Long-Term Patient-Reported Dyspareunia After Definitive Chemoradiation for Anal Cancer: Using the Anterior Vaginal Wall as an Organ-at-Risk to Define an Actionable Dosimetric Goal
Purpose: Chemoradiation therapy (CRT) is the standard treatment for squamous cell carcinoma of the anus (SCCA). This study aimed to investigate the relationship between vaginal dosimetry and long-term patient-reported dyspareunia after treatment. We further aimed to use the anterior vaginal wall (AV...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-05-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109424000125 |
| _version_ | 1797253914989428736 |
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| author | Michael K. Rooney, MD Joshua S. Niedzielski, PhD Ramon M. Salazar, PhD Angelica Arzola, PA-C Prajnan Das, MD, MS, MPH Eugene J. Koay, MD, PhD Albert Koong, MD, PhD Ethan B. Ludmir, MD Bruce D. Minsky, MD Sonal Noticewala, MD Grace L. Smith, MD, PhD, MPH Cullen Taniguchi, MD, PhD Emma B. Holliday, MD |
| author_facet | Michael K. Rooney, MD Joshua S. Niedzielski, PhD Ramon M. Salazar, PhD Angelica Arzola, PA-C Prajnan Das, MD, MS, MPH Eugene J. Koay, MD, PhD Albert Koong, MD, PhD Ethan B. Ludmir, MD Bruce D. Minsky, MD Sonal Noticewala, MD Grace L. Smith, MD, PhD, MPH Cullen Taniguchi, MD, PhD Emma B. Holliday, MD |
| author_sort | Michael K. Rooney, MD |
| collection | DOAJ |
| description | Purpose: Chemoradiation therapy (CRT) is the standard treatment for squamous cell carcinoma of the anus (SCCA). This study aimed to investigate the relationship between vaginal dosimetry and long-term patient-reported dyspareunia after treatment. We further aimed to use the anterior vaginal wall (AVW) as an organ at risk to define an actionable dosimetric clinical goal to decrease the risk of patient-reported dyspareunia. Methods and Materials: Women with SCCA treated with intensity modulated radiation therapy–based CRT were surveyed at least 2 years after successfully completing therapy. A Female Sexual Function Index (FSFI) pain subscore ≤4 was used to define dyspareunia. Dosimetric parameters were calculated for both the full vaginal canal and AVW. Multivariable linear regression models were created to identify predictors of FSFI pain subscore using backward selection to identify final variables include in the models. An actionable dosimetric predictor for dyspareunia was established using the Youden index method for cutoff optimization. Results: Of 184 women who were contacted, 90 (49%) returned completed surveys. Of those who completed surveys, 51 (56.7%) reported being sexually active, and 47 had dosimetric data available for review. Of sexually active respondents, 32 (68%) had an FSFI pain subscore ≤4. Multiple regression models were generated using the full vaginal canal and AVW as organs at risk, and both models showed similar predictive relationships with volumetric dose parameters emerging as the best dosimetric predictors for dysparenuia. Age over 65 years was also associated with higher FSFI pain subscores (eg, less pain with intercourse) in both models. AVW V35 Gy < 60% was identified as the optimal cutoff to reduce the risk of patient-reported dyspareunia. Conclusions: Increased dose to the vaginal canal is significantly associated with worse patient-reported dyspareunia following CRT for SCCA. Minimizing dose to the AVW to V35 Gy < 60% may reduce the risk of this quality of life-limiting toxicity. Further prospective evaluation is needed to validate these findings. |
| first_indexed | 2024-04-24T21:41:38Z |
| format | Article |
| id | doaj.art-813119b80ca348a1be22ecd72ed78e66 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-04-24T21:41:38Z |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-813119b80ca348a1be22ecd72ed78e662024-03-21T05:37:14ZengElsevierAdvances in Radiation Oncology2452-10942024-05-0195101449Long-Term Patient-Reported Dyspareunia After Definitive Chemoradiation for Anal Cancer: Using the Anterior Vaginal Wall as an Organ-at-Risk to Define an Actionable Dosimetric GoalMichael K. Rooney, MD0Joshua S. Niedzielski, PhD1Ramon M. Salazar, PhD2Angelica Arzola, PA-C3Prajnan Das, MD, MS, MPH4Eugene J. Koay, MD, PhD5Albert Koong, MD, PhD6Ethan B. Ludmir, MD7Bruce D. Minsky, MD8Sonal Noticewala, MD9Grace L. Smith, MD, PhD, MPH10Cullen Taniguchi, MD, PhD11Emma B. Holliday, MD12Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartment of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartment of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartment of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartment of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartment of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartment of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartment of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartment of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartment of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartment of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartment of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartment of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Corresponding author: Emma B. Holliday, MDPurpose: Chemoradiation therapy (CRT) is the standard treatment for squamous cell carcinoma of the anus (SCCA). This study aimed to investigate the relationship between vaginal dosimetry and long-term patient-reported dyspareunia after treatment. We further aimed to use the anterior vaginal wall (AVW) as an organ at risk to define an actionable dosimetric clinical goal to decrease the risk of patient-reported dyspareunia. Methods and Materials: Women with SCCA treated with intensity modulated radiation therapy–based CRT were surveyed at least 2 years after successfully completing therapy. A Female Sexual Function Index (FSFI) pain subscore ≤4 was used to define dyspareunia. Dosimetric parameters were calculated for both the full vaginal canal and AVW. Multivariable linear regression models were created to identify predictors of FSFI pain subscore using backward selection to identify final variables include in the models. An actionable dosimetric predictor for dyspareunia was established using the Youden index method for cutoff optimization. Results: Of 184 women who were contacted, 90 (49%) returned completed surveys. Of those who completed surveys, 51 (56.7%) reported being sexually active, and 47 had dosimetric data available for review. Of sexually active respondents, 32 (68%) had an FSFI pain subscore ≤4. Multiple regression models were generated using the full vaginal canal and AVW as organs at risk, and both models showed similar predictive relationships with volumetric dose parameters emerging as the best dosimetric predictors for dysparenuia. Age over 65 years was also associated with higher FSFI pain subscores (eg, less pain with intercourse) in both models. AVW V35 Gy < 60% was identified as the optimal cutoff to reduce the risk of patient-reported dyspareunia. Conclusions: Increased dose to the vaginal canal is significantly associated with worse patient-reported dyspareunia following CRT for SCCA. Minimizing dose to the AVW to V35 Gy < 60% may reduce the risk of this quality of life-limiting toxicity. Further prospective evaluation is needed to validate these findings.http://www.sciencedirect.com/science/article/pii/S2452109424000125 |
| spellingShingle | Michael K. Rooney, MD Joshua S. Niedzielski, PhD Ramon M. Salazar, PhD Angelica Arzola, PA-C Prajnan Das, MD, MS, MPH Eugene J. Koay, MD, PhD Albert Koong, MD, PhD Ethan B. Ludmir, MD Bruce D. Minsky, MD Sonal Noticewala, MD Grace L. Smith, MD, PhD, MPH Cullen Taniguchi, MD, PhD Emma B. Holliday, MD Long-Term Patient-Reported Dyspareunia After Definitive Chemoradiation for Anal Cancer: Using the Anterior Vaginal Wall as an Organ-at-Risk to Define an Actionable Dosimetric Goal Advances in Radiation Oncology |
| title | Long-Term Patient-Reported Dyspareunia After Definitive Chemoradiation for Anal Cancer: Using the Anterior Vaginal Wall as an Organ-at-Risk to Define an Actionable Dosimetric Goal |
| title_full | Long-Term Patient-Reported Dyspareunia After Definitive Chemoradiation for Anal Cancer: Using the Anterior Vaginal Wall as an Organ-at-Risk to Define an Actionable Dosimetric Goal |
| title_fullStr | Long-Term Patient-Reported Dyspareunia After Definitive Chemoradiation for Anal Cancer: Using the Anterior Vaginal Wall as an Organ-at-Risk to Define an Actionable Dosimetric Goal |
| title_full_unstemmed | Long-Term Patient-Reported Dyspareunia After Definitive Chemoradiation for Anal Cancer: Using the Anterior Vaginal Wall as an Organ-at-Risk to Define an Actionable Dosimetric Goal |
| title_short | Long-Term Patient-Reported Dyspareunia After Definitive Chemoradiation for Anal Cancer: Using the Anterior Vaginal Wall as an Organ-at-Risk to Define an Actionable Dosimetric Goal |
| title_sort | long term patient reported dyspareunia after definitive chemoradiation for anal cancer using the anterior vaginal wall as an organ at risk to define an actionable dosimetric goal |
| url | http://www.sciencedirect.com/science/article/pii/S2452109424000125 |
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