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- Hofsjo, A., et al.
(författare)
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Radiotherapy for cervical cancer - impact on the vaginal epithelium and sexual function
- 2018
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 57:3, s. 338-345
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Tidskriftsartikel (refereegranskat)abstract
- Background: Women who have been treated for cervical cancer have persistent changes in their sexual function, which result in considerable distress. The aim of this study was to investigate the morphology of the vaginal epithelium in cervical cancer survivors treated with radiotherapy and its correlation to serum levels of sex steroid hormones and sexual function.Material and methods: We included 34 patients treated for cervical cancer with radiotherapy and 37 healthy age-matched control women scheduled for benign gynecological surgery. After inspection and grading of vaginal atrophy, vaginal biopsies were taken. Epithelial structures were analyzed by measuring epithelial thickness as well as the number, height and width of the dermal papillae and the dermal papillae distance. Sex steroid hormone levels were analyzed and a questionnaire designed to assess sexual function was filled out.Results: In the cervical cancer survivors treated with radiotherapy, the vaginal epithelium volume was reduced compared to control women. Longer distance between the dermal papillae (p<.001) and a shorter distance from basal layer to epithelial surface (p<.05) were measured. Mucosal atrophy was observed in 91% of the survivors. There was no difference in serum estradiol between cancer survivors and control women, implying that the cancer survivors were sufficiently substituted. The epithelial thickness correlated to serum levels of estradiol. The cervical cancer survivors reported more physical sexual symptoms. The highest relative risk (RR) was found for insufficient vaginal lubrication (RR 12.6), vaginal inelasticity (RR 6.5), reduced genital swelling when sexually aroused (RR 5.9), and for reduction of vaginal length during intercourse (RR 3.9).Conclusion: We found that cervical cancer treatment including radiotherapy is associated with vaginal epithelial atrophy and sexual dysfunction. To hamper the atrophic process affecting the sexual function, an early start of local estrogen after therapy might be of importance.
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- Hofsjo, A., et al.
(författare)
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Radiotherapy-induced vaginal fibrosis in cervical cancer survivors
- 2017
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 56:5, s. 661-666
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cervical cancer survivors treated with radiotherapy report vaginal inelasticity and decreased lubrication that may affect their sexual health, but it is unknown which normal tissue reactions mediate these symptoms. The aim of this study was to investigate the morphology of the connective tissue of the vaginal wall in cervical cancer survivors treated with radiotherapy.Material and methods: We recruited 34 cervical cancer survivors treated with radiotherapy and 37 age-matched controls. Via clinical examination the degree of vaginal atrophy and pelvic fibrosis were estimated. We collected vaginal biopsies, which underwent morphometric analysis focused on elastin and collagen. Additionally, radiation dose at biopsy site were calculated and correlated to the clinical and morphological findings.Results: The survivors had marked morphological vaginal changes, most prominent in the survivors that had received the highest radiation dose at the biopsy site. Mucosal atrophy was observed in 91% and pelvic fibrosis in 97%. A shorter vagina was measured; 7.0cm versus 10.3cm in controls (p<0.001). The area fraction of elastin was greater in survivors; 10.0% (range 5.8-12.9), compared with controls; 3.4% (range 1.8-5.8), p<0.001. The survivors had signs of elastosis with thick aggregated elastin fibers irregularly scattered throughout the connective tissue, while the controls had elastin fibers in a thin sub-epithelial layer. The area fraction of high density collagen in the connective tissue was larger among the survivors (p<0.001). The collagen with the highest density (fibrosis) was more common in the group of cancer survivors that had received external radiation.Conclusions: We found drastic differences in the vaginal wall between the irradiated cervical cancer survivors and the controls, indicating that radiotherapy-induced vaginal symptoms are mediated by connective tissue fibrosis and elastosis. Our results also support that patients treated with external radiation have the highest risk of developing vaginal fibrosis with impairment of their sexual health. ITBOL MM, 1974, OBSTETRICS AND GYNECOLOGY, V44, P249 ITBOL MM, 1974, AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, V119, P181
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- Schmidt, Fabian, et al.
(författare)
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Using Machine Learning to Recommend Personalized Modular Treatments for Common Mental Health Disorders
- 2023
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Ingår i: Proceedings - 2023 IEEE International Conference on Digital Health, ICDH 2023. - : Institute of Electrical and Electronics Engineers (IEEE). ; , s. 150-157
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Konferensbidrag (refereegranskat)abstract
- So far, initial treatment recommendations for internet-based cognitive behavioral therapy (iCBT) decision support were mostly high-level or static. Personalized treatment recommendations could pave the way toward better treatment outcomes and adaptive treatments by leveraging information from past patients. We explore the disadvantages of multi-class recommendation and propose a modular approach using multilabel classification for treatment recommendations. Our machine learning-based treatment recommender composes treatment programs from a set of modules. It achieves a 79.02% F1-score on historically successful treatments, significantly outperforming the existing system by around 4% while offering other advantages such as interpretability and robustness. Using our recommendation as an initial starting point, clinicians can adjust the modular treatments to provide a more personalized treatment.
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