Radiation-induced morphological changes in the vagina

Background and purpose Treatment-induced chronic vaginal changes after definitive radio(chemo)therapy for locally advanced cervical cancer patients are reported as one of the most distressing consequences of treatment, with major impact on quality of life. Although these vaginal changes are regularl...

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Bibliographic Details
Published in:Strahlentherapie und Onkologie 2012-11, Vol.188 (11), p.1010-1019
Main Authors: Kirchheiner, K., Fidarova, E., Nout, R.A., Schmid, M.P., Sturdza, A., Wiebe, E., Kranz, A., Polterauer, S., Pötter, R., Dörr, W.
Format: Article
Language:English
Subjects:
Adult
Aged
Chemotherapy, Adjuvant
Colposcopy
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Medicine
Medicine & Public Health
Middle Aged
Neoplasm Staging
Oncology
Original Article
Prospective Studies
Quality of Life
Radiation Injuries - classification
Radiation Injuries - diagnosis
Radiation Injuries - pathology
Radiotherapy
Uterine Cervical Neoplasms - drug therapy
Uterine Cervical Neoplasms - pathology
Uterine Cervical Neoplasms - radiotherapy
Vagina - pathology
Vagina - radiation effects
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Summary:Background and purpose Treatment-induced chronic vaginal changes after definitive radio(chemo)therapy for locally advanced cervical cancer patients are reported as one of the most distressing consequences of treatment, with major impact on quality of life. Although these vaginal changes are regularly documented during gynecological follow-up examinations, the classic radiation morbidity grading scales are not concise in their reporting. The aim of the study was therefore to identify and qualitatively describe, on the basis of vaginoscopies, morphological changes in the vagina after definitive radio(chemo)therapy and to establish a classification system for their detailed and reproducible documentation. Patients and methods Vaginoscopy with photodocumentation was performed prospectively in 22 patients with locally advanced cervical cancer after definitive radio(chemo)therapy at 3–24 months after end of treatment. All patients were in complete remission and without severe grade 3/4 morbidity outside the vagina. Results Five morphological parameters, which occurred consistently after treatment, were identified: mucosal pallor, telangiectasia, fragility of the vaginal wall, ulceration, and adhesions/occlusion. The symptoms in general were observed at different time points in individual patients; their quality was independent of the time of assessment. Based on the morphological findings, a comprehensive descriptive and semiquantitative scoring system was developed, which allows for classification of vaginal changes. A photographic atlas to illustrate the morphology of the alterations is presented. Conclusion Vaginoscopy is an easily applicable, informative, and well-tolerated procedure for the objective assessment of morphological vaginal changes after radio(chemo)therapy and provides comprehensive and detailed information. This allows for precise classification of the severity of individual changes.
ISSN:0179-7158
1439-099X
DOI:10.1007/s00066-012-0222-0