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Radiation-induced morphological changes in the vagina

Morphologische Veränderungen der Vagina nach Strahlentherapie

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Abstract

Background and purpose

Treatment-induced chronic vaginal changes after definitive radio(chemo)therapy for locally advanced cervical cancer patients are reported as one of the most distressing consequences of treatment, with major impact on quality of life. Although these vaginal changes are regularly documented during gynecological follow-up examinations, the classic radiation morbidity grading scales are not concise in their reporting. The aim of the study was therefore to identify and qualitatively describe, on the basis of vaginoscopies, morphological changes in the vagina after definitive radio(chemo)therapy and to establish a classification system for their detailed and reproducible documentation.

Patients and methods

Vaginoscopy with photodocumentation was performed prospectively in 22 patients with locally advanced cervical cancer after definitive radio(chemo)therapy at 3–24 months after end of treatment. All patients were in complete remission and without severe grade 3/4 morbidity outside the vagina.

Results

Five morphological parameters, which occurred consistently after treatment, were identified: mucosal pallor, telangiectasia, fragility of the vaginal wall, ulceration, and adhesions/occlusion. The symptoms in general were observed at different time points in individual patients; their quality was independent of the time of assessment. Based on the morphological findings, a comprehensive descriptive and semiquantitative scoring system was developed, which allows for classification of vaginal changes. A photographic atlas to illustrate the morphology of the alterations is presented.

Conclusion

Vaginoscopy is an easily applicable, informative, and well-tolerated procedure for the objective assessment of morphological vaginal changes after radio(chemo)therapy and provides comprehensive and detailed information. This allows for precise classification of the severity of individual changes.

Zusammenfassung

Hintergrund und Zielsetzung

Veränderungen der Vagina werden von Patientinnen nach definitiver Radio(chemo)therapie bei lokal fortgeschrittenem Zervixkarzinom als äußerst belastende chronische Morbidität beschrieben, welche die Lebensqualität signifikant beeinträchtigen kann. Obwohl diese vaginalen Nebenwirkungen routinemäßig in den gynäkologischen Nachsorgeuntersuchungen erfasst werden, werden sie in den klassischen Dokumentationssystemen für Nebenwirkungen der Strahlentherapie nur sehr unpräzise abgebildet. Ziele der vorliegenden Studie waren daher die Identifikation und qualitative Beschreibung morphologischer Veränderungen der Vagina nach definitiver Radio(chemo)therapie anhand von vaginoskopischen Bildern und die Etablierung eines spezifischen Klassifikationssystems für eine detaillierte und reproduzierbare Dokumentation.

Material und Methoden

Von 22 Patientinnen mit lokal fortgeschrittenem Zervixkarzinom wurden vaginoskopische Bilder in einem Zeitraum von 3–24 Monaten nach definitiver Radio(chemo)therapie angefertigt. Alle Patientinnen waren in kompletter Remission und wiesen keine schwerwiegenden G3- oder G4-Nebenwirkungen außerhalb der Vagina auf.

Ergebnisse

Es wurden regelhaft 5 morphologische Parameter bei den Patientinnen nach Radio(chemo)therapie beobachtet: Blässe der Schleimhaut, Teleangiektasien, Fragilität der Vaginalwand, Ulzerationen und Verklebungen bzw. Okklusionen. Diese Endpunkte wurden in den einzelnen Patientinnen zu verschiedenen Zeitpunkten gefunden, waren in ihrer Qualität aber unabhängig vom Zeitpunkt der Erhebung. Aufbauend auf diesen morphologischen Befunden wurde ein umfassendes deskriptives und semiquantitatives Beurteilungssystem für die Klassifikation vaginaler Nebenwirkungen entwickelt. Ein Bildatlas, der die Morphologie der Veränderungen illustriert, wird präsentiert.

Schlussfolgerung

Die Vaginoskopie ist eine einfach anzuwendende, informative und von den Patientinnen gut tolerierte Untersuchungsmethode. Sie ist geeignet, morphologische Veränderungen der Vagina nach Radio(chemo)therapie objektiv zu erheben, und liefert umfassende und detaillierte Informationen, die eine präzise und reproduzierbare Klassifikation erlauben.

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Acknowledgments

The study was supported by funds of the Oesterreichische Nationalbank (Anniversary Fund, project number: 12542OENB). The Department of Radiation Oncology at the Medical University of Vienna receives/received financial and/or equipment support for research and educational purposes from Nucletron B.V., Varian Medical Systems, Inc., and Isodose Control B.V. We thank Dr. Sandra Schüssler for her support and previous work.

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18–20, 1090, Vienna, Austria

    K. Kirchheiner MSc, E. Fidarova, M.P. Schmid, A. Sturdza, A. Kranz, R. Pötter & W. Dörr

  2. Department of Clinical Oncology, University Medical Center Leiden, Leiden, The Netherlands

    R.A. Nout

  3. Department of General Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    S. Polterauer

  4. Department of Radiation Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Canada

    E. Wiebe

  5. Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria

    W. Dörr

Authors
  1. K. Kirchheiner MSc
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  2. E. Fidarova
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  3. R.A. Nout
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  4. M.P. Schmid
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  5. A. Sturdza
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  6. E. Wiebe
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  7. A. Kranz
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  8. S. Polterauer
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  9. R. Pötter
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  10. W. Dörr
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Corresponding author

Correspondence to K. Kirchheiner MSc.

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Kirchheiner, K., Fidarova, E., Nout, R. et al. Radiation-induced morphological changes in the vagina. Strahlenther Onkol 188, 1010–1019 (2012). https://doi.org/10.1007/s00066-012-0222-0

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  • DOI: https://doi.org/10.1007/s00066-012-0222-0

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