title: Hyaluronic acid and vitamins are effective in reducing vaginal atrophy in women receiving radiotherapy.
abstract: OBJECTIVE
  During the last decades, therapies targeting cervical cancer have been considerably improved. Surgery and radiotherapy (RT) represent the main common therapeutic approach in cervical cancer. In order to minimize the side effects of radiotherapy approach, several protocols have been developed such as brachytherapy (BRT). Among the side effects associated with RT, the vaginal atrophy is the most important and common one. Vaginal atrophy, in turn, leads to additional alterations like inflammation, associated to relevant symptoms such as itching, burning and dyspareunia. All these alterations heavily affect the quality of women's life. The aim of our study was to evaluate the toxicity induced by RT on vaginal mucosa, and the adjuvant action of a product containing LMWHA, vitamin A, and Vitamin E (Santes®, Lo.Li. Pharma, Rome, Italy). The introduction of adjuvant therapies may have likely had a relevant place in providing that result.
  
  
  METHODS
  A prospective randomized study was designed. From October 2006 to October 2008, 45 women with a mean age 38 ± 6 years were enrolled. After surgery, all patients were treated with 4 weeks of RT and 4 weeks of BRT, concomitantly with chemiotherapy. They were randomly assigned in two groups: 23 women were treated with two suppositories (Santes®) per day for 4 months. For the first two months the preventive treatment was simultaneous to RT and BRT. Instead the control groups for composed by 22 patients and they did not undergo any treatment during RT. To evaluate the efficacy of Santes® treatment three biopsies were performed.
  
  
  RESULTS
  At the second biopsy, after the BRT therapy, the treated group showed a statistically significant improvement (P<0.05 vs. control) on inflammation, cell atypia, fibrosis, mucositis and bleeding. At the third biopsy, two months after BRT, further statistically improvement were observed for all RT/BRT associated side effects. The treatment showed an efficacy also in terms of pain severity.
  
  
  CONCLUSIONS
  Our data suggest that low molecular weight HA shows good performances in treating RT-damaged tissue and plays a key role in all steps of the healing process. Indeed the results shows that women exposed to RT treatments and simultaneously treated with Santes®, had an optimal resolution of vaginal atrophy and related symptoms.
authors.affiliation: Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy - mariano.bizzarri@uniroma1.it.
authors.forename: S
authors.initials: S
authors.lastname: Dinicola
authors.forename: V
authors.initials: V
authors.lastname: Pasta
authors.forename: D
authors.initials: D
authors.lastname: Costantino
authors.forename: C
authors.initials: C
authors.lastname: Guaraldi
authors.forename: M
authors.initials: M
authors.lastname: Bizzarri
mesh_terms: D000328:Adult; D001284:Atrophy / Q000209:etiology / Q000517:prevention & control; D001918:Brachytherapy / Q000379:methods; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011832:Radiation Injuries / Q000517:prevention & control*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy* / Q000628:therapy; D014623:Vaginal Diseases / Q000209:etiology / Q000517:prevention & control*; D014801:Vitamin A / Q000008:administration & dosage; D014810:Vitamin E / Q000008:administration & dosage; D014815:Vitamins / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D014815:Vitamins; D014801:Vitamin A; D014810:Vitamin E; D006820:Hyaluronic Acid