Radiation-Induced Vaginal Stenosis in Patients With Cervical Cancer in Low- and Middle-Income Countries: A Scoping Review.

PURPOSE: Radiation-induced vaginal stenosis (RIVS) is a common late toxicity of cervical cancer radiation therapy, yet its incidence, assessment, and reporting in low- and middle-income countries (LMICs) are poorly characterized. This scoping review synthesizes existing evidence on the incidence, assessment methods, and management of RIVS in LMIC settings.

METHODS AND MATERIALS: A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. PubMed, Scopus, and Web of Science were searched for available literature through December 2024 for studies reporting RIVS among women with cervical cancer treated with radiation therapy in LMICs. Data were extracted on study characteristics, incidence, assessment methods, and management. Nonparametric tests and Spearman correlations were used to explore associations between reported incidence and study-level variables.

RESULTS

Twenty-four studies met the inclusion criteria, representing nine LMICs as defined by the World Bank; no studies originated from low-income countries. The median publication year was 2020, and half of the studies were retrospective. Among studies reporting extractable incidence data, the median (IQR) overall incidence of RIVS was 48.8% (33.5-75.9). Studies that identified RIVS as a primary outcome reported significantly higher incidence than those in which it was not a primary focus (P < .001). Incidence was also higher in studies published after 2014 (P = .02). No significant differences were observed across countries, regions, or income groups. Reporting of management strategies was limited, with only 6 studies describing toxicity management.

CONCLUSIONS

RIVS is common among patients with cervical cancer treated in LMICs, yet assessment and reporting remain inconsistent, and management practices are poorly described. The absence of data from low-income countries and the limited use of standardized toxicity assessment hinder accurate estimation of survivorship burden. Improved documentation, standardized assessment, and culturally informed interventions are needed to address late vaginal morbidity in LMICs.