Treatments for invasive carcinoma of the cervix: what are their impacts on the pelvic floor functions?

Abstract

Aims: Describe the impact of surgery, radiotherapy and chemoradiation in the pelvic floor functions in cervical cancer patients. Materials and Methods: A prospective study with women submitted to radical hysterectomy (RH) (n = 20), exclusive radiotherapy (RT) (n = 20) or chemoradiation (CT/RT) (n = 20) for invasive cervical cancer. Urinary, intestinal and sexual function, as well as vaginal length and pelvic floor muscle contraction were evaluated. Comparisons between groups were performed by Kruskal-Wallis and Chi-square tests (p < 0.05). Results: The groups were similar in stress urinary incontinence incidence (p = 0.56), urinary urgency (p = 0.44), urge incontinence (p = 0.54), nocturia (p = 0.53), incomplete bowel emptying (p = 0.76), bowel urgency (p = 0.12) and soilage (p = 0.43). The CT/ RT group presented a higher urinary frequency (p < 0.001) and diarrhea (p = 0.025). Patients in the RH group were more sexually active (p = 0.01) and experienced less dyspareunia (p = 0.021). Vaginal length was shorter in RT group (5.5 ± 1.9 cm) and CT/ RT(5.3 ± 1.5 cm) than in the RH group (7.4 ± 1.1 cm) (p < 0.001). Pelvic floor muscle contraction was similar (p = 0.302). Conclusions: RT and CT/RT treatment for cervical carcinoma are more associated to sexual and intestinal dysfunctions.

Effects of radiation therapy on the structure and function of the pelvic floor muscles of patients with cancer in the pelvic area: a systematic review

“…In their study, Allgayer et al [28] did not observe significant difference between radiated and non-irradiated patients for anal resting and maximal squeeze pressure for the same outcome measure. Noronha et al [36] demonstrated no significant difference between the surgical group (RH) and the radiation groups for pelvic floor maximum strength, as measured by bidigital palpation. Still, a tendency toward a significant difference was obtained when comparing the RH and RT groups (p = 0.06 by omnibus test): we observed that the RT group appeared to have a greater proportion of extremely low maximum strength scores (such as 0 and 1) on the Oxford scale.…”

“…Two papers compared the irradiated subjects to non-cancer, non-irradiated subjects [28,29] and two more to subjects with cancer but who did not receive radiation [36,37], and three others compared to preradiation measures [38][39][40]. Two articles rated "low to moderate quality" [40,29], two rated "good quality" [36,28], and three of "excellent quality" [38,39,37] (Table 2). In a retrospective cohort study by Theisen et al [40], resting and maximal squeeze pressure data measured by anal manometry was reported (Table 4).…”

“…Overall, these findings indicate a trend supporting changes in the PFM function after RT in the treatment of pelvic cancers such as prostate, colorectal, and gynecological cancers. Effect sizes could be calculated from five studies [28,36,38,37,30] once the necessary data had been obtained from the authors. The latter two studies show a strong detrimental effect (effect size of −3.8 and −3.9, respectively) of RT on EMG average resting activity, EMG average work activity, and spontaneous activity for men treated for prostate and rectal cancer [38,37].…”

“…Although, the strong effect sizes obtained from non-significantly different variables reflect possible irregularities in their data distribution. The former three studies on the other hand show weak to strong detrimental effect (effect sizes between −0.14 and −1.26) of radiation of muscle resting pressure and maximum squeeze pressure, i.e., maximal strength for men treated for prostate cancer and women treated for cervical cancer [28,36]. These effect sizes were not combined together because of the use of different outcome measures to document muscle activity and contractile response of the PFMs.…”

“…Their cohort still reported many PFM dysfunction such as urgency and fecal incontinence, and the unexpected results of anal resting pressure were not further discussed, nor analyzed for confoundings or possible bias. The other reviewed articles [36,40,29,30,33], although most of lesser methodological quality (high dropout rates, younger controls, etc. ), all generally point toward detrimental effects of RT on the PFM function.…”