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Patient-reported sexual frequency and vaginal functioning in patients with locally advanced cervical cancer following definitive radiochemotherapy and image-guided adaptive brachytherapy (EMBRACE study)
  1. K Kirchheiner1,
  2. IM Jürgenliemk-Schulz2,
  3. C Haie-Meder3,
  4. JC Lindegaard4,
  5. A Sturdza1,
  6. U Mahantshetty5,
  7. B Segedin6,
  8. K Bruheim7,
  9. B Rai8,
  10. R Cooper9,
  11. E van der Steen-Banasik10,
  12. E Wiebe11,
  13. M Sundset12,
  14. E van Limbergen13,
  15. E Villafranca14,
  16. H Westerveld15,
  17. LT Tan16,
  18. K Tanderup4,
  19. R Pötter1,
  20. RA Nout17 and
  21. EMBRACECollaborative Group
  1. 1Department of Radiotherapy, General Hospital Vienna, Medical University Vienna, Vienna, Austria
  2. 2Department of Radiation Oncology, University Medical Centre Utrecht – Utrecht Cancer Centre, Utrecht, The Netherlands
  3. 3Department of Radiotherapy, Gustave-Roussy Cancer Campus, Villejuif, France
  4. 4Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
  5. 5Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
  6. 6Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
  7. 7Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
  8. 8Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  9. 9Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
  10. 10Department of Radiotherapy, Radiotherapiegroep Arnhem, Arnhem, The Netherlands
  11. 11Department of Oncology, Cross Cancer Institute and University of Alberta, Edmonton, AB, Canada
  12. 12Clinic of Oncology and Women’s Clinic, St. Olavs Hospital, Trondheim, Norway
  13. 13Department of Radiation Oncology, UZ Leuven, Leuven, Belgium
  14. 14Department of Radiation Oncology, Hospital of Navarra, Pamplona, Spain
  15. 15Department of Radiation Oncology, University of Amsterdam, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
  16. 16Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
  17. 17Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands


Introduction/Background To evaluate sexual frequency and vaginal functioning in patients treated with combined external beam radiotherapy ± chemotherapy and image-guided adaptive brachytherapy in the prospective, observational, multi-center EMBRACE study (

Methodology Patient-reported sexual outcomes were prospectively assessed according to EORTC-QLQ-CX24 questionnaires at baseline (available for 1027 patients) and follow-ups: 1st year every 3M (months), 2nd/3rd year every 6M and yearly thereafter (available for 1044 patients with no evidence of disease). Sexual activity was analysed longitudinally, and defined as frequent if reported (to some degree) in ≥50% of follow-up and as occasional if reported in <50%. Prevalence rates over time were displayed. Associations between dyspareunia and vaginal functioning were evaluated with Spearman’s rank correlations, pooling observations over all follow-ups (N=2670).

Results After the diagnosis of cancer, 230/1027 (22.4%) of patients reported some degree of sexual activity. During follow-up (median 36M), 433/1044 (41.5%) patients reported no sexual activity, 128 (12.3%) occasional and 483 (46.3%) frequent sexual activity. Prevalence rates (figure 1A–F) revealed a slow increase of sexual activity during the 1st year of follow-up, reaching a plateau up to 5 years. Vaginal functioning problems during intercourse showed a substantial increase after treatment and remained either elevated or showed signs of slight improvement over time. Sexual enjoyment was impaired, with 37–48% of patients reporting to have ‘not at all’/‘a little’ sexual enjoyment over time.

Abstract – Figure 1

Prevalence rates of A. sexual activity, B. sexual enjoyment, C. vaginal shortening, D. vaginal tightening, E. vaginal dryness and F. pain during intercourse. BM = baseline, M = months in follow-up

Patient-reported vaginal dryness, shortening and tightening were significantly correlated with dyspareunia to r=0.407, 0.539, 0.552, respectively (figure 2A–C).

Abstract – Figure 2

Association between pain during intercourse and A. vaginal dryness, B. vaginal shortnening and C. vaginal tightening. Observations pooled over all follw-ups.

Conclusion More than half of locally advanced cervical cancer patients are sexually active and the majority of those report frequent sexual activity. Treatment-induced vaginal changes (dryness, shortening and tightening) are associated with dyspareunia. Sexual enjoyment is compromised in almost half of sexually active patients. This underlines the importance of efforts directed towards prevention of vaginal morbidity and sexual rehabilitation after treatment.

Disclosure The findings of this abstract were submitted to ESTRO (European Society for Radiotherapy & Oncology, accepted for oral presentation in April 2019, Milano, Italy) and ASTRO (American Society for Radiation Oncology, accepted for oral presentation in September 2019, Chicago, USA). All authors declare no conflict of interest. The EMBRACE study was sponsored by the Medical University of Vienna. Unrestricted research funding was provided by Nucletron, an Elekta company and Varian Medical Systems. Financial support by the Austrian Federal Ministry of Science, Research and Economy, and the Austrian Foundation for Research, Technology, and Development, the Danish Cancer Society and CIRRO - The Lundbeck Foundation Center for Investigational Research in Radiation Oncology is gratefully acknowledged.

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