Vaginal dilator use to promote sexual wellbeing after radiotherapy in gynecological cancer survivors.

ABSTRACT: This study investigated the efficacy of a vaginal dilator (VD) for the treatment of radiation-induced vaginal stenosis (VS) and the effect of a VD on sexual quality of life.Fifty three patients with endometrial or cervical cancers participated in this prospective observational study. All participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined 4 times after radiotherapy (RT) and were also asked to complete a validated sexual function-vaginal changes questionnaire. SPSS version 20 and Minitab version 16 were used for the statistical analysis. The statistical significance was set at P < .05.The VS grading score decreased and the comfortably insertable VD size gradually increased throughout a year of VD use; all patients with initial grade 3 showed a VS of grade 2 after 12 months of VD use and 65.8% of the patients with initial grade 2 demonstrated a final VS of grade 1, while 77.8% of the participants who started with the first size of VD reached the third size after 12 months. Starting VD therapy ≤3 months after the end of RT was associated with a significant decrease in VS. A total of 60.9% of participants reported that they did not feel their vaginas were too small during intercourse after 12 months of dilation, whereas only 11.5% gave the same answer before starting dilation. Furthermore, 47.17% rated their satisfaction with their sexual life 5 out of 7 and only 3.77% gave a score of 3 after 12 months of dilation.Endometrial and cervical cancer survivors are encouraged to use VD to treat VS and for sexual rehabilitation after RT. This study recommends starting vaginal dilation no more than 3 months after treatment at least 2 to 3 times a week for 10 to 15 minutes over 12 months. However, larger, well-designed randomized clinical trials should be conducted to develop specific guidelines for VD use and efficacy in VS and sexual sexual quality of life after RT.

Skin exposure to UVB light induces a skin-brain-gonad axis and sexual behavior.

Ultraviolet (UV) light affects endocrinological and behavioral aspects of sexuality via an unknown mechanism. Here we discover that ultraviolet B (UVB) exposure enhances the levels of sex-steroid hormones and sexual behavior, which are mediated by the skin. In female mice, UVB exposure increases hypothalamus-pituitary-gonadal axis hormone levels, resulting in larger ovaries; extends estrus days; and increases anti-Mullerian hormone (AMH) expression. UVB exposure also enhances the sexual responsiveness and attractiveness of females and male-female interactions. Conditional knockout of p53 specifically in skin keratinocytes abolishes the effects of UVB. Thus, UVB triggers a skin-brain-gonadal axis through skin p53 activation. In humans, solar exposure enhances romantic passion in both genders and aggressiveness in men, as seen in analysis of individual questionaries, and positively correlates with testosterone level. Our findings suggest opportunities for treatment of sex-steroid-related dysfunctions.

Longitudinal Changes in Health-related Quality of Life After 125I Low-dose-rate Brachytherapy for Localized Prostate Cancer.

BACKGROUND/AIM: The factors associated with longitudinal changes in health-related quality of life (HRQOL) are unclear. In this study we aimed to evaluate the longitudinal changes and predictors of HRQOL after 125I low-dose-rate brachytherapy (LDB) for localised prostate cancer (PCA). PATIENTS AND METHODS: We evaluated 180 patients with localised PCA treated with LDB. The HRQOL was evaluated at 3 weeks before LDB and at 1, 3, 6, 12, 18, 24, 36, and 48 months after LDB using the International Prostate Symptom Score, Medical Outcome Study 8-Items Short Form Health Survey (SF-8), and University of California Los Angeles Prostate Cancer Index (UCLA-PCI). RESULTS: All HRQOL scores, except for UCLA-PCI sexual function and SF-8 mental component summary (MCS), were improved to baseline after an early transient deterioration. In contrast, the sexual function did not return to baseline after early deterioration. Meanwhile, the MCS scores showed no significant decline after implantation and trended upward. The prostate V100 and baseline UCLA-PCI sexual function scores predicted a clinically significant decrease in sexual function in the late post-implantation period. CONCLUSION: Most aspects of the HRQOL of PCA patients who underwent LDB improved to baseline. The results that V100 and baseline sexual function were predictors of late post-LDB may provide more accurate information for patients with preserved sexual function before treatment and for their partners.

Long-term sexual functioning in germ-cell tumor survivors.

BACKGROUND: Survivors of germ-cell tumors (GCT) may suffer from long-term adverse consequences. Our study was conducted to assess a long-term sexual functioning in GCT survivors. METHODS: GCT survivors (N = 170) from the National Cancer Institute in Slovakia completed a Sexual Function Questionnaire that was modified from PROMIS Sexual Function and Satisfaction Questionnaire 9-year median follow up (range 5-32) as a primary exploratory aim. Study groups consisted of 17 survivors (10%) who had active surveillance (AS, controls), and 153 (90%) survivors who received treatment beyond orchiectomy (Tx), including cisplatin-based chemotherapy (CT, N = 132; 78%), radiotherapy to the retroperitoneal lymph nodes (RT, N = 12; 7%) or both (CTRT, N = 9; 5%). RESULTS: In univariate analysis, treatment of any type resulted in difficulty to maintain erection during sexual intercourse compared to patients treated with AS (P = 0.04). Survivors who received CTRT had lower ability to achieve orgasm during sexual activities (P = 0.04) and they reported disappointment with their overall quality of sex life (P = 0.002). The number of attempts to initiate sexual intercourse did not differ. Sexual relationships caused none or mild anxiety and the desire to be sexually active was higher after CTRT (P = 0.05). Multivariable analysis confirmed that orgasmic dysfunction after ≥400 mg/m2 of cisplatin and issues in maintaining erection after Tx were independent of retroperitoneal lymph-node dissection (P = 0.03 and P = 0.04, respectively). Survivors were disappointed with the quality of sex life and had stronger desire to be sexually active independent of age, (P = 0.01 and P = 0.05, respectively). CONCLUSIONS: This study identified an impairment in sexual function may represent an issue for long-term GCT survivors. Treatment with chemotherapy plus radiotherapy were associated with disappointment and stronger sexual desire, while a higher cumulative dose of cisplatin may be responsible for orgasmic dysfunction.

A prospective analysis of health-related quality of life in intermediate and high-risk prostate cancer patients managed with intensity modulated radiation therapy, with vs. without hormonal therapy.

INTRODUCTION: Combined radiotherapy and hormonal treatment are recommended for intermediate- and high-risk prostate cancer (CaP). This study compared the long-term effects on health-related quality of life (HRQoL) of intermediate- and high-risk CaP patients managed with radiation therapy (RT) with vs. without hormone therapy (HT). METHODS: Patients with intermediate- and high-risk CaP enrolled in the Center for Prostate Disease Research diagnosed from 2007 to 2017 were included. EPIC and SF-36 questionnaires were completed and HRQoL scores were compared for patients receiving RT vs. RT + HT at baseline (pretreatment), 6, 12, 24, 36, 48, and 60 months after CaP diagnosis. Longitudinal patterns of change in HRQoL were modeled using linear regression models, adjusting for baseline HRQoL, age at CaP diagnosis, race, comorbidities, National Comprehensive Cancer Network (NCCN) risk stratum, time to treatment, and follow-up time. RESULTS: Of 164 patients, 93 (56.7%) received RT alone and 71 (43.3%) received RT + HT. Both groups reported comparable baseline HRQoL. Patients receiving RT+HT were more likely to be NCCN high risk as compared to those receiving only RT. The RT + HT patients experienced worse sexual function, hormonal function, and hormonal bother than those who only received RT; however, HRQoL recovered over time for the RT + HT group. No significant differences were observed between groups in urinary and bowel domains or SF-36 mental and physical scores. CONCLUSION: Combined RT + HT treatment was associated with temporary lower scores in sexual and hormonal HRQoL compared with RT only. Intermediate- and high-risk CaP patients should be counseled about the possible declines in HRQoL associated with HT.

Sexual Function, Quality of Life, and Mood After Radiation Therapy in Patients with Anal Cancer.

PURPOSE/OBJECTIVE(S): Definitive chemoradiation (CRT) results in high cure rates of anal cancer, with advanced radiation (RT) techniques improving toxicity. However, there is limited data regarding these patients' sexual function (SF), quality of life (QOL), and mood. We hypothesized that anal cancer treatment would result in detrimental effects on SF, QOL, and mood. MATERIALS/METHODS: We prospectively surveyed patients with anal cancer treated with definitive CRT. We assessed SF for women with the Female Sexual Function Index (FSFI) and for men with the International Index of Erectile Function (IIEF). For all patients, we assessed QOL using EORTC QLQ-C30 and CR29 and mood using the Hospital Anxiety and Depression Scale (HADS). We reported descriptive statistics for SF, QOL, and mood and used univariate analysis to evaluate predictors of SF for women. RESULTS: Of 50 eligible patients, 84% completed the surveys. Median time from RT until survey was 36 months (1-97 months). Women (n = 34) reported poor SF overall (mean FSFI score = 15, scale 2-36, standard deviation (SD) 10.4). Most women reported poor SF related to satisfaction, desire, orgasm, arousal, pain, and lubrication. Men (n = 8) also had poor overall satisfaction (mean IIEF score = 6.1, scale 2-10, SD 3.6). Men reported poor erectile function and lower satisfaction with intercourse. Mean QLQ-C30 QOL score was 86.5 (SD 16.3). Results from EORTC QLQ-CR-20 demonstrated patients experienced poor sexual interest. Per HADS, 2.5% reported depression and 18% anxiety. CONCLUSION: Patients with anal cancer experience sexual dysfunction after RT, with QOL and mood symptoms similar to patients with other cancers. Our data support the need for ongoing efforts to understand and address issues with SF, QOL, and mood following RT for these patients.

Effect of non-ablative laser treatment on overactive bladder symptoms, urinary incontinence and sexual function in women with urodynamic stress incontinence.

OBJECTIVE: To investigate the effects of non-ablative laser treatment on overactive bladder (OAB) syndromes, stress urinary incontinence and sexual function in women with urodynamic stress incontinence (USI). MATERIALS AND METHODS: Between April 2015 and June 2015, consecutive patients with USI with OAB syndromes underwent two sessions of Erbium:YAG laser treatment in a tertiary hospital. Patients received validated urological questionnaires, urodynamic studies, 1-h pad test and measurement of vaginal pressure before, one and three months after laser treatment. Questionnaires at 12 months were completed by telephone interview. Adverse effects and patients' satisfaction were also assessed. RESULTS: We included 30 patients with a mean age of 52.6 ± 8.8 years. Three months after therapy, mean 1-h pad test significantly decreased (P = 0.039). Significant improvement in OAB symptoms in four questionnaires were noted at three months post treatment, but not sustained for 12 months in two of them. Three months after therapy, mean vaginal pressure significantly improved (P = 0.009). Of 24 (82.7%) sexually active patients, 62.5% (15/24) and 54.2% (13/24) of their sexual partners reported improved sexual gratification three months later. No major adverse effects were noticed. CONCLUSIONS: Erbium:YAG laser treatment can resolve USI and coexistent OAB symptoms three months after therapy. Sexual experience is also improved. However, repeated laser therapy may be necessary after six months.

Perceptions and practices regarding women's vaginal health following radiation therapy: A survey of radiation oncologists practicing in the United States.

PURPOSE: Vaginal stenosis (VS) is a recognized complication of pelvic and vaginal radiation therapy (RT). METHODS AND MATERIALS: A 26-item survey assessing the signs/symptoms, risk factors, diagnosis, prevention, treatment, and impact of VS on women's sexual health was distributed to radiation oncologists. Descriptive statistics were calculated. Chi-square tests examined differences in categorical responses. RESULTS: A total of 233 (10.5%) participants completed the entire survey. Twelve percent, 21%, and 68% report treating gynecologic (GYN) tumors only, non-GYN pelvic tumors only, or both, respectively. Regarding risk factors, 78% believed that VS can be caused by pelvic RT alone, 91% by vaginal brachytherapy alone, and 98% by combined pelvic RT and vaginal brachytherapy. Approximately one-half of respondents felt that being postmenopausal and having a hysterectomy before radiation therapy were risk factors for VS, whereas the other half felt that these were not risk factors. All respondents agreed that VS is a clinical diagnosis. Respondents indicated that VS symptoms include dyspareunia, vaginal pain, dryness, and/or bleeding (100%, 90%, 85%, and 72%, respectively); 65% indicated all 4. The most commonly recommended treatment for VS is vaginal dilator use. Radiation oncologists who treat GYN-only versus non-GYN cancers were more likely to perform a vaginal examination, to distribute written instructions regarding vaginal dilator use (P = .002), to have vaginal bleeding reported after RT (P = .001), and to refer patients to a sexual counselor (P = .007). Most providers (73%) expressed willingness to participate in prospective research on the diagnosis and treatment of VS. CONCLUSIONS: This is the first large-scale survey of radiation oncologists' perceptions and practices regarding VS. There is agreement among providers regarding the signs/symptoms of VS and strategies for its prevention/treatment using vaginal dilators. Further prospective and observational research is needed. This survey shows a willingness on the part of providers to take part in prospective research regarding the diagnosis, impact, and treatment of VS on women's sexual health.

Assessment of sexual function in Japanese men with prostate cancer undergoing permanent brachytherapy without androgen deprivation therapy: Analysis from the Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation database.

OBJECTIVES: To evaluate male sexual function in Japanese prostate cancer patients undergoing permanent brachytherapy without endocrine treatment, using quality of life measures of the Expanded Prostate Cancer Index Composite. METHODS: A total of 482 patients were selected as analysis subjects from the nationwide database for the Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation. The patients were asked to complete the Expanded Prostate Cancer Index Composite questionnaires before and at 3, 12, 24, and 36 months after the permanent brachytherapy. Changes in their responses were analyzed, and any association of the outcomes was investigated. Furthermore, changes over time in their answers to Q18 (usual quality of your erections) were analyzed. RESULTS: A total of 72 patients (14.9%) had received external beam radiation. A total of 68 patients (14.1%) had taken any 5-phosphodiesterase inhibitor medications. Regarding Q18, 232 patients (48.2%) selected either "There was no sexual activity" or "There was no desire for erection" before receiving permanent brachytherapy. Of all the 482 patients, sexual function was preserved in 138 patients (28.7%) 3 years after permanent brachytherapy. Overall satisfaction has significantly improved without regard for the deterioration of sexual function. Significant factors for maintaining sexual activity were patient age and sexual activity before permanent brachytherapy. CONCLUSIONS: In Japanese patients undergoing permanent brachytherapy alone for prostate cancer, the sexual function is not well preserved. However, decreased sexual function does not seem to represent a major factor determining patients' overall satisfaction. These findings might be peculiar to Japanese patients, in whom elderly subjects account for the majority.

Quality of Life of Patients with Advanced Cervical Cancer before and after Chemoradiotherapy.

BACKGROUND: Cervical cancer is the most frequently diagnosed cancer among women in India. Understanding quality of life (QOL) in women undergoing chemoradiotherapy for cervical cancer will help in introducing interventions for better care and outcomes in these women. This study assessed QOL before and after chemo radiotherapy in cervical cancer patients. MATERIALS AND METHODS: This followup study covered sixtyseven newly diagnosed women with advanced cervical cancer (stages 2b to 4b). Structured questionnaires (the European Organization for Research and Treatment of Cancer, EORTC QLQC30 and EORTC QLQCX24) were used to assess the change in QOL after 6 months of treatment. RESULTS: The mean age of women at the time of detection of cervical cancer was 52.3±11.29 years (Range 3075 years). Six months survival was 92.53%. The mean global health score of cervical cancer patients after six months of treatment was 59.52, which was significantly higher than the pretreatment score of 50.15 (p=0.00007). Physical, cognitive and emotional functioning improved significantly (p<0.05) after treatment. Fatigue, pain, insomnia and appetite loss improved but episodes of diarrhea increased after treatment. The mean "symptoms score" using EORTC QLQCX24 post treatment was 20.0 which was significantly lower as compared to the pre treatment score 30.0 (p<0.00001). Sexual enjoyment and sexual functioning decreased significantly after treatment. CONCLUSIONS: QOL of newly diagnosed cervical cancer patients improved significantly following chemoradio therapy. Enhancement was also demonstrated on three of the five functional scales of EORTC QLQC30. To further improve QOL, interventions focusing on social and psychological support and physical rehabilitation may be needed.

Comportamento sexual das mulheres em tratamento radioterápico / Sexual behavior of women in radiotherapytreatment

Women with cancer undergoing radiotherapy, radiotherapy and / or brachytherapy may change in sexual behavior, with influence on psychosocial, sexual and functional aspects as well as quality of life. This study aims to analyze the scientific evidence related to sexual behavior and quality of life of women who underwent radiotherapy. It is literature type integrative review. Data collection was conducted in May 2014 and was carried out through the Virtual Health Library, from the bottom of LILACS and MEDLINE, by combining the descriptors: "sexual behavior and radiotherapy" and "sexual behavior and brachytherapy". They selected 23 studies for the sample with no time limit. With the intention of promoting the contributions the production of knowledge about sexual behavior / symptoms after cancer treatment in women with brachytherapy and radiation, emerging two main themes: psychosocial, sexual and functional changes; quality of life. Identifies what is needed directed multidisciplinary action women with cancer in relation to sexuality, there are weaknesses in the care geared to these. Such assistance needs to be planned for the woman and her partner, so that living with cancer and treatment is quality.

As mulheres com câncer submetidas à radioterapia, teleterapia e/ou braquiterapia podem ter alteração nocomportamento sexual, com influência nos aspectos psicossociais, sexuais e funcionais, bem como na qualidade de vida. Este estudo tem como objetivo analisar as evidências científicas relacionadas ao comportamento sexual e qualidade de vida de mulheres que realizaram tratamento com radioterapia. Trata-se de pesquisa bibliográfica do tipo revisão integrativa. A coleta dos dados foi realizada no mês de maio de 2014, e ocorreu por meio da Biblioteca Virtual em Saúde, a partir das bases de dados LILACS e MEDLINE, através da combinação dos descritores: "sexual behaviorandradiotherapy" e "sexual behaviorandbrachytherapy". Foram selecionados 23 estudos para compor a amostra sem tempo limite. Com a intenção de promover os contributos da produção do conhecimento sobre o comportamento sexual/sintomas após tratamento de câncer em mulheres com braquiterapia e radioterapia, emergindo dois eixos temáticos: alterações psicossociais, sexuais e funcionais; qualidade de vida. Identifica-se que é necessária ação multidisciplinar direcionada as mulheres com câncer em relação à sexualidade, há fragilidade no cuidado voltado a essas. Tal assistência necessita ser planejada para a mulher e seu parceiro, de forma que a convivência com o câncer e tratamento seja de qualidade.

Impact of Androgen Deprivation Therapy on Sexual and Hormonal Function in Patients Receiving Radiation Therapy for Prostate Cancer.

BACKGROUND: Androgen deprivation therapy (ADT) added to radiation therapy (RT) in intermediate to high risk prostate cancer negatively impacts quality of life. OBJECTIVES: To compare health-related quality of life (HR-QOL) in patients receiving combined RT with and without ADT METHODS: The study population comprised patients treated with definitive RT for prostate cancer who completed the Expanded Prostate Cancer Index Composite-26 form between 3 and 24 months after completing RT. Covariance and a stepwise backward logistic regression model was used. RESULTS: Data were available for 143 patients who received RT+ADT and 70 who received RT alone. The sexual function and hormonal vitality scores of patients receiving RT+ADT were significantly lower than those receiving RT alone (P < 0.0001). Patients with only compulsory school education had significantly lower sexual function scores than patients with university level education (P ≤ 0.005). Patients with depression had significantly lower hormonal vitality scores than those without depression (P ≤ 0.0001). CONCLUSIONS: The addition of ADT to RT is responsible for decrements in quality of life in the sexual and hormonal vitality domains, which is further compounded by depression and lack of education. This underlines the need to improve education, identify and treat depression, and develop strategies to improve the quality of life of patients receiving combination therapy.

Psychological distress and health-related quality of life among head and neck cancer patients during the first year after treatment.

PURPOSE: Patients treated for head and neck cancer present some of the most significant posttreatment morbidity of any group of patients with cancer. Our aim is to describe quality of life and psychological distress after different treatments among head and neck cancer patients during the first year after treatment. METHODS: A total of 86 patients treated for head and neck cancer were evaluated within 1 year of the end of treatment by means of the Distress Thermometer (DT) and EORTC C30 and H&N35 questionnaires. Type of treatment was classified into 3 groups: surgery, chemo-/radiotherapy, and combined treatment. RESULTS: Forty-one percent of patients showed a high level of distress (DT >5). Distress was higher in patients with a tracheotomy or with previous cancer in another district. Quality of life was homogeneous across treatment types after adjustment for stage and time since end of treatment, except for higher levels of suffering related to sensory problems, social eating, and dry mouth among patients treated with combined therapy. CONCLUSIONS: The DT and EORTC questionnaires proved to be effective and easy tools to monitor distress and quality of life in patients with head and neck cancer. Monitoring the quality of life perceived by each patient during his/her course of treatment could be useful in planning the rehabilitation process while performing follow-up visits.

Long-Term Toxicity and Quality of Life in Patients Treated for Locally Advanced Cervical Cancer.

OBJECTIVE: The aim of this study was to analyze the long-term toxicity and quality of life (QOL) in patients with locally advanced cervical cancer (LACC) treated with chemoradiation [chemotherapy/radiotherapy (CT/RT)] or neoadjuvant CT (NACT) followed by radical surgery (RS). METHODS: Fifty-nine patients with LACC in remission after treatment with NACT + RS (n = 34) or CT/RT (n = 25) were interviewed with an Incontinence Impact Questionnaire (IIQ-7), a Quality of Life Questionnaire (EORTC QLQ-C30), and a Quality of Life Questionnaire for Cervical Cancer (EORTC QLQ-CX24) to compare long-term toxicity and QOL. RESULTS: The mean age was 53 ± 9.8 and 59 ± 11.5 years in the NACT + RS and CT/RT groups, respectively. Overall, diarrhea and constipation were reported in 15 and 68%, respectively, while bladder complaints and a low level of sexual enjoyment were reported in 36 and 47%, respectively. The NACT + RS patients showed a worse sexual activity (74.71 ± 33.57 vs. 92.06 ± 17.96; p = 0.019) and sexual enjoyment (71.21 ± 23.67 vs. 88.88 ± 21.71; p = 0.040) and more frequently complained of constipation (49.01 ± 34.06 vs. 26.66 ± 31.66; p = 0.013), while CT/RT patients more frequently suffered from diarrhea (1.96 ± 7.96 vs. 14.66 ± 28.40; p = 0.017). CONCLUSIONS: Many patients treated for LACC have long-term complaints regarding sexual activity and bladder and bowel function. The majority of QOL aspects were similar in the two groups at long-term follow-up. However, diarrhea was more frequent and severe in CT/RT patients, while constipation was more frequent and severe in NACT + RS patients, and they showed a worse sexual life perception. Larger randomized trials addressing these issues are needed.

Sexual Difficulties after Pelvic Radiotherapy: Improving Clinical Management.

Modern multimodality cancer treatment has led to more than 2 million people living with and beyond cancer in the UK, an impressive survival statistic on which clinicians and services continue to build. However, what is less readily acknowledged by health professionals and patients alike are the 500,000 people whose daily lives are adversely affected by the longer term consequences of cancer treatment. Macmillan Cancer Support estimate as many as 350,000 people in the UK experience sexual consequences of cancer and its treatment, an aspect of survivorship and rehabilitation that receives relatively scant attention in service provision, policy development and research terms. This overview addresses the sexual impact of radical pelvic radiotherapy for the more common (prostate, ano-rectal, cervical and endometrial) adult malignancies. Through discussion of the clinical assessment and management of desire, arousal, orgasmic and sexual pain difficulties that arise after pelvic radiotherapy, this overview offers an integrated biopsychosocial model of practice that incorporates the physical, psychological and relationship elements of these treatment sequelae. It is important that clinicians raise the profile of the sexual consequences of cancer treatment as a legitimate aspect of survivorship and service provision. Only in this way can the identification and management of treatment-induced sexual difficulties, frequently experienced by patients and their partners, be better understood and managed. Increased focus on the sexual consequences of treatment and cancer survivorship more broadly may, in time, lead to greater clinical recognition, service development and, most importantly, increased research devoted to the effective management of what remains a neglected aspect of cancer care.

Participation of irradiated Anopheles arabiensis males in swarms following field release in Sudan.

BACKGROUND: The success of the sterile insect technique (SIT) depends the release of large numbers of sterile males, which are able to compete for mates with the wild male population within the target area. Unfortunately, the processes of colonisation, mass production and irradiation may reduce the competitiveness of sterile males through genetic selection, loss of natural traits and somatic damage. In this context, the capacity of released sterile Anopheles arabiensis males to survive, disperse and participate in swarms at occurring at varying distances from the release site was studied using mark-release-recapture (MRR) techniques. METHODS: In order to assess their participation in swarms, irradiated and marked laboratory-reared male mosquitoes were released 50, 100 or 200 m from the known site of a large swarm on three consecutive nights. Males were collected from this large swarm on subsequent nights. Over the three days a total of 8,100 males were released. Mean distance travelled (MDT), daily probability of survival and estimated population size were calculated from the recapture data. An effect of male age at the time of release on these parameters was observed. RESULTS: Five per cent of the males released over three days were recaptured. In two-, three- and four-day-old males, MDT was 118, 178 and 170 m, and the daily survival probability 0.95, 0.90 and 0.75, respectively. From the recapture data on the first day following each release, the Lincoln index gives an estimation of 32,546 males in the natural population. DISCUSSION: Sterile An. arabiensis males released into the field were able to find and participate in existing swarms, and possibly even initiate swarms. The survival probability decreased with the age of male on release but the swarm participation and the distance travelled by older males seemed higher than for younger males. The inclusion of a pre-release period may thus be beneficial to male competitiveness and increase the attractiveness of adult sexing techniques, such as blood spiking.

Patient-reported outcomes following stereotactic body radiation therapy for clinically localized prostate cancer.

BACKGROUND: Stereotactic body radiation therapy (SBRT) delivers high doses of radiation to the prostate while minimizing radiation to adjacent normal tissues. Large fraction sizes may increase the risk of functional decrements. Treatment-related bother may be more important to a patient than treatment-related dysfunction. This study reports on patient-reported outcomes following SBRT for clinically localized prostate cancer. METHODS: Between August 2007 and July 2011, 228 consecutive hormone-naïve patients with clinically localized prostate cancer were treated with 35-36.25 Gy SBRT delivered using the CyberKnife Radiosurgical System (Accuray) in 5 fractions. Quality of life was assessed using the American Urological Association Symptom Score (AUA) and the Expanded Prostate Cancer Index Composite (EPIC)-26. Urinary symptom flare was defined as an AUA score 15 or more with an increase of 5 or more points above baseline 6 months after treatment. RESULTS: 228 patients (88 low-, 126 intermediate- and 14 high-risk) at a median age of 69 (44-90) years received SBRT with a minimum follow-up of 24 months. EPIC urinary and bowel summary scores declined transiently at 1 month and experienced a second, more protracted decline between 9 months and 18 months before returning to near baseline 2 years post-SBRT. 14.5% of patients experienced late urinary symptom flare following treatment. Patients who experienced urinary symptom flare had poorer bowel quality of life following SBRT. EPIC scores for urinary bother declined transiently, first at 1 month and again at 12 months, before approaching pre-treatment scores by 2 years. Bowel bother showed a similar pattern, but the second decline was smaller and lasted 9 months to 18 months. EPIC sexual summary and bother scores progressively declined over the 2 years following SBRT without recovery. CONCLUSIONS: In the first 2 years, the impact of SBRT on urination and defecation was minimal. Transient late increases in urinary and bowel dysfunction and bother were observed. However, urinary and bowel function and bother recovered to near baseline by 2 years post-SBRT. Sexual dysfunction and bother steadily increased following treatment without recovery. SBRT for clinically localized prostate cancer was well tolerated with treatment-related dysfunction and bother comparable to conventionally fractionated radiation therapy or brachytherapy.

Sexual dysfunction in cancer patients: a review.

Cancer is a life-threatening disease despite the advanced therapeutic strategies now available. A common problem is that physicians and patients tend to concentrate on intensive medical treatment options and underestimate the treatment-related adverse effects. In this review, we summarize one of these adverse effects in cancer patients; sexual dysfunction (SD). In addition, current therapeutic choices with optimal doses and patient selection strategies are defined. All patients should be informed about problems associated with therapy-related SD and must be guided toward the most appropriate therapeutic options before starting treatment.

Longitudinal trajectory of sexual functioning after hematopoietic cell transplantation: impact of chronic graft-versus-host disease and total body irradiation.

This prospective study described the trajectory of sexual well-being from before hematopoietic cell transplantation (HCT) to 3 years after in 131 allogeneic and 146 autologous HCT recipients using Derogatis Interview for Sexual Function and Derogatis Global Sexual Satisfaction Index. Sixty-one percent of men and 37% of women were sexually active pre-HCT; the prevalence declined to 51% (P = .01) in men and increased to 48% (P = .02) in women at 3 years post-HCT. After HCT, sexual satisfaction declined in both sexes (P < .001). All sexual function domains were worse in women compared with men (P ≤ .001). Orgasm (P = .002) and drive/relationship (P < .001) declined in men, but sexual cognition/fantasy (P = .01) and sexual behavior/experience (P = .01) improved in women. Older age negatively impacted sexual function post-HCT in both sexes (P < .01). Chronic graft-versus-host disease was associated with lower sexual cognition/fantasy (P = .003) and orgasm (P = .006) in men and sexual arousal (P = .05) and sexual satisfaction (P = .005) in women. All male sexual function domains declined after total body irradiation (P < .05). This study identifies vulnerable subpopulations that could benefit from interventional strategies to improve sexual well-being.

The effect of high dose rate brachytherapy in combination with external beam radiotherapy on men's health-related quality of life and sexual function over a 2 year time span.

AIM: To investigate changes in health-related quality of life and sexual function in men after high dose rate (HDR) brachytherapy and external beam radiotherapy (EBRT), with or without androgen deprivation therapy, for localised prostate cancer. MATERIALS AND METHODS: Eligible men who had undergone HDR brachytherapy/EBRT for their prostate cancer completed questionnaires before any treatment (baseline) and at 3 monthly intervals. The European Organization for Research and Treatment of Cancer (EORTC) C30 quality of life measure (QLQ-C30), the PR25 prostate-specific supplement and the International Index of Erectile Function-Short Form (IIEF-SF) were completed. An analysis of changes from baseline to 2 years, for the 87 men who completed surveys, was carried out. RESULTS: The mean EORTC QLQ-C30 quality of life scores, urinary, bowel and sexual symptoms had all improved. However, improvements did not return men to baseline levels at 2 years. Sexual function as measured by both scales was least likely to recover. There were no differences due to androgen deprivation therapy. Minimally important differences were still reported by men at 2 years as follows: urinary (36%), bowel (24%), hormone treatment side-effects (40%), IIEF-SF (55%). Discrepancies between mean and minimally important differences changes are explained by some men remaining more affected by their therapy than others. CONCLUSION: The findings do not support our first hypothesis that urinary, bowel and sexual problems in these men will return to baseline levels once therapy is completed and 2 years have elapsed. Our findings indicate the changes men experience are significant, do occur early, and many do not resolve in the longer term.