ESTRO meets Asia 2024 Congress Report

At the ESTRO meets Asia 2024 congress, which took place in August in Kuala Lumpur, I presented my study on sexual quality-of-life (QoL) in patients with locally advanced cervical cancer who were undergoing curative treatment with chemoradiation followed by image-guided brachytherapy. The study involved 50 newly diagnosed patients, whose sexual outcomes were assessed at various intervals post-treatment with the use of structured tools such as the Change in Sexual Function Questionnaire-14 (CSFQ-14) and the European Organisation for Research and Treatment of Cancer QoL Questionnaire, Cervical Cancer module-24 (EORTC QLQ CX-24). The baseline sexual QOL of patients was comparable with that of 50 healthy controls except for the scores for decrease in interest (CSFQ-14). Our study revealed that all sexual components of the CSFQ-14 were significantly lower three months after treatment compared with pre-treatment levels. There was a subsequent increase in all components after six months except for sexual interest, but none of the components returned to their baseline scores, which indicated a lingering impact of treatment on patients' sexual well-being.

The study indicated that survivors experienced declines in "body image" and increased “sexual worry” six and nine months after their treatment, compared with baseline. This is probably attributable to their cancer diagnoses and subsequent treatment, as indicated by the results on the EORTC QLQ CX-24 scale. Disease-related and dosimetric parameters were analysed. Pre-menopausal women demonstrated a profound fall and slower recovery in sexual scores (CSFQ-14) at six months compared with post-menopausal women.

Furthermore, our study highlighted that extensive tumour growth beyond the cervix into the vagina and parametrium consistently affected the physical aspects of arousal and orgasm in our patients. Patients with vaginal involvement exhibited a notable decrease in orgasm and a declining trend in arousal compared with those without vaginal involvement. We observed that 13 of the 50 patients had vaginal stenosis at six months (Grade 1=1; Grade 2=1; Grade 3=1). The mean recto-vaginal dose of patients was 65.3Gy (range 59-73Gy). A fifth (22%) of the women experienced at least Grade 1 toxicity. We observed a significant correlation between the recto-vaginal dose and the occurrence of vaginal stenosis. However, we were unable to establish a correlation between the vaginal source dose/posterior-inferior border of the pubic symphysis point system and vaginal stenosis.

In conclusion, cervical cancer patients demonstrated sexual dysfunction in both psychological (sexual worry) and functional components (arousal, orgasm, vaginal narrowing/shortening). We recommend that all women with cervical cancer undergo sexual counselling both before treatment and during follow-up. Our findings emphasise the need for improved treatment-planning techniques to minimise doses to related organs at risk.

Dr Jayapalan Subalakshmi

Senior resident

Department of Radiotherapy & Clinical Oncology

Post Graduate Institute of Medical Education and Research (PGIMER)

Chandigarh, India.

Email: subalakshmijayapalan@gmail.com