Table 2.
Investigated risk factors and their associations with sexual and gynecological outcomes.
| Study | Patients included in analysis | Patient/tumor-related risk factors | Treatment-related risk factors | Association to outcomes |
|---|---|---|---|---|
| Arzola et al. [41] | 47 | Younger age | AVW D50% >48.4 Gy | Worse FSFI total, desire, and pain scores |
| Corrigan et al. [33] | 50 | Smoking, chemotherapy, age, time from treatment, tumor stage, nodal stage | Max. dose to the tumor, external genitalia V30Gy(%), and external genitalia V20Gy(%) | No associations with FSFI scores |
| Das et al. [42] | 32 | Age, time from treatment, gender, race, T-, N-stage, Colostomy, History of other cancers, History of depression | Prescribed CTV-T dose ≤55 Gy vs. >55 Gy | No associations with MOS Sexual Problems Scale |
| DeFrancesco et al. [32] | 31 | Vaginal invasion | – | Worse sexual function |
| Gilbert et al. [17] | 89–65 (BL to 6mo) | – | Prescribed CTV-T dose 50.4 Gy vs. 41.4 Gy | Sexual function returned to near baseline levels for 41.1 Gy, not for 50.4 Gy, but no statistically significant difference. |
| Gilbert et al [20] | 46–26 (BL to 1Y) | T1/2 vs T3/4 | – | T3/4 Higher sexual symptom score (difference not tested) |
| Hosni et al. [24] | 51 | – | Prescribed CTV-T dose ≤54 vs. >54 Gy | No significant difference in dyspareunia at 1Y |
| Hosni et al. [30] | 47 | Tumor relapse | Prescribed CTV-T dose ≤54 vs. >54 Gy | Clinically but no statistically significant difference in dyspareunia 1-5Y |
| Joseph et al. [31] | 38 | Time 60 months post-CRT, Age (≤58 vs. ≥58 years), T-Stage (T1/2 vs T3/4) | PTV 54 volume, PTV 45 volume, multiple vaginal doses VXX | No predictors of dyspareunia |
| Koerber et al. [44] | 91 | – | IMRT vs. 3DCRT | Same prevalence of vaginal atrophy |
| Koerber et al. [19] | 31 | – | Genital V20Gy > 35% | Associated with chronic dyspareunia |
| 47-31 | IMRT vs. 3DCRT | No significant difference in vaginal stenosis, discharge, dryness or dyspareunia | ||
| Law et al. [39] | 81 (of these 25 anal cancer) | Younger age | – | Associated with maintained/returned VD size |
| Education, marital status, menopausal status, Sexually active at baseline, Topical estrogen, smoking, comorbidities | – | Not associated with maintained/returned VD size | ||
| Mirabeau-Beale et al. [25] |
70 52 (dosimetry) |
– | Vaginal parameters: Dose max, EUD, D50, V20, V30, V40, and V50. External genitals (V20, V30, V40), vaginal length, or vaginal volume | Not associated with maintained/returned VD size |
| Younger age, earlier treatment year | Higher tumor dose (trend, P = 0.06) | Associated with higher VS grades | ||
| Mitchell et al. [35] | 36 | – | Intrafractional VD use | Less dyspareunia with VD (trend not significant) |
| Possiel et al [22] | 149 | – | VMAT vs. 3DCRT | No difference in vaginal dryness and dyspareunia |
| Rooney et al. [34] | 47 | Age ≥65 | Vaginal wall: mean dose, V45 Gy, and L50-%50 Gy. AVW: mean dose, D2.0 cc, and V35 Gy. Cut-off: V35 Gy > 60% for the AVW | Lower FSFI pain score (less pain) |
| Sauter et al. [23] | 30 | – | IMRT vs. 3DCRT | No difference in sexual dysfunction |
| Sauter et al. [14] | 28 | – |
IMRT vs. 3DCRT; Prescribed CTV-T dose >55.8 Gy |
Better sexual function scores with IMRT and higher dose |
| Savoie et al. [16] | 89 | Higher age, post-menopause status | – | Lower desire score |
| Primary tumor site, ostomy status, or treatment type. | – | No association to desire score | ||
| Son et al. [40] | 54 | – | gEUD to vagina <35 Gy, mean vaginal dose <43 Gy | Reduced risk of VS |
| Age, menopausal status | – | Not predictive for VS | ||
| Tang et al. [27] | 27 | – | Intrafractional VD use | Better MOS score (trend, not significant) |
| Age, T-, N- stage, other GI tox, history of depression/anxiety | Prescribed CTV-T dose>54 Gy | No association to MOS score | ||
| Welzel et al. [43] | 10 | Marital status | Prescribed CTV-T dose>50.4 Gy | Associated with worse sexual function QoL scores |
| Tumor stage, tumor localization, time since RT, surgical treatment, age, physical activity, GI late tox. | – | No associations with worse sexual function QoL scores | ||
| Yerramilli et al. [18] | 20 | Age, relationship status, or time since completion of RT or RT-related late toxicity | None | No associations with sexual dysfunction |
AVW anterior vaginal wall, CTV-T clinical target volume - tumor, EUD/gEUD equivalent uniform dose/generalized equivalent uniform dose, FSFI Female Sexual Function Index, IMRT intensity-modulated radiotherapy, MOS Medical Outcomes Study Sexual Problems Scale, PTV planning target volume, QoL quality of life, RT radiotherapy, VD vaginal dilator, VS vaginal stenosis, VXX (e.g., V20, V30, V35) volume (%) of tissue receiving XX Gy.