Role of vaginal pallor reaction in predicting late vaginal stenosis after high-dose-rate brachytherapy in treatment-naive patients with cervical cancer.
OBJECTIVE
To assess actual rates of late vaginal stenosis and identify predisposing factors for complications among patients with previously untreated cervical cancer following high-dose-rate brachytherapy.


METHODS
We performed longitudinal analyses of 57 patients using the modified Dische score at 6, 12, 18, 24, 36, and 60 months after treatment, which consisted of 15 interstitial brachytherapys and 42 conventional intracavitary brachytherapys, with a median follow-up time of 36 months (range, 6 to 144 months).


RESULTS
More than half of the patients developed grade 1 (mild) vaginal stenosis within the first year of follow-up, and grade 2 (97.5%, moderate) to grade 3 (severe) stenosis gradually increased with time. Actual stenosis rates for grade 1, 2, and 3 were 97.5% (95% confidence interval [CI], 92.7 to 97.5), 60.7% (95% CI, 42.2 to 79.3), and 7.4% (95% CI, 0 to 18.4) at 3 years after treatment. Pallor reaction grade 2-3 at 6 months was only a statistically significant predisposing factor for grade 2-3 late vaginal stenosis 3 years or later with a hazard ratio of 3.48 (95% CI, 1.32 to 9.19; p=0.018) by a multivariate Cox proportional hazard model. Patients with grade 0-1 pallor reaction at 6 months showed a grade ≥2 vaginal stenosis rate of 53%, whereas the grade 2-3 pallor reaction group achieved a grade ≥2 vaginal stenosis rate at 3 years at 100% (p=0.001).


CONCLUSIONS
High-dose-rate brachytherapy was associated with high incidence of late vaginal stenosis. Pallor reaction grade 2-3 at 6 months was predictive of late grade 2-3 vaginal stenosis at 3 years after treatment. These findings should prove helpful for patient counseling and preventive intervention.
Department of Radiology, Osaka Medical College, Takatsuki, Japan.
Ken
K
Yoshida
Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan. hideya10@hotmail.com.
Hideya
H
Yamazaki
Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Satoaki
S
Nakamura
Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Koji
K
Masui
Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Tadayuki
T
Kotsuma
Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Hironori
H
Akiyama
Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Eiichi
E
Tanaka
Department of Radiology, Osaka Medical College, Takatsuki, Japan.
Nobuhiko
N
Yoshikawa
Department of Radiology, Osaka Medical College, Takatsuki, Japan.
Yasuo
Y
Uesugi
Department of Radiology, Osaka Medical College, Takatsuki, Japan.
Taiju
T
Shimbo
Department of Radiology, Osaka Medical College, Takatsuki, Japan.
Yoshifumi
Y
Narumi
Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan.
Yasuo
Y
Yoshioka
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D003251:Constriction, Pathologic / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008875:Middle Aged; D010167:Pallor; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*; D014623:Vaginal Diseases / Q000209:etiology* / Q000473:pathology
D007496:Iridium Radioisotopes; D019275:Radiopharmaceuticals
Brachytherapy; Constriction, Pathologic; Pallor; Prospective Studies; Uterine Cervical Neoplasms