Brachytherapy for vaginal intraepithelial neoplasia

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 194; pp. 73 - 77
• Main Authors: Zolciak-Siwinska, Agnieszka, Gruszczynska, Ewelina, Jonska-Gmyrek, Joanna, Kulik, Anna, Michalski, Wojciech
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.11.2015
• Subjects: Adult; Aged; Aged, 80 and over; Brachytherapy; Brachytherapy - adverse effects; Carcinoma in Situ - radiotherapy; Female; Humans; Irradiation; Late effects; Middle Aged; Obstetrics and Gynecology; Radiotherapy Dosage; Retrospective Studies; Vaginal Neoplasms - mortality; Vaginal Neoplasms - radiotherapy; VAIN; VAIN; Irradiation; Late effects; Brachytherapy
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2015.08.018

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.