title: Clinical and treatment factors associated with vaginal stenosis after definitive chemoradiation for anal canal cancer.
abstract: OBJECTIVE
  We sought to evaluate the incidence of vaginal stenosis (VS) and identify clinical and treatment factors that predict for VS in female patients with anal cancer treated with definitive chemoradiation.
  
  
  METHODS
  The cohort included 95 consecutive women receiving definitive chemoradiation between 2003 and 2012. All but 1 received intensity modulated radiation therapy; median primary tumor dose 50.4 Gy (range, 41.4-60). A modified National Cancer Institute Common Terminology Criteria for Adverse Events version 4 was used to score VS based on the medical record description of dyspareunia, pain with dilator use, vaginal dryness, or difficult pelvic examination. Ordered logistic regression was performed to assess VS predictors.
  
  
  RESULTS
  Median age was 60.4 years (range, 19-97). With median follow-up of 2.5 years, 70 women (74%) had adequate information to assess VS. Of these, VS grade distribution was 21.4% grade 0, 14.3% grade 1, 27.1% grade 2, and 37.1% grade 3. By multivariable ordered logistic regression, younger age (P = .02), higher tumor dose (P = .06), and earlier treatment year (P = .04) were associated with higher grade of VS.
  
  
  CONCLUSIONS
  VS is a common late complication in women treated definitively with chemoradiation for anal canal cancer. Younger age, higher tumor dose, and earlier year of treatment were associated with a higher grade of stenosis. Prospective investigation into patient reported outcomes is warranted, including sexual function and VS prevention strategies to better understand its effect on long-term survivorship.
authors.affiliation: Harvard Radiation Oncology Program, Boston, Massachusetts. Electronic address: KMIRABEAUBEALE@lroc.harvard.edu.
authors.forename: Kristina
authors.initials: K
authors.lastname: Mirabeau-Beale
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Theodore S
authors.initials: TS
authors.lastname: Hong
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Niemierko
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Marek
authors.initials: M
authors.lastname: Ancukiewicz
authors.affiliation: Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Blaszkowsky
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Crowley
authors.affiliation: Department of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: James C
authors.initials: JC
authors.lastname: Cusack
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Lorraine C
authors.initials: LC
authors.lastname: Drapek
authors.affiliation: Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Nataliya
authors.initials: N
authors.lastname: Kovalchuk
authors.affiliation: Department of Rehabilitation Services, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Meghan
authors.initials: M
authors.lastname: Markowski
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Brian
authors.initials: B
authors.lastname: Napolitano
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Nyamwanda
authors.affiliation: Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: David P
authors.initials: DP
authors.lastname: Ryan
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: John
authors.initials: J
authors.lastname: Wolfgang
authors.affiliation: Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kachnic
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Wo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000139:chemically induced / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D014621:Vagina / Q000473:pathology*; D055815:Young Adult