Pilot study of fractional CO2 laser therapy for genitourinary syndrome of menopause in gynecologic cancer survivors

Quick, Allison; Dockter, Travis; Le‐Rademacher, Jennifer; Salani, Ritu; Hudson, Catherine; Hundley, Andrew F.; Terstriep, Shelby A.; Streicher, Lauren; Faubion, Stephanie S.; Loprinzi, Charles L.; Coleman, Jenell S.; Wang, Karen C.; Lustberg, Maryam B.

doi:10.1016/j.maturitas.2020.10.018

Cited by 34 publications

(66 citation statements)

References 41 publications

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“…However, a randomized double-blind, sham-controlled study of 58 postmenopausal women by Salvatore et al showed that vaginal symptoms and FSFI and UDI-6 scores were improved in the treatment group compared to the sham group [19]. Another randomized sham-controlled pilot study was also conducted in women with gynecologic cancers which showed that laser treatments were safe and appeared to improve sexual function based on FSFI scores [51].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Follow-Up of Fractional CO2 Laser Therapy for Genitourinary Syndrome of Menopause in Breast Cancer Survivors

Quick

Hundley

Evans

et al. 2022

JCM

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(1) Background: The objective of this study was to determine the long-term efficacy of fractional CO2 laser therapy in breast cancer survivors. (2) Methods: This was a single-arm study of breast cancer survivors. Participants received three treatments of fractional CO2 laser therapy and returned for a 4 week follow-up. Participants were contacted for follow-up at annual intervals. The Vaginal Assessment Scale (VAS), the Female Sexual Function Index (FSFI), the Female Sexual Distress Scare Revised (FSDS-R), the Urinary Distress Inventory (UDI), and adverse events were collected and reported for the two-year follow-up. The changes in scores were compared between the four-week and two-year and the one-year and two-year follow-ups using paired t-tests. (3) Results: In total, 67 BC survivors were enrolled, 59 completed treatments and the four week follow-up, 39 participated in the one-year follow-up, and 33 participated in the two-year follow-up. After initial improvement in the VAS from baseline to the four week follow-up, there was no statistically significant difference in the VAS score (mean Δ 0.23; 95% CI [−0.05, 0.51], p = 0.150) between the four week follow-up and the two-year follow-up. At the two-year follow-up, the FSFI and FSDS-R scores remained improved from baseline and there was no statistically significant change in the FSFI score (mean Δ −0.83; 95% CI [−3.07, 2.38] p = 0.794) or the FSDS-R score (mean Δ −2.85; 95% CI [−1.88, 7.59] p = 0.227) from the one to two-year follow-up. The UDI scores approached baseline at the two-year follow-up; however, the change between the one- and two-year follow-ups was not statistically significant (mean Δ 4.76; 95% CI [−1.89, 11.41], p = 0.15). (4) Conclusions: Breast cancer survivors treated with fractional CO2 laser therapy have sustained improvement in sexual function two years after treatment completion, suggesting potential long-term benefit.

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Section: Discussionmentioning

confidence: 99%

Long-Term Follow-Up of Fractional CO2 Laser Therapy for Genitourinary Syndrome of Menopause in Breast Cancer Survivors

Quick

Hundley

Evans

et al. 2022

JCM

Self Cite

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“…New data is being released regarding the treatment of oncological patients for whom hormonal treatment methods are impossible due to their breast cancer diagnosis. Laser treatment seems to be an alternative solution and a safe and effective treatment method [20,21].…”

Section: Discussionmentioning

confidence: 99%

The CO2 ablative laser treatment in perimenopausal patients with vulvovaginal atrophy

2021

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“…Of these, 52% were satisfied with the results after an average 11-month follow-up time. A very current (2021) RCT with only 18 gynecologic cancer survivors concluded that fractional CO2 Laser therapy is feasible in these patients, with preliminary evidence of safety and improvement in sexual function compared with those of sham treatment[ 226 ]. Although large, sham-controlled RCTs have not been completed to date in women with breast cancer, one ongoing Greek clinical trial with 50 BCSs with GSM and with microablative fractional CO2 Laser therapy (Vaginal Laser Therapy for the Management of Genitourinary Syndrome of Menopause of Breast Cancer Survivors: NCT03738605) had an estimated study completion date of August 2020,but the conclusions are not yet available[ 227 ].…”

Section: Current Treatment Options For Genitourinary Syndrome Of Meno...mentioning

confidence: 99%

Management of genitourinary syndrome of menopause in breast cancer survivors: An update

López¹

2022

WJCO

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There is increasing attention about managing the adverse effects of adjuvant therapy (Chemotherapy and anti-estrogen treatment) for breast cancer survivors (BCSs). Vulvovaginal atrophy (VVA), caused by decreased levels of circulating estrogen to urogenital receptors, is commonly experienced by this patients. Women receiving antiestrogen therapy, specifically aromatase inhibitors, often suffer from vaginal dryness, itching, irritation, dyspareunia, and dysuria, collectively known as genitourinary syndrome of menopause (GSM), that it can in turn lead to pain, discomfort, impairment of sexual function and negatively impact on multiple domains of quality of life (QoL). The worsening of QoL in these patients due to GSM symptoms can lead to discontinuation of hormone adjuvant therapies and therefore must be addressed properly. The diagnosis of VVA is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Systemic estrogen treatment is contraindicated in BCSs. In these patients, GSM may be prevented, reduced and managed in most cases but this requires early recognition and appropriate treatment, but it is normally undertreated by oncologists because of fear of cancer recurrence, specifically when considering treatment with vaginal estrogen therapy (VET) because of unknown levels of systemic absorption of estradiol. Lifestyle modifications and nonhormonal treatments (vaginal moisturizers, lubricants, and gels) are the first-line treatment for GSM both in healthy women as BCSs, but when these are not effective for symptom relief, other options can be considered, such as VET, ospemifene, local androgens, intravaginal dehydroepiandrosterone (prasterone), or laser therapy (erbium or CO2 Laser). The present data suggest that these therapies are effective for VVA in BCSs; however, safety remains controversial and a there is a major concern with all of these treatments. We review current evidence for various nonpharmacologic and pharmacologic therapeutic modalities for GSM in BCSs and highlight the substantial gaps in the evidence for safe and effective therapies and the need for future research. We include recommendations for an approach to the management of GSM in women at high risk for breast cancer, women with estrogen-receptor positive breast cancers, women with triple-negative breast cancers, and women with metastatic disease.

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Pilot study of fractional CO2 laser therapy for genitourinary syndrome of menopause in gynecologic cancer survivors

Cited by 34 publications

References 41 publications

Long-Term Follow-Up of Fractional CO2 Laser Therapy for Genitourinary Syndrome of Menopause in Breast Cancer Survivors

Long-Term Follow-Up of Fractional CO2 Laser Therapy for Genitourinary Syndrome of Menopause in Breast Cancer Survivors

The CO2 ablative laser treatment in perimenopausal patients with vulvovaginal atrophy

Management of genitourinary syndrome of menopause in breast cancer survivors: An update

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