Vaginal estrogen cream for prevention of early vaginal occlusion from radiation vaginitis in cervical cancer patients

Abstract

Objective : To determine whether estrogen cream can reduce early vaginal shortening, in cervical cancer patients after complete radiotherapy, compared to placebo cream. Design : A randomized, double-blinded placebo controlled trial. Setting : Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University. Method : Sixty four premenopausal cervical cancer patients who complete radiotherapy were enrolled in this study. Thirty two patients were randomly assigned to the estrogen (E) and placebo group (P). Patients' baseline characteristics such as age, parity, cesarean section, body mass index (BMI), tumor staging, tumor size, and vaginal length, percentage of parabasal cell > 25, serum estradiol, vaginal symptom score and sexual practice were recorded before and after application of vaginal cream with digital pressure and compared between both groups. Result : 6 out of 64 patients were lost to follow up. The incidence of vaginal shortening in both groups was about 19%; 12.5% in estrogen group which less than 26.9% in placebo group, (P=0.193). Mean changes of vaginal lengths (3.0 ±5.7 mm.) in estrogen group and (1.7 ±5.3 mm) in placebo group (P=0.403). However, by estrogen cream with patients' satisfaction, it showed the improvement of the general health of the vagina, by decreasing the percentage of parabasal cell more significantly than placebo cream (P<0.001). And with 0.5 gm of conjugates estrogen vaginally, serum estradiols were still in menopausal level, without systemic absorption, and no serious side effect. Conclusion : With digital pressure, vaginal estrogen cream can reduce early vaginal shortening, in cervical cancer patients after complete radiotherapy, not better than placebo. However, within 4 week period, estrogen cream can improve vaginal mucosa without systemic absorption.