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首页> 外文期刊>Acta oncologica. >Radiotherapy-induced vaginal fibrosis in cervical cancer survivors
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Radiotherapy-induced vaginal fibrosis in cervical cancer survivors

机译：放射疗法诱导宫颈癌幸存者中的阴道纤维化

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Background: Cervical cancer survivors treated with radiotherapy report vaginal inelasticity and decreased lubrication that may affect their sexual health, but it is unknown which normal tissue reactions mediate these symptoms. The aim of this study was to investigate the morphology of the connective tissue of the vaginal wall in cervical cancer survivors treated with radiotherapy.Material and methods: We recruited 34 cervical cancer survivors treated with radiotherapy and 37 age-matched controls. Via clinical examination the degree of vaginal atrophy and pelvic fibrosis were estimated. We collected vaginal biopsies, which underwent morphometric analysis focused on elastin and collagen. Additionally, radiation dose at biopsy site were calculated and correlated to the clinical and morphological findings.Results: The survivors had marked morphological vaginal changes, most prominent in the survivors that had received the highest radiation dose at the biopsy site. Mucosal atrophy was observed in 91% and pelvic fibrosis in 97%. A shorter vagina was measured; 7.0cm versus 10.3cm in controls (p<0.001). The area fraction of elastin was greater in survivors; 10.0% (range 5.8-12.9), compared with controls; 3.4% (range 1.8-5.8), p<0.001. The survivors had signs of elastosis with thick aggregated elastin fibers irregularly scattered throughout the connective tissue, while the controls had elastin fibers in a thin sub-epithelial layer. The area fraction of high density collagen in the connective tissue was larger among the survivors (p<0.001). The collagen with the highest density (fibrosis) was more common in the group of cancer survivors that had received external radiation.Conclusions: We found drastic differences in the vaginal wall between the irradiated cervical cancer survivors and the controls, indicating that radiotherapy-induced vaginal symptoms are mediated by connective tissue fibrosis and elastosis. Our results also support that patients treated with external radiation have the highest risk of developing vaginal fibrosis with impairment of their sexual health.
机译：背景：用放射治疗治疗的宫颈癌幸存者报告了阴道内弹性和减少可能影响其性健康的润滑性，但它未知正常组织反应介导这些症状。本研究的目的是探讨用放疗治疗的宫颈癌幸存者中阴道壁结缔组织的形态。材料和方法：我们招募了34种宫颈癌幸存者，治疗放疗和37次匹配对照。通过临床检查估计阴道萎缩和盆腔纤维化程度。我们收集了阴道活组织检查，这是整个形态学分析，重点是Elastin和胶原蛋白。另外，计算活组织检查部位的放射剂量与临床和形态学发现相关。结果：幸存者患有形态阴道变化，在活检部位接受最高辐射剂量的幸存者中最突出。粘膜萎缩在91％和骨盆纤维化中观察到97％。测量了更短的阴道; 7.0cm对控制中的10.3cm（p <0.001）。幸存者中弹性蛋白的面积级数更大;与对照相比，10.0％（范围为5.8-12.9）; 3.4％（1.8-5.8），P <0.001。幸存者具有弹性症的迹象，厚聚集的弹性蛋白纤维不规则地散射在整个结缔组织中，而对照纤维在薄的子上皮层中具有弹性蛋白纤维。在幸存者中，结缔组织中高密度胶原的面积分数较大（P <0.001）。具有最高密度（纤维化）的胶原蛋白在接受外部放射性的癌症幸存者中更常见。结论：我们发现辐照宫颈癌幸存者和对照之间的阴道壁中的急剧差异，表明放射治疗引起的阴道症状是通过结缔组织纤维化和弹性的介导的。我们的研究结果还支持外辐射治疗的患者具有发展性阴道纤维化的风险最高，具有其性健康的损害。

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