Supportive Care for HDR Brachytherapy in Gynecological Cancer: A Single Center Experience

Brachytherapy (BT) is a standard component of treatment for patients with gynecological cancers, particularly cervical and endometrial cancer. This study aimed to evaluate the potential benefits of local supportive therapies for vaginal toxicity administered during and after vaginal or intracervical BT, within a standardized supportive care framework.

A retrospective analysis was conducted on 105 patients treated between 2010 and 2016 for endometrial, cervical, or vaginal cancer with primary indication for BT. All patients underwent BT using an Iridium-192 source. Treatment protocols varied by diagnosis: patients with endometrial cancer received 25 Gy in five fractions, while patients with cervical cancer received 20 Gy in 4 fractions and were additionally treated with external beam radiotherapy. Patients were advised to follow a supportive care regimen including local estrogen, topical steroids, and moisturizing agents (e.g., Bepanthen^® ointment). Clinical examinations were performed, and quality of life was assessed using the EORTC QLQ-EN24 questionnaire.

Vaginal toxicity is a well-known complication of radiation therapy. In our cohort, 51% of patients experienced Grade I vaginal late toxicity according to the LENTSOMA scale. No Grade II or higher acute or late toxicities were reported. Adherence with the recommended supportive care was suboptimal; 26% (n=11) of patients did not perform any local supportive therapy despite repeated counseling.

Effective patient education and consistent guidance are crucial for ensuring adherence to supportive care protocols. Properly implemented, local supportive therapy may help mitigate both acute and late toxicity associated with BT. In our collective, a rate of 51% vaginal dryness was observed. However, the specific benefit of adding local vaginal steroid therapy or local estrogen remains inconclusive and requires further investigation.