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Katja Lindel - One of the best experts on this subject based on the ideXlab platform.
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The impact of Vaginal Dilator use on Vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer
Strahlentherapie und Onkologie, 2019Co-Authors: Sati Akbaba, Jan T. Oelmann-avendano, David Krug, Juliane Hoerner-rieber, Nils H. Nicolay, Nathalie Arians, Tilman Bostel, Katja Lindel, Juergen Debus, Robert FoersterAbstract:BackgroundDespite a lack of evidence and low compliance, current guidelines recommend the use of a Vaginal Dilator (VD) after pelvic radiotherapy (RT). We analyzed the effect of VD on Vaginal stenosis (VS) and its influence on sexual quality of life (QoL) in women treated with adjuvant RT for endometrial cancer (EC).MethodsBetween 2014 and 2015, 56 consecutive patients were instructed to use a VD after completion of treatment. The maximum diameter of the comfortably introducible VD was measured before and at 1 year after treatment. The degree of VS was evaluated clinically, and sexual QoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) sexual functioning items before RT, during RT, at 6 weeks, and at 1 year after RT.ResultsOne year after RT, mean VD diameter had decreased by 2.7 ± 3.2 mm ( p
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The impact of Vaginal Dilator use on Vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer
Strahlentherapie und Onkologie, 2019Co-Authors: Sati Akbaba, Jan T. Oelmann-avendano, David Krug, Juliane Hoerner-rieber, Nils H. Nicolay, Nathalie Arians, Tilman Bostel, Katja Lindel, Juergen Debus, Robert FoersterAbstract:Hintergrund Trotz fehlender Evidenzlage und geringer Compliance empfehlen die aktuellen Leitlinien die Anwendung eines Vaginaldilatators (VD) nach pelviner Radiotherapie (RT). Wir analysierten den Effekt eines Vaginaldilatators auf die Vaginalstenose (VS) und auf die sexuelle Lebensqualität (QoL) bei Frauen mit Endometriumkarzinom (EC) nach erfolgter adjuvanter RT. Methoden Zwischen 2014 und 2015 wurden 56 Patientinnen instruiert, einen VD nach Beendigung der RT zu benutzen. Der maximale Durchmesser des am angenehmsten einführbaren VD wurde vor und 1 Jahr nach Therapie gemessen. Die Ausprägung der VS wurde 1 Jahr nach Therapie klinisch erfasst und die sexuelle QoL anhand der von der European Organisation for Research and Treatment of Cancer (EORTC) vorgegebenen sexuellen Funktionsfragen vor, während, 6 Wochen und 1 Jahr nach RT bestimmt. Ergebnisse Der mittlere VD-Durchmesser nahm 1 Jahr nach RT um 2,7 ± 3,2 mm ab ( p
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the impact of Vaginal Dilator use on Vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer
Strahlentherapie Und Onkologie, 2019Co-Authors: Sati Akbaba, David Krug, Nils H. Nicolay, Nathalie Arians, Tilman Bostel, Juergen Debus, Jan Oelmannavendano, Juliane Hoernerrieber, Katja LindelAbstract:BACKGROUND: Despite a lack of evidence and low compliance, current guidelines recommend the use of a Vaginal Dilator (VD) after pelvic radiotherapy (RT). We analyzed the effect of VD on Vaginal stenosis (VS) and its influence on sexual quality of life (QoL) in women treated with adjuvant RT for endometrial cancer (EC). METHODS: Between 2014 and 2015, 56 consecutive patients were instructed to use a VD after completion of treatment. The maximum diameter of the comfortably introducible VD was measured before and at 1 year after treatment. The degree of VS was evaluated clinically, and sexual QoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) sexual functioning items before RT, during RT, at 6 weeks, and at 1 year after RT. RESULTS: One year after RT, mean VD diameter had decreased by 2.7 ± 3.2 mm (p < 0.001) and 36 patients (64.3%) had clinical VS (grade I-III). A larger decrease in VD diameter correlated with a higher degree of clinical VS (p < 0.001). VD use (p = 0.81), RT modality (p = 0.68), and adjuvant ChT (p = 0.87) had no influence on VD diameter. Sexual activity decreased during RT and increased beyond pre-RT values 1 year after RT (p < 0.001). Sexual enjoyment decreased continuously during and after completion of RT (p = 0.013) and was influenced negatively by a higher degree of clinical VS (p = 0.01). CONCLUSION: Almost two thirds of patients developed clinical VS 1 year after adjuvant RT for EC, and sexual enjoyment was substantially reduced by VS. The use of a VD after RT may not serve to prevent sexual impairments and VS.
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Prognostic factors for long-term quality of life after adjuvant radiotherapy in women with endometrial cancer
Strahlentherapie und Onkologie, 2016Co-Authors: Robert Foerster, Nathalie Arians, Juergen Debus, Lara Schnetzke, Thomas Bruckner, Harald Rief, Katja LindelAbstract:Background Adjuvant radiotherapy (RT) for endometrial cancer (EC) may affect patients’ quality of life (QoL). There is a paucity of data on prognostic factors for long-term QoL and sexual functioning. This study aimed to investigate such factors and assess the role of the Vaginal Dilator (VD). Methods QoL was assessed in 112 EC patients 6 years (median) after RT. QoL was compared to normative data, and the influence of age, tumor characteristics, lymphadenectomy, RT, and acute toxicities was assessed. VD use and its effect on subjective Vaginal shortening/tightness was analyzed. Results QoL was reduced, particularly in younger patients. Vaginal brachytherapy only and intensity-modulated RT (IMRT) were associated with better global health status and reduced chronic gastrointestinal (GI) symptoms. Higher acute GI toxicity was associated with increased chronic GI symptoms, particularly diarrhea, and reduced role functioning. Higher acute urinary toxicity was associated with increased chronic urological symptoms, muscular/pelvic pain, and chronic GI symptoms, as well as with reduced emotional/social functioning and reduced global health status. Sexual interest/activity was increased despite Vaginal dryness and dyspareunia. Sexual interest/activity increased with age. Only few, mainly younger patients used the VD. VD use >1 year was found in women with higher sexual interest/activity. Acute Vaginal toxicity and chronic pain prevented VD use. Subjective Vaginal shortening/tightness was not reduced in VD users. Conclusion RT technique and acute toxicities are prognostic for the extent of chronic symptoms and long-term QoL. Sexuality is important even at a higher age. Few patients use the VD and a reduction of subjective Vaginal shortening/tightness was not achieved. Hintergrund Eine adjuvante Radiotherapie (RT) kann die Lebensqualität von Patientinnen mit Endometriumkarzinom (EC) beeinflussen. Daten zu prognostischen Faktoren für die langfristige Lebensqualität (QoL) und die Sexualfunktion sind rar. Ziel war es, diese Faktoren und die Rolle des VaginalDilators (VD) zu untersuchen. Methoden Zur QoL wurden 112 EC-Patientinnen 6 Jahre (median) nach RT befragt. Die QoL wurde mit Normdaten verglichen und der Einfluss von Alter, Tumorcharakteristika, Operation, RT und Akuttoxizitäten bestimmt. Nutzung und Einfluss des VD auf die subjektiv empfundene Vaginale Verkürzung/Enge wurden analysiert. Ergebnisse Die QoL war insbesondere bei jüngeren Patientinnen reduziert. Alleinige endoVaginale Brachytherapie und intensitätsmodulierte RT (IMRT) korrelierten mit einem besseren Gesamtgesundheitszustand und weniger chronischen gastrointestinalen (GI) Symptomen. Höhergradige GI-Akuttoxizität korrelierte mit vermehrt chronischen GI-Symptomen, insbesondere Durchfall, und reduzierter Rollenfunktion. Höhergradige urologische Akuttoxizität korrelierte mit vermehrten chronischen urologischen Symptomen, Muskel- und Beckenschmerzen, chronischen GI-Symptomen, insbesondere Durchfall, reduzierter emotionaler/sozialer Funktion sowie reduziertem Gesamtgesundheitszustand. Mehr sexuelles Interesse/Aktivität trotz vermehrter Vaginaler Trockenheit und Dyspareunie. Sexuelles Interesse/Aktivität nahmen mit dem Alter zu. Wenige, jüngere Patientinnen nutzen den VD. VD-Nutzung >1 Jahr bei Frauen mit mehr sexuellem Interesse/Aktivität. Vaginale Akuttoxizität und chronische Schmerzen verhinderten die VD-Nutzung. Der VD reduzierte die subjektiv empfundene Vaginale Verkürzung/Enge nicht. Schlussfolgerung RT-Technik und Akuttoxizitäten sind prognostisch für das Ausmaß chronischer Symptome und die langfristige QoL. Sexualität ist auch im hohen Alter wichtig. Wenige Patientinnen nutzen den VD und die subjektiv empfundene Vaginale Verkürzung/Enge nahm nicht ab.
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Prognostic factors for long-term quality of life after adjuvant radiotherapy in women with endometrial cancer
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al], 2016Co-Authors: Robert Foerster, Nathalie Arians, Juergen Debus, Lara Schnetzke, Thomas Bruckner, Harald Rief, Katja LindelAbstract:Background Adjuvant radiotherapy (RT) for endometrial cancer (EC) may affect patients’ quality of life (QoL). There is a paucity of data on prognostic factors for long-term QoL and sexual functioning. This study aimed to investigate such factors and assess the role of the Vaginal Dilator (VD).
Nathalie Arians - One of the best experts on this subject based on the ideXlab platform.
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Intrafractional Vaginal dilation in anal cancer patients undergoing pelvic radiotherapy (DILANA) – a prospective, randomized, 2-armed phase-II-trial
BMC cancer, 2020Co-Authors: Nathalie Arians, Matthias F. Häfner, Johannes Krisam, Kristin Lang, Antje Wark, Stefan A. Koerber, Adriane Hommertgen, Jürgen DebusAbstract:BACKGROUND The incidence of anal cancer is rising in the last decades and more women are affected than men. The prognosis after chemoradiation is very good with complete remission rates of 80-90%. Thus, reducing therapy-related toxicities and improving quality of life are of high importance. With the development of new radiotherapy techniques like IMRT (Intensity-modulated radiotherapy), the incidence of acute and chronic gastrointestinal toxicities has already been reduced. However, especially in female anal cancer patients genital toxicities like Vaginal fibrosis and stenosis are of great relevance, too. Up to now, there are no prospective data reporting incidence rates, techniques of prevention or impact on quality of life. The aim of the DILANA trial is to evaluate the incidence and grade of Vaginal fibrosis, to optimize radiotherapy by reducing dose to the Vaginal wall to minimize genital toxicities and improve quality of life of anal cancer patients. METHODS The study is designed as a prospective, randomized, two-armed, open, single-center phase-II-trial. Sixty patients will be randomized into one of two arms, which differ only in the diameter of a tampon used during treatment. All patients will receive standard (chemo) radiation with a total dose of 45-50.4 Gy to the pelvic and inguinal nodes with a boost to the anal canal up to 54-60 Gy. The primary objective is the assessment of the incidence and grade of Vaginal fibrosis 12 months after (chemo) radiation depending on the extent of Vaginal dilation. Secondary endpoints are toxicities according to the CTC AE version 5.0 criteria, assessment of clinical feasibility of daily use of a tampon, assessment of compliance for the use of a Vaginal Dilator and quality of life. DISCUSSION Prospective studies are needed evaluating the incidence and grade of Vaginal fibrosis after (chemo) radiation in female anal cancer patients. Furthermore, the assessment of techniques to reduce the incidence of Vaginal fibrosis like intrafractional Vaginal dilation as well as other radiotherapy-independent methods like using a Vaginal Dilator are essential. Additionally, implementation of a systematic assessment of Vaginal stenosis is necessary to grant reproducibility and comparability of future data. TRIAL REGISTRATION The trial is registered with clinicaltrials.gov (NCT04094454, 19.09.2019).
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The impact of Vaginal Dilator use on Vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer
Strahlentherapie und Onkologie, 2019Co-Authors: Sati Akbaba, Jan T. Oelmann-avendano, David Krug, Juliane Hoerner-rieber, Nils H. Nicolay, Nathalie Arians, Tilman Bostel, Katja Lindel, Juergen Debus, Robert FoersterAbstract:BackgroundDespite a lack of evidence and low compliance, current guidelines recommend the use of a Vaginal Dilator (VD) after pelvic radiotherapy (RT). We analyzed the effect of VD on Vaginal stenosis (VS) and its influence on sexual quality of life (QoL) in women treated with adjuvant RT for endometrial cancer (EC).MethodsBetween 2014 and 2015, 56 consecutive patients were instructed to use a VD after completion of treatment. The maximum diameter of the comfortably introducible VD was measured before and at 1 year after treatment. The degree of VS was evaluated clinically, and sexual QoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) sexual functioning items before RT, during RT, at 6 weeks, and at 1 year after RT.ResultsOne year after RT, mean VD diameter had decreased by 2.7 ± 3.2 mm ( p
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The impact of Vaginal Dilator use on Vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer
Strahlentherapie und Onkologie, 2019Co-Authors: Sati Akbaba, Jan T. Oelmann-avendano, David Krug, Juliane Hoerner-rieber, Nils H. Nicolay, Nathalie Arians, Tilman Bostel, Katja Lindel, Juergen Debus, Robert FoersterAbstract:Hintergrund Trotz fehlender Evidenzlage und geringer Compliance empfehlen die aktuellen Leitlinien die Anwendung eines Vaginaldilatators (VD) nach pelviner Radiotherapie (RT). Wir analysierten den Effekt eines Vaginaldilatators auf die Vaginalstenose (VS) und auf die sexuelle Lebensqualität (QoL) bei Frauen mit Endometriumkarzinom (EC) nach erfolgter adjuvanter RT. Methoden Zwischen 2014 und 2015 wurden 56 Patientinnen instruiert, einen VD nach Beendigung der RT zu benutzen. Der maximale Durchmesser des am angenehmsten einführbaren VD wurde vor und 1 Jahr nach Therapie gemessen. Die Ausprägung der VS wurde 1 Jahr nach Therapie klinisch erfasst und die sexuelle QoL anhand der von der European Organisation for Research and Treatment of Cancer (EORTC) vorgegebenen sexuellen Funktionsfragen vor, während, 6 Wochen und 1 Jahr nach RT bestimmt. Ergebnisse Der mittlere VD-Durchmesser nahm 1 Jahr nach RT um 2,7 ± 3,2 mm ab ( p
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the impact of Vaginal Dilator use on Vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer
Strahlentherapie Und Onkologie, 2019Co-Authors: Sati Akbaba, David Krug, Nils H. Nicolay, Nathalie Arians, Tilman Bostel, Juergen Debus, Jan Oelmannavendano, Juliane Hoernerrieber, Katja LindelAbstract:BACKGROUND: Despite a lack of evidence and low compliance, current guidelines recommend the use of a Vaginal Dilator (VD) after pelvic radiotherapy (RT). We analyzed the effect of VD on Vaginal stenosis (VS) and its influence on sexual quality of life (QoL) in women treated with adjuvant RT for endometrial cancer (EC). METHODS: Between 2014 and 2015, 56 consecutive patients were instructed to use a VD after completion of treatment. The maximum diameter of the comfortably introducible VD was measured before and at 1 year after treatment. The degree of VS was evaluated clinically, and sexual QoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) sexual functioning items before RT, during RT, at 6 weeks, and at 1 year after RT. RESULTS: One year after RT, mean VD diameter had decreased by 2.7 ± 3.2 mm (p < 0.001) and 36 patients (64.3%) had clinical VS (grade I-III). A larger decrease in VD diameter correlated with a higher degree of clinical VS (p < 0.001). VD use (p = 0.81), RT modality (p = 0.68), and adjuvant ChT (p = 0.87) had no influence on VD diameter. Sexual activity decreased during RT and increased beyond pre-RT values 1 year after RT (p < 0.001). Sexual enjoyment decreased continuously during and after completion of RT (p = 0.013) and was influenced negatively by a higher degree of clinical VS (p = 0.01). CONCLUSION: Almost two thirds of patients developed clinical VS 1 year after adjuvant RT for EC, and sexual enjoyment was substantially reduced by VS. The use of a VD after RT may not serve to prevent sexual impairments and VS.
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Prognostic factors for long-term quality of life after adjuvant radiotherapy in women with endometrial cancer
Strahlentherapie und Onkologie, 2016Co-Authors: Robert Foerster, Nathalie Arians, Juergen Debus, Lara Schnetzke, Thomas Bruckner, Harald Rief, Katja LindelAbstract:Background Adjuvant radiotherapy (RT) for endometrial cancer (EC) may affect patients’ quality of life (QoL). There is a paucity of data on prognostic factors for long-term QoL and sexual functioning. This study aimed to investigate such factors and assess the role of the Vaginal Dilator (VD). Methods QoL was assessed in 112 EC patients 6 years (median) after RT. QoL was compared to normative data, and the influence of age, tumor characteristics, lymphadenectomy, RT, and acute toxicities was assessed. VD use and its effect on subjective Vaginal shortening/tightness was analyzed. Results QoL was reduced, particularly in younger patients. Vaginal brachytherapy only and intensity-modulated RT (IMRT) were associated with better global health status and reduced chronic gastrointestinal (GI) symptoms. Higher acute GI toxicity was associated with increased chronic GI symptoms, particularly diarrhea, and reduced role functioning. Higher acute urinary toxicity was associated with increased chronic urological symptoms, muscular/pelvic pain, and chronic GI symptoms, as well as with reduced emotional/social functioning and reduced global health status. Sexual interest/activity was increased despite Vaginal dryness and dyspareunia. Sexual interest/activity increased with age. Only few, mainly younger patients used the VD. VD use >1 year was found in women with higher sexual interest/activity. Acute Vaginal toxicity and chronic pain prevented VD use. Subjective Vaginal shortening/tightness was not reduced in VD users. Conclusion RT technique and acute toxicities are prognostic for the extent of chronic symptoms and long-term QoL. Sexuality is important even at a higher age. Few patients use the VD and a reduction of subjective Vaginal shortening/tightness was not achieved. Hintergrund Eine adjuvante Radiotherapie (RT) kann die Lebensqualität von Patientinnen mit Endometriumkarzinom (EC) beeinflussen. Daten zu prognostischen Faktoren für die langfristige Lebensqualität (QoL) und die Sexualfunktion sind rar. Ziel war es, diese Faktoren und die Rolle des VaginalDilators (VD) zu untersuchen. Methoden Zur QoL wurden 112 EC-Patientinnen 6 Jahre (median) nach RT befragt. Die QoL wurde mit Normdaten verglichen und der Einfluss von Alter, Tumorcharakteristika, Operation, RT und Akuttoxizitäten bestimmt. Nutzung und Einfluss des VD auf die subjektiv empfundene Vaginale Verkürzung/Enge wurden analysiert. Ergebnisse Die QoL war insbesondere bei jüngeren Patientinnen reduziert. Alleinige endoVaginale Brachytherapie und intensitätsmodulierte RT (IMRT) korrelierten mit einem besseren Gesamtgesundheitszustand und weniger chronischen gastrointestinalen (GI) Symptomen. Höhergradige GI-Akuttoxizität korrelierte mit vermehrt chronischen GI-Symptomen, insbesondere Durchfall, und reduzierter Rollenfunktion. Höhergradige urologische Akuttoxizität korrelierte mit vermehrten chronischen urologischen Symptomen, Muskel- und Beckenschmerzen, chronischen GI-Symptomen, insbesondere Durchfall, reduzierter emotionaler/sozialer Funktion sowie reduziertem Gesamtgesundheitszustand. Mehr sexuelles Interesse/Aktivität trotz vermehrter Vaginaler Trockenheit und Dyspareunie. Sexuelles Interesse/Aktivität nahmen mit dem Alter zu. Wenige, jüngere Patientinnen nutzen den VD. VD-Nutzung >1 Jahr bei Frauen mit mehr sexuellem Interesse/Aktivität. Vaginale Akuttoxizität und chronische Schmerzen verhinderten die VD-Nutzung. Der VD reduzierte die subjektiv empfundene Vaginale Verkürzung/Enge nicht. Schlussfolgerung RT-Technik und Akuttoxizitäten sind prognostisch für das Ausmaß chronischer Symptome und die langfristige QoL. Sexualität ist auch im hohen Alter wichtig. Wenige Patientinnen nutzen den VD und die subjektiv empfundene Vaginale Verkürzung/Enge nahm nicht ab.
Robert Foerster - One of the best experts on this subject based on the ideXlab platform.
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The impact of Vaginal Dilator use on Vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer
Strahlentherapie und Onkologie, 2019Co-Authors: Sati Akbaba, Jan T. Oelmann-avendano, David Krug, Juliane Hoerner-rieber, Nils H. Nicolay, Nathalie Arians, Tilman Bostel, Katja Lindel, Juergen Debus, Robert FoersterAbstract:BackgroundDespite a lack of evidence and low compliance, current guidelines recommend the use of a Vaginal Dilator (VD) after pelvic radiotherapy (RT). We analyzed the effect of VD on Vaginal stenosis (VS) and its influence on sexual quality of life (QoL) in women treated with adjuvant RT for endometrial cancer (EC).MethodsBetween 2014 and 2015, 56 consecutive patients were instructed to use a VD after completion of treatment. The maximum diameter of the comfortably introducible VD was measured before and at 1 year after treatment. The degree of VS was evaluated clinically, and sexual QoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) sexual functioning items before RT, during RT, at 6 weeks, and at 1 year after RT.ResultsOne year after RT, mean VD diameter had decreased by 2.7 ± 3.2 mm ( p
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The impact of Vaginal Dilator use on Vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer
Strahlentherapie und Onkologie, 2019Co-Authors: Sati Akbaba, Jan T. Oelmann-avendano, David Krug, Juliane Hoerner-rieber, Nils H. Nicolay, Nathalie Arians, Tilman Bostel, Katja Lindel, Juergen Debus, Robert FoersterAbstract:Hintergrund Trotz fehlender Evidenzlage und geringer Compliance empfehlen die aktuellen Leitlinien die Anwendung eines Vaginaldilatators (VD) nach pelviner Radiotherapie (RT). Wir analysierten den Effekt eines Vaginaldilatators auf die Vaginalstenose (VS) und auf die sexuelle Lebensqualität (QoL) bei Frauen mit Endometriumkarzinom (EC) nach erfolgter adjuvanter RT. Methoden Zwischen 2014 und 2015 wurden 56 Patientinnen instruiert, einen VD nach Beendigung der RT zu benutzen. Der maximale Durchmesser des am angenehmsten einführbaren VD wurde vor und 1 Jahr nach Therapie gemessen. Die Ausprägung der VS wurde 1 Jahr nach Therapie klinisch erfasst und die sexuelle QoL anhand der von der European Organisation for Research and Treatment of Cancer (EORTC) vorgegebenen sexuellen Funktionsfragen vor, während, 6 Wochen und 1 Jahr nach RT bestimmt. Ergebnisse Der mittlere VD-Durchmesser nahm 1 Jahr nach RT um 2,7 ± 3,2 mm ab ( p
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Prognostic factors for long-term quality of life after adjuvant radiotherapy in women with endometrial cancer
Strahlentherapie und Onkologie, 2016Co-Authors: Robert Foerster, Nathalie Arians, Juergen Debus, Lara Schnetzke, Thomas Bruckner, Harald Rief, Katja LindelAbstract:Background Adjuvant radiotherapy (RT) for endometrial cancer (EC) may affect patients’ quality of life (QoL). There is a paucity of data on prognostic factors for long-term QoL and sexual functioning. This study aimed to investigate such factors and assess the role of the Vaginal Dilator (VD). Methods QoL was assessed in 112 EC patients 6 years (median) after RT. QoL was compared to normative data, and the influence of age, tumor characteristics, lymphadenectomy, RT, and acute toxicities was assessed. VD use and its effect on subjective Vaginal shortening/tightness was analyzed. Results QoL was reduced, particularly in younger patients. Vaginal brachytherapy only and intensity-modulated RT (IMRT) were associated with better global health status and reduced chronic gastrointestinal (GI) symptoms. Higher acute GI toxicity was associated with increased chronic GI symptoms, particularly diarrhea, and reduced role functioning. Higher acute urinary toxicity was associated with increased chronic urological symptoms, muscular/pelvic pain, and chronic GI symptoms, as well as with reduced emotional/social functioning and reduced global health status. Sexual interest/activity was increased despite Vaginal dryness and dyspareunia. Sexual interest/activity increased with age. Only few, mainly younger patients used the VD. VD use >1 year was found in women with higher sexual interest/activity. Acute Vaginal toxicity and chronic pain prevented VD use. Subjective Vaginal shortening/tightness was not reduced in VD users. Conclusion RT technique and acute toxicities are prognostic for the extent of chronic symptoms and long-term QoL. Sexuality is important even at a higher age. Few patients use the VD and a reduction of subjective Vaginal shortening/tightness was not achieved. Hintergrund Eine adjuvante Radiotherapie (RT) kann die Lebensqualität von Patientinnen mit Endometriumkarzinom (EC) beeinflussen. Daten zu prognostischen Faktoren für die langfristige Lebensqualität (QoL) und die Sexualfunktion sind rar. Ziel war es, diese Faktoren und die Rolle des VaginalDilators (VD) zu untersuchen. Methoden Zur QoL wurden 112 EC-Patientinnen 6 Jahre (median) nach RT befragt. Die QoL wurde mit Normdaten verglichen und der Einfluss von Alter, Tumorcharakteristika, Operation, RT und Akuttoxizitäten bestimmt. Nutzung und Einfluss des VD auf die subjektiv empfundene Vaginale Verkürzung/Enge wurden analysiert. Ergebnisse Die QoL war insbesondere bei jüngeren Patientinnen reduziert. Alleinige endoVaginale Brachytherapie und intensitätsmodulierte RT (IMRT) korrelierten mit einem besseren Gesamtgesundheitszustand und weniger chronischen gastrointestinalen (GI) Symptomen. Höhergradige GI-Akuttoxizität korrelierte mit vermehrt chronischen GI-Symptomen, insbesondere Durchfall, und reduzierter Rollenfunktion. Höhergradige urologische Akuttoxizität korrelierte mit vermehrten chronischen urologischen Symptomen, Muskel- und Beckenschmerzen, chronischen GI-Symptomen, insbesondere Durchfall, reduzierter emotionaler/sozialer Funktion sowie reduziertem Gesamtgesundheitszustand. Mehr sexuelles Interesse/Aktivität trotz vermehrter Vaginaler Trockenheit und Dyspareunie. Sexuelles Interesse/Aktivität nahmen mit dem Alter zu. Wenige, jüngere Patientinnen nutzen den VD. VD-Nutzung >1 Jahr bei Frauen mit mehr sexuellem Interesse/Aktivität. Vaginale Akuttoxizität und chronische Schmerzen verhinderten die VD-Nutzung. Der VD reduzierte die subjektiv empfundene Vaginale Verkürzung/Enge nicht. Schlussfolgerung RT-Technik und Akuttoxizitäten sind prognostisch für das Ausmaß chronischer Symptome und die langfristige QoL. Sexualität ist auch im hohen Alter wichtig. Wenige Patientinnen nutzen den VD und die subjektiv empfundene Vaginale Verkürzung/Enge nahm nicht ab.
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Prognostic factors for long-term quality of life after adjuvant radiotherapy in women with endometrial cancer
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al], 2016Co-Authors: Robert Foerster, Nathalie Arians, Juergen Debus, Lara Schnetzke, Thomas Bruckner, Harald Rief, Katja LindelAbstract:Background Adjuvant radiotherapy (RT) for endometrial cancer (EC) may affect patients’ quality of life (QoL). There is a paucity of data on prognostic factors for long-term QoL and sexual functioning. This study aimed to investigate such factors and assess the role of the Vaginal Dilator (VD).
Richard J Paulson - One of the best experts on this subject based on the ideXlab platform.
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Spontaneous twin gestation after Vaginal dilation in a woman with uterus didelphys and bladder exstrophy.
Obstetrics and gynecology, 2002Co-Authors: Eliran Mor, Peyman Saadat, Rebecca Z Sokol, Richard J PaulsonAbstract:Bladder exstrophy is an uncommon anomaly rarely associated with uterus didelphys. Fertility is limited by associated Vaginal malformations, which have traditionally required surgical reconstruction. A woman with a history of bladder exstrophy and hypoplastic vagina presented complaining of painful intercourse. The patient underwent Vaginal Dilator treatment after corrective surgery for the bladder defect. Without any further fertility therapy she subsequently conceived twins, with one implantation in each horn of a didelphic uterus. Bladder exstrophy, uterus didelphys, and Vaginal hypoplasia share a common embryological devel-opment, and the finding of one anomaly can alert to the presence of another. Vaginal Dilators may be used in place of surgical reconstruction to allow conception.
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Spontaneous twin gestation after Vaginal dilation in a woman with uterus didelphys and bladder exstrophy
Obstetrics & Gynecology, 2002Co-Authors: Eliran Mor, Peyman Saadat, Rebecca Z Sokol, Richard J PaulsonAbstract:Abstract BACKGROUND: Bladder exstrophy is an uncommon anomaly rarely associated with uterus didelphys. Fertility is limited by associated Vaginal malformations, which have traditionally required surgical reconstruction. CASE: A woman with a history of bladder exstrophy and hypoplastic vagina presented complaining of painful intercourse. The patient underwent Vaginal Dilator treatment after corrective surgery for the bladder defect. Without any further fertility therapy she subsequently conceived twins, with one implantation in each horn of a didelphic uterus. CONCLUSION: Bladder exstrophy, uterus didelphys, and Vaginal hypoplasia share a common embryological devel-opment, and the finding of one anomaly can alert to the presence of another. Vaginal Dilators may be used in place of surgical reconstruction to allow conception.
Juergen Debus - One of the best experts on this subject based on the ideXlab platform.
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The impact of Vaginal Dilator use on Vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer
Strahlentherapie und Onkologie, 2019Co-Authors: Sati Akbaba, Jan T. Oelmann-avendano, David Krug, Juliane Hoerner-rieber, Nils H. Nicolay, Nathalie Arians, Tilman Bostel, Katja Lindel, Juergen Debus, Robert FoersterAbstract:BackgroundDespite a lack of evidence and low compliance, current guidelines recommend the use of a Vaginal Dilator (VD) after pelvic radiotherapy (RT). We analyzed the effect of VD on Vaginal stenosis (VS) and its influence on sexual quality of life (QoL) in women treated with adjuvant RT for endometrial cancer (EC).MethodsBetween 2014 and 2015, 56 consecutive patients were instructed to use a VD after completion of treatment. The maximum diameter of the comfortably introducible VD was measured before and at 1 year after treatment. The degree of VS was evaluated clinically, and sexual QoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) sexual functioning items before RT, during RT, at 6 weeks, and at 1 year after RT.ResultsOne year after RT, mean VD diameter had decreased by 2.7 ± 3.2 mm ( p
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The impact of Vaginal Dilator use on Vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer
Strahlentherapie und Onkologie, 2019Co-Authors: Sati Akbaba, Jan T. Oelmann-avendano, David Krug, Juliane Hoerner-rieber, Nils H. Nicolay, Nathalie Arians, Tilman Bostel, Katja Lindel, Juergen Debus, Robert FoersterAbstract:Hintergrund Trotz fehlender Evidenzlage und geringer Compliance empfehlen die aktuellen Leitlinien die Anwendung eines Vaginaldilatators (VD) nach pelviner Radiotherapie (RT). Wir analysierten den Effekt eines Vaginaldilatators auf die Vaginalstenose (VS) und auf die sexuelle Lebensqualität (QoL) bei Frauen mit Endometriumkarzinom (EC) nach erfolgter adjuvanter RT. Methoden Zwischen 2014 und 2015 wurden 56 Patientinnen instruiert, einen VD nach Beendigung der RT zu benutzen. Der maximale Durchmesser des am angenehmsten einführbaren VD wurde vor und 1 Jahr nach Therapie gemessen. Die Ausprägung der VS wurde 1 Jahr nach Therapie klinisch erfasst und die sexuelle QoL anhand der von der European Organisation for Research and Treatment of Cancer (EORTC) vorgegebenen sexuellen Funktionsfragen vor, während, 6 Wochen und 1 Jahr nach RT bestimmt. Ergebnisse Der mittlere VD-Durchmesser nahm 1 Jahr nach RT um 2,7 ± 3,2 mm ab ( p
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the impact of Vaginal Dilator use on Vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer
Strahlentherapie Und Onkologie, 2019Co-Authors: Sati Akbaba, David Krug, Nils H. Nicolay, Nathalie Arians, Tilman Bostel, Juergen Debus, Jan Oelmannavendano, Juliane Hoernerrieber, Katja LindelAbstract:BACKGROUND: Despite a lack of evidence and low compliance, current guidelines recommend the use of a Vaginal Dilator (VD) after pelvic radiotherapy (RT). We analyzed the effect of VD on Vaginal stenosis (VS) and its influence on sexual quality of life (QoL) in women treated with adjuvant RT for endometrial cancer (EC). METHODS: Between 2014 and 2015, 56 consecutive patients were instructed to use a VD after completion of treatment. The maximum diameter of the comfortably introducible VD was measured before and at 1 year after treatment. The degree of VS was evaluated clinically, and sexual QoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) sexual functioning items before RT, during RT, at 6 weeks, and at 1 year after RT. RESULTS: One year after RT, mean VD diameter had decreased by 2.7 ± 3.2 mm (p < 0.001) and 36 patients (64.3%) had clinical VS (grade I-III). A larger decrease in VD diameter correlated with a higher degree of clinical VS (p < 0.001). VD use (p = 0.81), RT modality (p = 0.68), and adjuvant ChT (p = 0.87) had no influence on VD diameter. Sexual activity decreased during RT and increased beyond pre-RT values 1 year after RT (p < 0.001). Sexual enjoyment decreased continuously during and after completion of RT (p = 0.013) and was influenced negatively by a higher degree of clinical VS (p = 0.01). CONCLUSION: Almost two thirds of patients developed clinical VS 1 year after adjuvant RT for EC, and sexual enjoyment was substantially reduced by VS. The use of a VD after RT may not serve to prevent sexual impairments and VS.
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Prognostic factors for long-term quality of life after adjuvant radiotherapy in women with endometrial cancer
Strahlentherapie und Onkologie, 2016Co-Authors: Robert Foerster, Nathalie Arians, Juergen Debus, Lara Schnetzke, Thomas Bruckner, Harald Rief, Katja LindelAbstract:Background Adjuvant radiotherapy (RT) for endometrial cancer (EC) may affect patients’ quality of life (QoL). There is a paucity of data on prognostic factors for long-term QoL and sexual functioning. This study aimed to investigate such factors and assess the role of the Vaginal Dilator (VD). Methods QoL was assessed in 112 EC patients 6 years (median) after RT. QoL was compared to normative data, and the influence of age, tumor characteristics, lymphadenectomy, RT, and acute toxicities was assessed. VD use and its effect on subjective Vaginal shortening/tightness was analyzed. Results QoL was reduced, particularly in younger patients. Vaginal brachytherapy only and intensity-modulated RT (IMRT) were associated with better global health status and reduced chronic gastrointestinal (GI) symptoms. Higher acute GI toxicity was associated with increased chronic GI symptoms, particularly diarrhea, and reduced role functioning. Higher acute urinary toxicity was associated with increased chronic urological symptoms, muscular/pelvic pain, and chronic GI symptoms, as well as with reduced emotional/social functioning and reduced global health status. Sexual interest/activity was increased despite Vaginal dryness and dyspareunia. Sexual interest/activity increased with age. Only few, mainly younger patients used the VD. VD use >1 year was found in women with higher sexual interest/activity. Acute Vaginal toxicity and chronic pain prevented VD use. Subjective Vaginal shortening/tightness was not reduced in VD users. Conclusion RT technique and acute toxicities are prognostic for the extent of chronic symptoms and long-term QoL. Sexuality is important even at a higher age. Few patients use the VD and a reduction of subjective Vaginal shortening/tightness was not achieved. Hintergrund Eine adjuvante Radiotherapie (RT) kann die Lebensqualität von Patientinnen mit Endometriumkarzinom (EC) beeinflussen. Daten zu prognostischen Faktoren für die langfristige Lebensqualität (QoL) und die Sexualfunktion sind rar. Ziel war es, diese Faktoren und die Rolle des VaginalDilators (VD) zu untersuchen. Methoden Zur QoL wurden 112 EC-Patientinnen 6 Jahre (median) nach RT befragt. Die QoL wurde mit Normdaten verglichen und der Einfluss von Alter, Tumorcharakteristika, Operation, RT und Akuttoxizitäten bestimmt. Nutzung und Einfluss des VD auf die subjektiv empfundene Vaginale Verkürzung/Enge wurden analysiert. Ergebnisse Die QoL war insbesondere bei jüngeren Patientinnen reduziert. Alleinige endoVaginale Brachytherapie und intensitätsmodulierte RT (IMRT) korrelierten mit einem besseren Gesamtgesundheitszustand und weniger chronischen gastrointestinalen (GI) Symptomen. Höhergradige GI-Akuttoxizität korrelierte mit vermehrt chronischen GI-Symptomen, insbesondere Durchfall, und reduzierter Rollenfunktion. Höhergradige urologische Akuttoxizität korrelierte mit vermehrten chronischen urologischen Symptomen, Muskel- und Beckenschmerzen, chronischen GI-Symptomen, insbesondere Durchfall, reduzierter emotionaler/sozialer Funktion sowie reduziertem Gesamtgesundheitszustand. Mehr sexuelles Interesse/Aktivität trotz vermehrter Vaginaler Trockenheit und Dyspareunie. Sexuelles Interesse/Aktivität nahmen mit dem Alter zu. Wenige, jüngere Patientinnen nutzen den VD. VD-Nutzung >1 Jahr bei Frauen mit mehr sexuellem Interesse/Aktivität. Vaginale Akuttoxizität und chronische Schmerzen verhinderten die VD-Nutzung. Der VD reduzierte die subjektiv empfundene Vaginale Verkürzung/Enge nicht. Schlussfolgerung RT-Technik und Akuttoxizitäten sind prognostisch für das Ausmaß chronischer Symptome und die langfristige QoL. Sexualität ist auch im hohen Alter wichtig. Wenige Patientinnen nutzen den VD und die subjektiv empfundene Vaginale Verkürzung/Enge nahm nicht ab.
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Prognostic factors for long-term quality of life after adjuvant radiotherapy in women with endometrial cancer
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al], 2016Co-Authors: Robert Foerster, Nathalie Arians, Juergen Debus, Lara Schnetzke, Thomas Bruckner, Harald Rief, Katja LindelAbstract:Background Adjuvant radiotherapy (RT) for endometrial cancer (EC) may affect patients’ quality of life (QoL). There is a paucity of data on prognostic factors for long-term QoL and sexual functioning. This study aimed to investigate such factors and assess the role of the Vaginal Dilator (VD).
