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Vaginal CO2 laser for the treatment of vulvovaginal atrophy in women with breast cancer: LAAVA pilot study

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Abstract

Purpose

Vulvovaginal atrophy (VVA) is a commonly reported issue among breast cancer patients, and its aetiology is multifactorial. Treatment is difficult in these women, particularly because the use of oestrogens has traditionally been discouraged. Vaginal laser treatment has been reported to improve symptoms. We aimed to assess the impact on symptoms and sexual function of vaginal laser in women with early breast cancer (EBC).

Methods

We performed a single-arm investigator initiated pilot study of female EBC patients with symptomatic VVA. A total of 3 vaginal laser treatments were administered 4 weeks apart. Questionnaires were completed at baseline, 4, 8 and 12 weeks. Our primary endpoint was symptomatic improvement of VVA at 12 weeks on 10 cm visual analogue scales. Our secondary endpoints were improvement in sexual function using the Female Sexual Function Index (FSFI) and patient-reported improvements in symptoms, sexual function and quality of life. Statistical analysis was performed with a Wilcoxon Signed Rank test.

Results

26 patients were enrolled between February 2016 and August 2017. All patients were post-menopausal, 25 of whom had received anti-oestrogen therapy for their breast cancer. Questionnaire compliance was high (98%) and all patients received the three pre-planned treatments. There was significant improvement in each of the VVA symptoms: dryness (p < 0.001), itch (p < 0.001), burning (p = 0.003), dysuria (p < 0.001) and dyspareunia (p < 0.001). Patients also reported improvement in sexual function on the FSFI (p ≤ 0.001).

Conclusions

Patients receiving vaginal laser had improvement in VVA symptoms and sexual function. Further randomised sham-controlled trials are needed to further assess this treatment.

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Abbreviations

EBC:

Early breast cancer

FSFI:

Female Sexual Function Index

GSM:

Genitourinary symptoms of menopause

HRT:

Hormone replacement therapy

MCID:

Minimum clinically important difference

QOL:

Quality of life

SD:

Standard deviation

VAS:

Visual analogue scale

VHI:

Vaginal Health Index

VVA:

Vulvovaginal atrophy

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Acknowledgements

Special thanks to Nina Singh and Rhonda Bignell. We would also like to thank our patients and their families.

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Authors and Affiliations

  1. Northern Sydney Cancer Centre, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia

    Antonia Pearson

  2. Sydney Adventist Hospital, Wahroonga, NSW, Australia

    Andrew Booker & Gavin Marx

  3. Melanoma Institute Australia, North Sydney, NSW, Australia

    Martin Tio

  4. University of Sydney, Sydney, NSW, Australia

    Antonia Pearson, Martin Tio & Gavin Marx

Authors
  1. Antonia Pearson
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  2. Andrew Booker
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  3. Martin Tio
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  4. Gavin Marx
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Correspondence to Antonia Pearson.

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The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Research involving human participants and/or animals

This study was approved by the Adventist HealthCare Limited Human Research Ethics Committee (HREC). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.

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Pearson, A., Booker, A., Tio, M. et al. Vaginal CO2 laser for the treatment of vulvovaginal atrophy in women with breast cancer: LAAVA pilot study. Breast Cancer Res Treat 178, 135–140 (2019). https://doi.org/10.1007/s10549-019-05384-9

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  • DOI: https://doi.org/10.1007/s10549-019-05384-9

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