7, 19%) and vaginal narrowing (9, 25%). Neither pelvic external beam nor chemotherapy was associated with worse sexual functions. Treated vaginal length of 6 cm or greater was a significant predictor for worse sexual dysfunction (p <0.001). Thirty-six patients were analyzed - median age 59 years, 75% endometrioid carcinoma. Median followup was 26 months. All patients reported using vaginal dilators routinely for at least 6 months after RT. RT consisted of HDR brachytherapy alone (27 patients, 75%) or in combination with pelvic external beam RT (9 patients, 25%). The prescribed brachytherapy surface dose ranged from 18 - 37.5 Gy in 3 - 5 fractions. The median vaginal length treated with brachytherapy was 4 cm (range 3-7 cm). Seven patients (19%) received adjuvant chemotherapy with RT. High grade symptoms were experienced, as follows: dyspareunia (9 patients, 25%), vaginal dryness (10, 28%), vaginal bleeding (7, 19%) and vaginal narrowing (9, 25%). Neither pelvic external beam nor chemotherapy was associated with worse sexual functions. Treated vaginal length of 6 cm or greater was a significant predictor for worse sexual dysfunction (p <0.001). ConclusionsIn this study, we observed a significantly higher risk of sexual dysfunction in women receiving HDR brachytherapy to a vaginal length of 6 cm or greater. Further evaluation in a prospective study is indicated to determine the impact of adjuvant treatment on sexual function in women with endometrial carcinoma. In this study, we observed a significantly higher risk of sexual dysfunction in women receiving HDR brachytherapy to a vaginal length of 6 cm or greater. Further evaluation in a prospective study is indicated to determine the impact of adjuvant treatment on sexual function in women with endometrial carcinoma.