Efeito do laser de CO2, da radiofrequência e do promestrieno na qualidade de vida e na saúde vaginal de mulheres com síndrome geniturinária da menopausa em uso de endocrinoterapia adjuvante para câncer de mama: dados preliminares de estudo clínico randomizado
Data
2023-06-14
Autores
Dedonatto, Chayane 
Orientadores
Patriarca, Marisa Teresinha
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar os efeitos do LASER (CO2L), da radiofrequência (RF) e do
promestrieno (CT) na saúde vaginal e na qualidade de vida de pacientes com de câncer de mama em uso de endocrinoterapia adjuvante e portadoras da síndrome geniturinária da menopausa (SGUM). Métodos: Estudo prospectivo randomizado em
que foram elegíveis mulheres com câncer de mama em uso de endocrinoterapia adjuvante (tamoxifeno ou anastrozol) com sinais e/ou sintomas SGUM de intensidade moderada a grave, de acordo com a escala visual analógica (EVA ³ 4). Após a assinatura do termo de consentimento, as pacientes preencheram os questionários
FSF-I (Female Sex Function Index) e IQo-L (Incontinence Quality of Life Instrument) e se submeteram ao exame ginecológico, com determinação do índice de saúde vaginal (ISV). A seguir, foram randomizadas em três grupos de tratamento: CO2L (n = 32), RF
(n = 33) ou CT (n = 30). Nos grupos CO2L e RF, foram realizadas três sessões mensais
para aplicação das energias na região vulvovaginal. O grupo CT fez uso domiciliar de 1g promestrieno creme vaginal, por 21 noites consecutivas, seguidas por aplicações
duas vezes por semana, por quatro meses. O seguimento foi realizado no quarto e décimo mês após o início das terapias, com avaliação dos mesmos parâmetros
aferidos inicialmente, bem como do grau de satisfação pós-tratamento por meio da
escala de 5 pontos de LIKERT. Resultados: Foram elegíveis 95 pacientes, cinquenta
e oito concluíram o seguimento de dez meses, 21 no grupo CO2L, 19 no RF e 18 no
CT. Após as terapias, em todos os grupos avaliados, houve melhora significativa da sintomatologia expressa pela redução da nota do EVA (p<0.05), melhora no ISV (p <
0.001). Além disso, houve melhora da função sexual, demonstrada pelo aumento da
pontuação do questionário FSF-I (p < 0.001). O questionário IQO-I revelou melhora persistente dos sintomas urinários no grupo das energias, que foi observada no grupo CT apenas durante o uso do promestrieno (p= 0.004). Conclusão: O tratamento com
energias (CO2L e RF) e com o promestrieno mostrou melhora significativa e semelhante dos sintomas da SGUM, da saúde vaginal e da qualidade de vida em
mulheres com câncer de mama em uso de endocrinoterapia adjuvante. Não foram
observados dano tecidual, estrutural ou complicações clínicas relevantes. O uso das
energias mostrou-se seguro neste grupo de pacientes desde que respeitados os
padrões técnicos.
Objective: To evaluate the effects of LASER (CO2L), radiofrequency (RF) and promestriene (CT) on vaginal health and quality of life in breast cancer survivors using adjuvant endocrine therapy (BCSA) with genitourinary syndrome of menopause (GSM). Methods: Prospective randomized trial in BCSA with moderate to severe signs and/or symptoms according to the visual analogue scale (VAS ³ 4) of GSM were eligible. After signing the consent form, patients completed FSF-I (Female Sex Function Index) and IQo-L (Incontinence Quality of Life Instrument) questionnaires and underwent a gynecological examination to determine the Vaginal Health Index (VHI). Women were randomized in three treatment groups: CO2L (n = 32), RF (n = 33) or CT (n = 30). In the CO2L and RF groups, a monthly session was held for three months to apply energies in the vulvovaginal area. The CT group used 1g of promestriene cream vaginally at home for 21 consecutive nights and then twice a week for four months. The follow-up was performed in the fourth and tenth month after the start of therapies, with assessment of the same parameters measured initially, as well as the satisfaction of the treatments using the 5-point LIKERT scale. Results: Ninety-five patients were eligible. Fifty-eight patients completed ten-month follow-up, 21 in the CO2L group, 19 in the RF and 18 in the CT group. After the therapies, there was a significant improvement in the symptomatology expressed by the reduction in the VAS score (p < 0.05) and an improvement in the VHI (p < 0.001) in all groups evaluated. There was an improvement in sexual function, demonstrated by an increase in the score of FSFI questionnaire (p < 0.001). The IQO-I questionnaire demonstrated persistent improvement of urinary symptoms in the energy group (CO2L and RF), wich was observed in the CT group only during the use of promestriene (p = 0.004). Conclusion: Treatment with energies (CO2L and RF) and with promestriene showed significant and similar improvement in symptoms of GSM, vaginal health and in the quality of life in BCSA. No tissue, structural damage or relevant clinical complications were observed. The use of energies proved to be safe in this group of patients, as long as the technical standards are respected.
Objective: To evaluate the effects of LASER (CO2L), radiofrequency (RF) and promestriene (CT) on vaginal health and quality of life in breast cancer survivors using adjuvant endocrine therapy (BCSA) with genitourinary syndrome of menopause (GSM). Methods: Prospective randomized trial in BCSA with moderate to severe signs and/or symptoms according to the visual analogue scale (VAS ³ 4) of GSM were eligible. After signing the consent form, patients completed FSF-I (Female Sex Function Index) and IQo-L (Incontinence Quality of Life Instrument) questionnaires and underwent a gynecological examination to determine the Vaginal Health Index (VHI). Women were randomized in three treatment groups: CO2L (n = 32), RF (n = 33) or CT (n = 30). In the CO2L and RF groups, a monthly session was held for three months to apply energies in the vulvovaginal area. The CT group used 1g of promestriene cream vaginally at home for 21 consecutive nights and then twice a week for four months. The follow-up was performed in the fourth and tenth month after the start of therapies, with assessment of the same parameters measured initially, as well as the satisfaction of the treatments using the 5-point LIKERT scale. Results: Ninety-five patients were eligible. Fifty-eight patients completed ten-month follow-up, 21 in the CO2L group, 19 in the RF and 18 in the CT group. After the therapies, there was a significant improvement in the symptomatology expressed by the reduction in the VAS score (p < 0.05) and an improvement in the VHI (p < 0.001) in all groups evaluated. There was an improvement in sexual function, demonstrated by an increase in the score of FSFI questionnaire (p < 0.001). The IQO-I questionnaire demonstrated persistent improvement of urinary symptoms in the energy group (CO2L and RF), wich was observed in the CT group only during the use of promestriene (p = 0.004). Conclusion: Treatment with energies (CO2L and RF) and with promestriene showed significant and similar improvement in symptoms of GSM, vaginal health and in the quality of life in BCSA. No tissue, structural damage or relevant clinical complications were observed. The use of energies proved to be safe in this group of patients, as long as the technical standards are respected.