Natalija Berza , Jurgis Vitols , Juris Vitols , Aigars Reinis , Ingus Skadins, Ronalds Macuks
Background: Cervical cancer is the most common gynaecologic cancer in women worldwide. While majority of cervical cancer patients are premenopausal, preservation of ovarian function remains crucial to maintain overall quality of life without menopausal symptoms as well as their quality of sexual life. Ovarian function depletion following treatment of cancer due to pelvic irradiation is affecting the quality of survivals and is recognized issue and efforts should be made to help young women to retain also their fertility potential.
Aim: to analyse the influence of adjuvant radiotherapy in the treatment of cervical cancer on ovarian function, menopausal symptoms and quality of sexual life.
Material and methods: In a prospective case-control study 37 patients diagnosed with a cervical cancer were included - 29 patients receiving adjuvant radiotherapy in the study group and 8 patients without radiotherapy in the control group that were undergoing surgical treatment in Riga Eastern Clinical university hospital from year 2007 till 2011.
Results: Mean concentrations of folliculostimulating hormone were higher in patients who received adjuvant radiotherapy in comparison to patients who received only surgical treatment – 94.12 ± 44.16 U/l (range 5.0 – 199.0) vs. 6.08 ± 2.90 U/l (range 2.9 – 11.5) U (p< 0.001). Higher concentrations of folliculostimulating hormone in serum correlated with adjuvant radiotherapy (0.683; p<0.001). Patients who received adjuvant radiotherapy more often experienced symptoms related to the decreased oestrogen levels. Only for depressed mood, headaches and weight gain no differences between groups were observed. Patients in the group with the adjuvant radiotherapy less frequently reported that their sexual life was fine; they were less frequently satisfied, more depressed, unconvinced and even felt anger concerning their sexual life. 37.5% patients in the surgery group and 20.7% patients in the combined treatment group had changed their sexual partners in the treatment period (p=0.36).
Conclusion: Patients with more aggressive treatment have compromised quality of their sexual life and overall quality of life due to earlier onset of menopause. This can be explained by impaired ovarian function caused by external-beam radiotherapy. Combined surgical treatment following radiotherapy should be applied only in patients with high risk factors for cervical cancer recurrence; moreover, ovaries should be mapped with a metallic clipators for better visualization when planning adjuvant radiotherapy to preserve ovarian function in premenopausal women.
