Management of radiation-induced gynecological toxicities: AFSOS-SFCE-GFRCP clinical practice guidelines

Radiation-induced gynecological toxicities are frequently under-recognized, under-diagnosed, and insufficiently managed. These adverse effects negatively impact patients' quality of life and may compromise oncological outcomes by delaying or interrupting cancer treatment. This guideline aims to define best clinical practices for the prevention, identification, and management of both acute and late radiation-induced gynecological toxicities. The French Association for Supportive Care in Cancer (AFSOS) convened a multidisciplinary task force to perform a literature review and apply a consensus methodology to establish these guidelines. External validation was conducted by an independent panel of experts. Optimal management involves a 3-phase approach: before, during, and after radiotherapy. Patients should receive pre-treatment counseling on potential gynecological and sexual side effects, along with preventive hygienic and dietary guidance. During treatment, acute toxicities such as vulvitis, vaginitis, urethritis, and proctitis should be actively managed. Post-radiotherapy care must address vaginal dryness, stenosis, synechiae, premature menopause, lymphedema, and sexual dysfunction, with integration of onco-sexological support as needed. Awareness and proactive management of radiation-induced gynecological toxicities are critical for maintaining quality of life and ensuring treatment continuity. This guideline provides structured recommendations to support clinicians in delivering comprehensive, patient-centered supportive care.