S400
Clinical - Gynaecological
ESTRO 2026
Brunaud 1 , Erik Monpetit 7 , Jean-Christophe Faivre 1 1 Radiation Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France. 2 Gynecology, Clinique Pasteur, Toulouse, France. 3 Radiation Oncology, Centre Oscar Lambret, Lille, France. 4 Gynecology, Centre Léon Bérard, Lyon, France. 5 Public Health, CHRU Jean Minjoz, Besançon, France. 6 Radiation Oncology, CHU Angers, Angers, France. 7 Radiation Oncology, Centre d'Oncologie Saint Yves, Vannes, France Purpose/Objective: Radiation-induced gynecological toxicities are frequently under-recognized, under- diagnosed, and insufficiently managed. These adverse effects negatively impact patients'
quality of life and may compromise oncological outcomes by delaying or
interrupting cancer treatment. This guideline aims to define best clinical practices for the prevention, identification, and management of both acute and late radiation-induced gynecological toxicities. Material/Methods: The French Association for Supportive Care in Cancer (AFSOS) convened a multidisciplinary task force to perform a literature review and apply a consensus methodology to establish these guidelines. External validation was conducted by an independent panel of experts. Results: Optimal management involves a three-phase approach: before, during, and after radiotherapy. Patients should receive pre- treatment counseling on potential gynecological and sexual side effects, along with preventive hygienic and dietary guidance. During treatment, acute toxicities such as vulvitis, vaginitis, urethritis, and proctitis should be actively managed. Post- radiotherapy care must address vaginal dryness, stenosis, synechiae, premature menopause, lymphedema, and sexual dysfunction, with integration of onco- sexological support as needed.
A trend toward higher NTCP with larger target volumes was observed, with IMPT showing similar or smaller increases than VMAT. Six-beam and SIB plans demonstrated improved robustness and OARs sparing compared with four-beam and SEQ plans. Conclusion: Robustly optimized IMPT can achieve clinically acceptable target coverage and substantial reductions in OARs doses and NTCPs compared with VMAT for vulvar cancer. Careful consideration of high-dose skin areas, hence skin toxicity, is required to guide the clinical implementation of IMPT. Keywords: vulvar cancer, IMPT, VMAT
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Management of Radiation-Induced Gynecological Toxicities: AFSOS-SFCE- GFRCP Clinical Practice Guidelines Marie Bruand 1 , Dorra Kanoun 2 , Florence Le Tinier 3 , Christine Rousset-Jablonski 4 , Sarah Nadjafizadeh 1 , Donavine Nimubona 5 , Charlotte Demoor-Goldschmitt 6 , Nicolas Martz 1 , William Gehin 1 , Claire Charra-
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