Title : Rehabilitation of reconvalescent oncogynecologic patients after radical treatment using aesthetic technologies
Abstract:
Relevance: Cervical cancer (CC) and uterine cancer (UC) are among the top of three most common cancers among women with an annual increase in the number of first diagnosed cases in people of reproductive age. On the background of the development of sex steroid deficiency after treatment, manifestations of atrophic changes of the genitourinary tract together with post-radiation changes lead to sexual dysfunction and a sharp decrease in the quality of life of this category of patients.
Objective: to evaluate the efficacy of stabilized hyaluronic acid for the correction of post-treatment changes of the vulvovaginal area in patients with RSM and RTM after radical treatment of the underlying disease.
Materials and Methods: The study included 201 patients with morphologically verified CC and UC FIGO stages I-III (CC - 83 (41,3%), UC - 118 (58,7%)) without signs of progression of the underlying disease (clinical group III) after surgical (67 (33,3%)), combined (75 (37,3%)) treatment or combined radiation/chemoradiation therapy (59 (29,4%)). The mean age of the patients was 56.6±10.0 years. All patients in the observed cohort were postmenopausal, with 40.8% due to treatment; the mean duration of the postmenopausal period was 9.5±7.1L. The mean age of onset of menopause was 47.0±6.5l; early menopause (up to 45l) occurred in 69 (34.3%) patients. In all patients before and 1 month after corrective treatment the degree of atrophic processes of vulva and vagina was evaluated - pH-metry with subsequent calculation of vaginal health index (VHI), menopausal index (MI), cytologic examination with calculation of vaginal epithelium maturation index (VMI). Sexual function was assessed by PISQ questionnaires. Non-hormonal treatment involved intravaginal and perineal insertion of implants based on stabilized hyaluronic acid according to the developed technique.
Results: The pH-metry performed before the corrective treatment showed that in the vast majority of patients (148 (73,6%) cases) the pH of vaginal discharge was ≥ 6,0 with a mean value of 6,3±0,8. When calculating VHI, all patients had vaginal atrophy of varying severity: the mean value of VHI was 9.2±3.6; VMI was 30.8±22.1, which corresponded to a severe degree of atrophy. The study of vaginal transudate acidity depending on the treatment method revealed the highest pH values in the group of patients treated with combined radiation/chemoradiation therapy - 6,59±0,6, in comparison with combined and surgical treatment - 6,43±0,8 (p=0,01) and 6,05±0,9 (p=0,001), respectively. In the same group, the VHI was statistically significantly lower, 9,2±3,6, compared to combined (p=0,02) and surgical (p=0,00001) methods. After restorative therapy, the pH values of vaginal discharge were significantly lower, and the VHI was higher than the initial values: the mean values were 5.37±0.7 and 15.85±2.7, respectively (p<0.00001). A statistically significant increase in vaginal transudate acidity (p<0.00001) compared to the baseline value was observed in all patient groups, regardless of the treatment method: up to 5.43±0.7; 5.42±0.8 and 5.26±0.7, respectively, with combined radiotherapy/chemoradiation, combined and surgical treatment (p>0.05).
Conclusions: Thus, all oncogynecologic patients after radical specialized treatment have atrophy of the vaginal mucosa, more pronounced after combined radiation/chemoradiation therapy. Non-hormonal regenerative therapy using hyaluronic acid-based implants is an effective method of improving the properties of the vaginal mucosa, regardless of the method of specialized treatment performed.
