12. Supportive therapy – Cervical Carcinoma

Please refer to Chapter 3 of the Level 3 guideline on “Supportive Therapy in Oncology Patients.”

Please refer to Chapter 4 of the Level 3 guideline on “Supportive Therapy in Oncology Patients.”

Please refer to Chapter 5 of the Level 3 guideline on “Supportive Therapy in Oncology Patients.”

Please refer to Chapter 6 of the Level 3 guideline on “Supportive Therapy in Oncology Patients.”

Please refer to Chapter 7 of the Level 3 guideline on “Supportive Therapy in Oncology Patients.”

Please refer to Chapter 8 of the Level 3 guideline on “Supportive Therapy in Oncology Patients.”

Please refer to Chapter 9 of the Level 3 guideline on “Supportive Therapy in Oncology Patients.”

Please refer to Chapter 10 of the Level 3 guideline on “Supportive Therapy in Oncology Patients.”

Please refer to Chapter 11 of the Level 3 guideline on “Supportive Therapy in Oncology Patients.”

Please refer to Chapter 12 of the Level 3 guideline on “Supportive Therapy in Oncology Patients.”

Acute radiotherapy-induced cystitis leads to symptoms such as dysuria, increasing urination frequency, and nocturia. The focus is on symptomatic treatment with analgesia and spasmolysis (metamizole [dipyrone], centrally acting analgetics, butylscopolamine, oxybutynin). Alkalization of the urine and iron substitution, or even transfusions in cases of recurrent micro- and macrohematuria, can supplement the therapy. Bacterial superinfections require the appropriate antibiotic therapy. According to the ASCO guideline (2008 Clinical Practice Guideline Update: Use of Chemotherapy and Radiation Therapy Protectants), preventive administration of amifostine (an aminothiol compound) may be considered in order to reduce radiotherapy-induced toxicity. Ethyol® (amifostine) is not approved for this indication in Germany. Critical weighing up of the side effects and benefits of amifostine for this off-label indication is necessary [488].

Radiogenic and/or chemotherapy-induced vaginal dryness can be reduced in patients with cervical carcinoma by administering inert lubricant gels. In individual cases when there is severe pain, local estrogen treatment can be administered after careful consideration of the risk and provision of the appropriate information to the patient. Approximately 4–6 weeks after the end of radiotherapy that has included the vaginal region, mechanical dilation (with vaginal dilators, dexpanthenol [Bepanthen] tampons) is a possible method for prophylaxis against vaginal stenosis [490].

Acute radiogenic vulvovaginitis can occur up to 90 days after the start of radiotherapy and is often reversible. Agents available for the treatment of vulvovaginitis include dexpanthenol, sitz baths with chamomile, and sitz baths with synthetic tannins such as phenol-formaldehyde-urea polycondensate. To restore the physiological pH value in the vagina, as a prerequisite for restoring the physiological vaginal flora, suppositories with freeze-dried cultures of Lactobacillus acidophilus and topical vaginal estrogens can be used if there are no absolute contraindications (estrogen-containing creams or gels, ovula, inserts, or vaginal tablets), or benzydamine-containing creams.

Providing the patient with sufficient information about the effects of the treatment on her sexual life and about the options for prophylactic and therapeutic measures (e.g., vaginal dilation) is an essential component of therapy for patients with cervical carcinoma [490] (see also chapter 15.5 Sexuality).