Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer survivors

Pieralli, Annalisa; Fallani, Maria Grazia; Becorpi, Angelamaria; Bianchi, Claudia; Corioni, Serena; Longinotti, Manuela; Tredici, Zelinda; Guaschino, Secondo

doi:10.1007/s00404-016-4118-6

Cited by 116 publications

(101 citation statements)

References 14 publications

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“…Ten studies included breast cancer survivors. [43][44][45][46][47][48][49][50][51][52] Below, we discuss the studies in terms of the therapeutic modality used. We present the results in terms of histological changes, physician assessment, subjective patient reports, adverse events, author recommendations and long-term outcomes.…”

Section: Resultsmentioning

confidence: 99%

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Review of non‐invasive vulvovaginal rejuvenation

Photiou

Lin

Dubin

et al. 2019

Acad Dermatol Venereol

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Vulvovaginal atrophy (VVA) or genitourinary syndrome of menopause (GSM) may affect up to 90% of menopausal women. Features include vulvovaginal atrophy, vulvovaginal laxity, vulvovaginal dryness and irritation, dyspareunia, anorgasmia and urinary symptoms. The vulva, vagina and bladder are oestrogen‐responsive tissues, but oestrogen replacement therapy is not possible in women who have hormone‐responsive cancers or normal oestrogen levels. Therefore, there is a role for alternative treatments. To date, three non‐surgical energy‐based therapies have been proposed: fractional microablative CO2 laser, erbium:YAG laser and temperature‐controlled radiofrequency (RF). Our objective was to assess the available evidence for the safety and efficacy of erbium:YAG laser, microablative fractional CO2 laser and RF in the treatment of VVA/GSM. The authors reviewed the current published literature evaluating these therapies. All three therapies appear safe; however, all the studies were uncontrolled and used different protocols and outcome measurements. Therefore, comparison of treatments is difficult. It appears that there is more evidence in favour of the CO2 laser than the erbium:YAG laser. Both lasers have more evidence than RF. In conclusion, microablative CO2 laser, erbium:YAG laser and RF may be offered to patients suffering from VVA/GSM as an alternative or adjunct to conventional therapies. Further well‐conducted controlled studies are needed.

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Section: Resultsmentioning

confidence: 99%

“…Sixteen studies used the VHIS . All reported a statistically significant improvement, regardless of whether it was one or up to three laser treatments.…”

Section: Discussionmentioning

confidence: 99%

Review of non‐invasive vulvovaginal rejuvenation

Photiou

Lin

Dubin

et al. 2019

Acad Dermatol Venereol

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“…The long-term effectiveness of laser therapy is still being studied. Pieralli et al [19] evaluated 50 breast cancer survivors after a course of vaginal fractional CO2 laser treatment found that 52% were satisfied after intermediate term follow-up (mean time 11 months). The recommended course of therapy costs thousands of U.S. dollars, involves three treatments spaced 6 weeks apart, and has a recommended follow-up maintenance of about a year after completion of therapy.…”

Section: Introductionmentioning

confidence: 99%

Missing documentation in breast cancer survivors: genitourinary syndrome of menopause

et al. 2017

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Objective Breast cancer survivors often take hormonal treatments to prevent the recurrence of breast cancer, particularly aromatase inhibitors that can worsen the symptoms of genitourinary syndrome of menopause (GSM) such as dyspareunia, dysuria, and urinary incontinence, all of which may adversely affect survivors’ quality of life. Few breast cancer survivors experiencing GSM receive adequate assessment or treatment. Methods In this descriptive study, we reviewed medical records for documented GSM and any treatments administered or referrals for treatment in 800 female patients who visited the Breast Cancer Survivorship Clinic at a comprehensive cancer center between July 1, 2010, and June 30, 2011, either ≥5 years after completion of treatment for invasive breast cancer or ≥6 months after completion of treatment for ductal carcinoma in situ. Results Of the 279 patients with documented symptoms of vaginal atrophy, only 111 (39.8%) had documentation of having received any form of treatment or referral. Of the 71 patients with documented symptoms of urinary tract atrophy, only 33.8% had documentation of having received treatment or referral for treatment. Conclusion Breast cancer survivors often experience GSM due to lack of estrogen. The worrisome lack of documentation of assessment or treatment for GSM in a large breast cancer survivorship practice reveals missed opportunities to improve quality of life. Dissemination of recent progress in the development of GSM assessment tools, patient handouts, and new treatments to providers who care for breast cancer survivors is needed to improve this process.

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“…Anecdotal claims for its success and glamorous marketing have led to many clinicians being wary of becoming involved with a therapy that has had a non-clinical connotation. However, more recently, a series of more clinical studies, backed up with histological data, have started to emerge that suggest that, for certain indications, particularly VVA, this modality may offer an alternative to our traditional treatments [1][2][3][4][5][6][7] . Readers of this journal will be very familiar with the prevalence and clinical problems posed by VVA (or genitourinary syndrome of menopause, GSM) and the central role of vaginal estrogens in its management 8 .…”

mentioning

confidence: 99%

“…Several of the studies have included women with breast cancer in their cohort 4 and a recent prospective study 6 looked specifically at this group, reporting significant improvement in VVA symptoms.…”

mentioning

confidence: 99%