J Gynecol Oncol.  2015 Jul;26(3):179-184. 10.3802/jgo.2015.26.3.179.

Role of vaginal pallor reaction in predicting late vaginal stenosis after high-dose-rate brachytherapy in treatment-naive patients with cervical cancer

• Yoshida K
• Yamazaki H
• Nakamura S
• Masui K
• Kotsuma T
• Akiyama H
• Tanaka E
• Yoshikawa
• Uesugi Y
• Shimbo T
• Narumi Y
• Yoshioka Y

• KMID: 2160803
• DOI: http://doi.org/10.3802/jgo.2015.26.3.179

Abstract

OBJECTIVE
To assess actual rates of late vaginal stenosis and identify predisposing factors for complications among patients with previously untreated cervical cancer following high-dose-rate brachytherapy.
METHODS
We performed longitudinal analyses of 57 patients using the modified Dische score at 6, 12, 18, 24, 36, and 60 months after treatment, which consisted of 15 interstitial brachytherapys and 42 conventional intracavitary brachytherapys, with a median follow-up time of 36 months (range, 6 to 144 months).
RESULTS
More than half of the patients developed grade 1 (mild) vaginal stenosis within the first year of follow-up, and grade 2 (97.5%, moderate) to grade 3 (severe) stenosis gradually increased with time. Actual stenosis rates for grade 1, 2, and 3 were 97.5% (95% confidence interval [CI], 92.7 to 97.5), 60.7% (95% CI, 42.2 to 79.3), and 7.4% (95% CI, 0 to 18.4) at 3 years after treatment. Pallor reaction grade 2-3 at 6 months was only a statistically significant predisposing factor for grade 2-3 late vaginal stenosis 3 years or later with a hazard ratio of 3.48 (95% CI, 1.32 to 9.19; p=0.018) by a multivariate Cox proportional hazard model. Patients with grade 0-1 pallor reaction at 6 months showed a grade > or =2 vaginal stenosis rate of 53%, whereas the grade 2-3 pallor reaction group achieved a grade > or =2 vaginal stenosis rate at 3 years at 100% (p=0.001).
CONCLUSION
High-dose-rate brachytherapy was associated with high incidence of late vaginal stenosis. Pallor reaction grade 2-3 at 6 months was predictive of late grade 2-3 vaginal stenosis at 3 years after treatment. These findings should prove helpful for patient counseling and preventive intervention.

Keyword

Brachytherapy; Constriction, Pathologic; Pallor; Prospective Studies; Uterine Cervical Neoplasms

MeSH Terms

Adult
Aged
Aged, 80 and over
Brachytherapy/*adverse effects/methods
Constriction, Pathologic/etiology/pathology
Female
Humans
Iridium Radioisotopes/therapeutic use
Middle Aged
*Pallor
Prognosis
Prospective Studies
Radiopharmaceuticals/therapeutic use
Retrospective Studies
Uterine Cervical Neoplasms/*radiotherapy
Vaginal Diseases/*etiology/pathology
Iridium Radioisotopes
Radiopharmaceuticals

Figure

• 

  Fig. 1 Schema of vaginal pallor reaction according to the modified Dische score for assessment for pallor reaction [56].

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  Fig. 2 Actual incidence of stenosis.

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  Fig. 3 Grade ≥2 actual stenosis rates according to pallor score grade ≥2 at 6 months. Patients with grade ≥2 pallor reactions at 6 months (dotted line) showed higher grade ≥2 stenosis rate (100% at 3 years or later) than counterpart (full line, 53% at 3 years and 69% at 5 years; p=0.001).

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