Brachytherapy for vaginal intraepithelial neoplasia. (November 2015)

• Record Type: Journal Article
• Authors: Zolciak-Siwinska, Agnieszka; Gruszczynska, Ewelina; Jonska-Gmyrek, Joanna; Kulik, Anna; Michalski, Wojciech
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 194(2015:Nov.)
• Page Start: 73
• Page End: 77
• Publication Date: 2015-11
• Subjects: VAIN -- Brachytherapy -- Irradiation -- Late effects; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2015.08.018
• Languages: English
• ISSNs: 0301-2115

Abstract

Abstract: Objective: To retrospectively evaluate the efficacy of high-dose-rate brachytherapy of vaginal intraepithelial neoplasia with a special focus on analysis of toxicity. Study design: Twenty consecutive patients were irradiated with brachytherapy of vaginal intraepithelial neoplasia with component ca in situ ( N = 3). Late complications of the vagina graded using the CTCAE v.3.0. General assessment three-step scale was introduced for simplicity of analysis. Results: The median age was 57 years (range: 28–80 years). The median follow-up time was 39 months (range: 14–115 months). Vaginal intraepithelial neoplasia recurrence was observed in 1 patient. The 3-year disease free survival rate was 90% (95% confidence interval [CI]: 71–100%). Observed late side effects: libido grades 1–2 in 15 (75%), vaginal discharge grade 2 (pad use indicated) in 2 (10%), dryness grade 2 (dyspareunia) in 7 (35%), mucositis grades 2–3 in 6 (30%), stenosis grades 2–3 in 7 (35%) and vaginitis grades 2–3 in 4 (20%) cases. General assessment was good in 9 (45%), average in 2 (10%), and bad in 9 (45%) patients. Treatment dose affected the toxicity ( p = 0.05). In groups of patients irradiated with biologically equivalent dose (assuming α / β = 3 Gy) of 47.3–63 Gy and ≥70 Gy, the risk of poor or moderate toxicity amounted to 16.7% (95% CI: 0–47%) and 71.4% (95% CI: 48–95%), respectively. Conclusion: Brachytherapy revealed to be effective method of vaginal intraepithelial neoplasia treatment, but applying EQD2 ≥ 70 Gy into vagina generates unacceptable toxicity.