S706
Clinical – Lower GI
ESTRO 2026
included vagina, paracolpium, and bulboclitoris. Additionally, the distal vagina was contoured to simulate the introitus region. For each structure, mean dose, D0.03 cm ³ , and V30-60 Gy(%) were analyzed. CX24 items were dichotomised by the worst grade across follow-up into non-to-mild versus moderate- severe symptoms. Differences between groups were analyzed using Student’s t-test or Mann-Whitney U test, or Fisher’s exact test for categorical variables. Given the exploratory nature, no multiplicity correction was applied. Results: Among 221 women in DACG-I, 86.9% provided a response to the sexual activity item during follow-up. Sixty reported being sexually active at ≥ 1 follow-up; 23 were from the selected center and were included in this analysis. Baseline characteristics are shown in Table 1. Baseline characteristics did not differ between symptom groups for dichotomized outcomes. Several dose-response patterns emerged (Table 2). For vaginal shortness, vaginal V50 Gy tended to be higher in the moderate-severe group (n=6). For vaginal tightness, the moderate-severe group (n=6) received higher vaginal mean dose and higher bulboclitoris mean dose, supported by increased bulboclitoris V30 Gy. For vaginal dryness, women with moderate-to-severe symptoms (n=13) had lower paracolpium V50 Gy and were more frequently treated with lower prescribed tumour doses (p=0.014). For sexual enjoyment, lower distal-vaginal V50 Gy was associated with preserved enjoyment (n=7), with a similar tendency for lower bulboclitoris V30 Gy. For dyspareunia, no dose-volume differences were identified.
Conclusion: This real-world analysis demonstrates the variability in treatment strategies of advanced anal cancer across disease presentation. Patients with synchronous metastatic disease were treated most intensively, whereas those with locally recurrent inoperable disease predominantly received best supportive care. Ongoing analyses will focus on evaluating clinical outcomes and treatment efficacy to aid interpretation of emerging clinical trial data, particularly in the context of immunotherapy for advanced anal cancer. Keywords: Anal cancer, real-world data Exploratory dosimetric analysis of vaginal and sexual dysfunction after radiotherapy for anal cancer in the DACG-I cohort Johanne H. Steffensen 1,2 , Camilla J.S. Kronborg 3,4 , Eva Serup-Hansen 5 , Karen-Lise G. Spindler 1 1 Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark. 2 2Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. 3 Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark. 4 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. 5 Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark Poster Discussion 2271 Purpose/Objective: Vaginal and sexual dysfunction are frequent late effects of pelvic radiotherapy (RT) for anal cancer (AC), yet evidence linking dose to female organs of interest remains scarce1-3. To address this gap, we conducted an exploratory pilot analysis of associations between local dose-volume parameters and patient-reported vaginal and sexual symptoms after RT for AC. Material/Methods: DACG-I (NCT05570279) is a nationwide prospective cohort of patients treated with curative-intent chemoradiotherapy (2015-2020). Patient-reported outcomes (EORTC QLQ-CX24) were collected before RT and at 1-, 3-, and 5-years post-treatment. This pilot analysis included women who reported sexual activity at ≥ 1 follow-up , enabling complete scoring of the CX24 vaginal and sexual symptom items, all from a single center. Organs delineated per Kronborg et al.4
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