Quantifying Radiation Induced Vaginal Stenosis for the Development of a Novel Dilator Device
Radiation (RT) affects the vagina by narrowing, tightening and scarring, termed vaginal stenosis (VS). VS occurs in up to 88% of patients treated with radiation for cervical cancer. VS is not well characterized in measurements. There is a lack of understanding of how short and tight the vagina becomes after RT. This study will use specific measurements of the vagina during the routine physician physical exam after RT in the follow up periods: after RT, 3 months, 6 months, and 12 months using a plastic commercial dilator set and length and width measurements. In addition, the study use a validated sexual health survey and a specific survey on vaginal dilation preferences to help stop VS after RT.
• Patients with histologically confirmed newly diagnosed advanced cervical cancer (squamous cell carcinoma, adenocarcinoma, and adenosquamous cell carcinoma): FIGO 2009 clinical stages IB2/IIA with positive para-aortic nodes, or FIGO 2009 clinical stages IIB/IIIB/IVA with positive pelvic or para-aortic lymph nodes (PALN). Pelvic or PALN nodal status confirmed by PET/CT scan or fine needle biopsy or extra peritoneal biopsy or laparoscopic biopsy. The PALN must be inferior to the T12/L1 interspace.
• ECOG performance status ≤2 (Karnofsky ≥60%, see Appendix II).
• Patients must have normal organ and marrow function as defined below:
‣ leukocytes ≥2,500/mcL
⁃ absolute neutrophil count ≥1,500/mcL
⁃ platelets ≥100,000/mcL
⁃ hemoglobin ≥8 g/dL (can be transfused with red blood cells pre- study)
⁃ total bilirubin ≤1.5 × institutional upper limit of normal (ULN)
⁃ AST(SGOT)/ALT(SGPT) ≤3 × ULN
⁃ alkaline phosphatase ≤2.5 × ULN
⁃ creatinine \<1.5 mg/dL INR and aPTT ≤1.5 × ULN (This applies only to patients who do not receive therapeutic anticoagulation; patients receiving therapeutic anticoagulation, such as low-molecular-weight heparin or warfarin, should be on a stable dose.)
• Age is \> 18 years.
• Patient does not have a known allergy to cisplatin or compounds of similar biologic composition.
• Ability to understand and the willingness to sign a written informed consent document.
• Patients positive for human immunodeficiency virus (HIV) are allowed on study, but HIV-positive patients must have:
• A stable regimen of highly active anti-retroviral therapy (HAART)
• No requirement for concurrent antibiotics or antifungal agents for the prevention of opportunistic infections
• A CD4 count above 250 cells/mcL and an undetectable HIV viral load on standard PCR-based tests.