Radiation-induced vaginal stenosis refers to narrowing and/or shortening of the vagina occurring as a result of radiotherapy to the vagina and/or pelvic area. In severe cases, the vagina may be completely obstructed.r
It can occur following external beam radiation therapy (EBRT) and/or brachytherapy (internal radiation) to the vagina for cervical, endometrial, vaginal, or anorectal malignancies.
Damage to the vaginal tissue occurs as a result of radiation injury. This has an acute phase, consisting of mucosal inflammation and ulceration followed by a chronic phase associated with ischaemic changes, atrophy, scarring, fibrosis and adhesions.rr These changes can result in shortening and narrowing of the vagina which, in severe cases, may become completely obstructed.rr
Reported rates of vaginal stenosis vary greatly. Reviews of studies in this area cite rates of between 1.2% and 88%.rrrr Possible reasons given for this wide variation include study methodologies, the type of cancer type being treated, the radiation dose received and whether other treatment modalities have also been utilised.rr It also appears that higher incidence levels are reported in studies in which the occurrence of vaginal stenosis is specifically evaluated.rr
A recent study of women with locally-advanced cervical cancer treated with brachytherapy found a relatively low rate of severe vaginal stenosis of CTCAE grade 3 or above (see below for grading information). However, a larger proportion of women experienced lower grade symptoms (CTCAE grade 1 or 2) typically occurring in the first 6 months after treatment.r
The reported time of onset of vaginal stenosis varies across different studies, reflecting the outcomes of different patient groups and varying treatment modalities. However, the condition usually develops in the first year after treatment.r
A number of factors have been proposed to affect the incidence of radiation-induced vaginal stenosis; however, the evidence is limited.r These include the location and stage of the tumour, patient age, menopausal status, treatment modality and dose of radiation received.