International journal of radiation oncology, biology, physics · 2026
Dosimetric Predictors of Sexual Toxicity in Cervical Cancer Patients Treated With Definitive Chemoradiation and Magnetic Resonance Imaging-Guided Brachytherapy.
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Gulstene Stephanie, Chuk Elizabeth, Conway Jessica, Hanuschak Jennifer, Han Kathy, Milosevic Michael, Lukovic Jelena, Ferguson Sarah E, Salman Ailya, Santiago Anna T, Rink Alexandra, Croke Jennifer M
Аннотация
PURPOSE: Definitive radiation therapy for cervical cancer results in significant vaginal and sexual toxicity. Prior work has investigated dosimetric predictors of vaginal toxicity; however, sexual health outcomes are lacking.
METHODS AND MATERIALS: Patients with stage IB to IVA cervical cancer treated with definitive chemoradiation and magnetic resonance-guided brachytherapy were enrolled in a prospective, cross-sectional study. Sexual toxicity was assessed using 2 validated patient-reported outcome measures: Female Sexual Function Index and Female Sexual Distress Scale-Revised. Clinical and treatment data were collected by chart review. Vaginal dosimetry was abstracted from individual treatment plans, including: vaginal D2cm3 (minimum dose to hottest 2 cm3 of vagina), International Commission on Radiation Units and Measurements rectovaginal point (point dose 5 mm posterior to the applicator at the top of vagina), lateral point (point dose 5 mm lateral to the applicator at the top of vagina), point dose at posterior-inferior border of the symphysis (PIBS), and PIBS ± 2 cm (point dose ± 2 cm to PIBS). Vaginal Total Reference Air Kerma assessed dose loading within the vagina. Descriptive statistics summarized the data. Correlations were evaluated using logistic and linear regression analyses.
RESULTS: Between August 2018 and April 2022, 73 patients were eligible. Median age was 49 (range, 25-81), median stage was IIB, 58% had vaginal involvement at diagnosis, and 33% had vaginal involvement at brachytherapy. Patients completed patient-reported outcome measures at a median of 19 months (range, 3-63) post treatment. Criteria for sexual dysfunction and distress were met in 73% (Female Sexual Function Index ≤ 26) and 55% (Female Sexual Distress Scale-Revised ≥ 11) of participants, respectively. Cumulative International Commission on Radiation Units and Measurements rectovaginal point dose >65 Gy (odds ratio, 5.04; 95% CI, 1.18-27.99; P = .040) and Vaginal Total Reference Air Kerma (odds ratio, 1.71; 95% CI, 1.04-3.04; P = .045) were associated with increased sexual distress on multivariable analysis.
CONCLUSIONS: Sexual health following radiation therapy for cervical cancer is a multifactorial issue. This analysis identifies a novel association between brachytherapy dosimetry and sexual toxicity. Further attention to and evaluation of vaginal doses could improve our understanding of sexual health outcomes.
METHODS AND MATERIALS: Patients with stage IB to IVA cervical cancer treated with definitive chemoradiation and magnetic resonance-guided brachytherapy were enrolled in a prospective, cross-sectional study. Sexual toxicity was assessed using 2 validated patient-reported outcome measures: Female Sexual Function Index and Female Sexual Distress Scale-Revised. Clinical and treatment data were collected by chart review. Vaginal dosimetry was abstracted from individual treatment plans, including: vaginal D2cm3 (minimum dose to hottest 2 cm3 of vagina), International Commission on Radiation Units and Measurements rectovaginal point (point dose 5 mm posterior to the applicator at the top of vagina), lateral point (point dose 5 mm lateral to the applicator at the top of vagina), point dose at posterior-inferior border of the symphysis (PIBS), and PIBS ± 2 cm (point dose ± 2 cm to PIBS). Vaginal Total Reference Air Kerma assessed dose loading within the vagina. Descriptive statistics summarized the data. Correlations were evaluated using logistic and linear regression analyses.
RESULTS: Between August 2018 and April 2022, 73 patients were eligible. Median age was 49 (range, 25-81), median stage was IIB, 58% had vaginal involvement at diagnosis, and 33% had vaginal involvement at brachytherapy. Patients completed patient-reported outcome measures at a median of 19 months (range, 3-63) post treatment. Criteria for sexual dysfunction and distress were met in 73% (Female Sexual Function Index ≤ 26) and 55% (Female Sexual Distress Scale-Revised ≥ 11) of participants, respectively. Cumulative International Commission on Radiation Units and Measurements rectovaginal point dose >65 Gy (odds ratio, 5.04; 95% CI, 1.18-27.99; P = .040) and Vaginal Total Reference Air Kerma (odds ratio, 1.71; 95% CI, 1.04-3.04; P = .045) were associated with increased sexual distress on multivariable analysis.
CONCLUSIONS: Sexual health following radiation therapy for cervical cancer is a multifactorial issue. This analysis identifies a novel association between brachytherapy dosimetry and sexual toxicity. Further attention to and evaluation of vaginal doses could improve our understanding of sexual health outcomes.