Longitudinal analysis of late vaginal mucosal reactions after high-dose-rate brachytherapy in patients with gynecological cancer.

Aim: To longitudinally examine the late vaginal mucosal reactions in patients following high-dose-rate brachytherapy (BT).

Patients And Methods: We examined late vaginal mucosal reactions in 100 patients using the modified Dische score at 6, 12, 18, 24, 36, and 60 months after treatment, which consisted of 37 interstitial BTs and 63 conventional intracavitary BTs, with a median follow-up of 41 months (range=6-144 months).

Results: There were no cases of lethal toxicity or severe toxicity requiring surgery. Bleeding or discharge grade 1 or more was exhibited by fewer than 2-4% of patients, and in most cases only until 1.5 years following treatment. Erythema was detected in approximately 30% (mainly grade 1) of the patients up to five years. With regard to ulceration, four patients (7%) developed superficial ulceration; however, no patient had ulceration lasting six months or longer. Telangiectasia increased gradually over time in approximately 91% of patients (grades 1 and 2=73% and 18%, respectively) in the five years following treatment. The pallor reaction also increased over time in 100% of patients (grades 1, 2, and 3=30%, 48%, and 22%, respectively) in the five years after treatment. Stenosis also increased with time in approximately 97% of patients (grades 1, 2, and 3=29%, 61%, and 7%, respectively) over five years. There was a close correlation between pallor reaction and stenosis.

Conclusion: High-dose-rate BT caused mild-to-moderate toxicities. Almost all patients showed pallor reaction, telangiectasia, and stenosis up to five years after treatment, and pallor reaction correlated with stenosis.