Introduction Purpose/Objective: To evaluate the association between regular vaginal dilation and/or sexual activity on vaginal stenosis in locally advanced cervical cancer patients after definitive radiochemotherapy and image-guided adaptive brachytherapy from the EMBRACE-I study.
Methods Material/Methods Physician-assessed vaginal stenosis (CTCAEv.3), vaginal dilation and patient-reported sexual activity (EORTC-QLQ-CX24) were prospectively assessed at baseline and during regular follow-up. For this longitudinal analysis, a subgroup of patients was selected with at least 3 follow-ups with information on vaginal dilation and/or sexual activity. Vaginal penetration summarized either the use of vaginal dilators or sexual activity or both. Regular vaginal penetration was defined, if reported in ≥50%; no/infrequent penetration, if reported in <50% of follow-ups.
Results Of 1416 patients overall, the subgroup for this longitudinal evaluation included 882 patients, with a median follow-up of 60 months. Regular penetration was associated with a significantly lower 5-year actuarial risk estimate for vaginal stenosis G≥2, compared to reporting no/infrequent penetration (23% vs. 37%, p≤0.001, figure 1). A multivariable Cox regression model confirmed this association (HR=0.630), adjusting for other known risk factors (table 1).
Conclusion/Implications Conclusion: Regular dilation and/or sexual activity is associated with significantly lower risk for vaginal stenosis in cervical cancer patients. As a correlation does not justify any cause-effect relation, it cannot finally be concluded that regular penetration prevents vaginal stenosis or if the development of vaginal stenosis interferes with these activities. However, as a randomized trial design is not appropriate in this context, the multivariable model supports the clinical observations and recommendations for prevention of vaginal stenosis.
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