Quality of life of patients with cervical and uterine cancer after radical treatment and rehabilitation options using hyaluronic acid-based volume-forming agents

Purpose of the study. To assess the quality of life of patients with cervical cancer (CC) and endometrial cancer (EC) after radical specialized treatment, and to evaluate the effectiveness of hyaluronic acid-based volumizing agents in correcting vulvovaginal atrophic changes.

Patients and methods. The study included data from 201 patients with morphologically verified cervical cancer (CC) stages I–III and endometrial cancer (EC) stages I–II (FIGO, 2018), who underwent examination and restorative treatment at the A. Tsyb Medical Radiological Research Centre. The mean age of the patients was 56.6 ± 10.0 years. All patients were postmenopausal, with menopause being treatment-induced in 40.8 % of cases; the mean duration of postmenopause was 9.5 ± 7.1 years. Patients were stratified into clinical groups according to the method of radical treatment: surgical – 67 (33.3 %), combined (surgery + radiotherapy) – 75 (37.3 %), and radiotherapy/chemoradiotherapy – 59 (29.4 %). Restorative therapy consisted of intravaginal and perineal administration of volumizing agents based on stabilized hyaluronic acid using the authors’ proprietary technique. Before and after the restorative therapy, vaginal transudate pH, the Vaginal Health Index (VHI), and sexual function (PISQ-12) were evaluated.

Results. Before restorative treatment, all patients demonstrated severe vulvovaginal atrophy, which was more pronounced in groups receiving radiotherapy alone or as adjuvant therapy. Vaginal pH levels were 6.59 ± 0.6 and 6.43 ± 0.8, respectively, compared with 6.05 ± 0.9 in the surgical group (p = 0.001 and p = 0.01, respectively). VHI values were 7.7 ± 2.5 and 9.2 ± 3.7 compared with 11.1 ± 3.7 (p = 0.00001 and p = 0.02, respectively). One month after restorative treatment, there was a statistically significant decrease in vaginal pH and an increase in VHI scores in all groups (p < 0.00001 for all comparisons): to 5.2 ± 0.8 and 17.3 ± 2.9 in the 1st group; to 5.5 ± 0.6 and 16.75 ± 3.0 in the 2^nd group; and to 5.4 ± 0.7 and 16.7 ± 2.6 in the 3rd group, with no significant differences between the groups (p > 0.05). The therapeutic effect persisted for 12 months. All positive changes observed during therapy contributed to normalization of sexual function. After 1 month, the PISQ-12 score decreased from 15.9 ± 6.7 to 12.0 ± 5.0 in the 1st group (p < 0.00001) and from 14.7 ± 6.0 to 12.0 ± 4.7 in the 3^rd group (p < 0.00001). In the combined treatment group, a significant improvement was observed at later follow-up: from 15.8 ± 4.9 to 9.5 ± 3.5 (p < 0.00001).

Conclusion. All gynecologic oncology patients experience vaginal mucosa atrophy after radical specialized treatment, which is more pronounce after combined radiation/chemoradiation therapy. This justifies starting for preventive measures immediately after completion of radiotherapy programs. Non-hormonal corrective therapy using hyaluronic acid-based volume-forming agents is an effective method for restoring vaginal mucosal properties, regardless of the specialized treatment method used.

1. Malignant neoplasms in Russia in 2024 (morbidity). Edited by Kaprin AD, Starinsky VV, Shakhzadova AO, Zolotarev NYu. Мoscow: P. Hertsen Moscow Oncology Research Institute – Branch of the National Medical Radiology Research Centre of the Ministry of Health of the Russian Federation, 2025, 178 p. (In Russ.). Available at: https://glavonco.ru/cancer_register/zis-2024.pdf. Accessed: 01.12.2025.

2. National Cancer Institute, SEER Program. Cancer Stat Facts: Corpus Uteri Cancer, 2024. Available at: https://seer.cancer.gov/statfacts/html/corp.html. Accessed: 21.11.2025.

3. National Cancer Institute, SEER Program. Cancer Stat Facts: Cervix Uteri Cancer, 2024. Available at: https://seer.cancer.gov/statfacts/html/cervix.html. Accessed: 25.07.2025.

4. Cianci S, Tarascio M, Arcieri M, La Verde M, Martinelli C, Capozzi VA, et al. Post Treatment Sexual Function and Quality of Life of Patients Affected by Cervical Cancer: A Systematic Review. Medicina (Kaunas). 2023 Apr 4;59(4):704. https://doi.org/10.3390/medicina59040704

5. Marino JL, Saunders CM, Emery LI, Green H, Doherty DA, Hickey M. Nature and severity of menopausal symptoms and their impact on quality of life and sexual function in cancer survivors compared with women without a cancer history. Menopause. 2014 Mar;21(3):267–274. https://doi.org/10.1097/gme.0b013e3182976f46

6. Carter J, Stabile C, Gunn A, Sonoda Y. The physical consequences of gynecologic cancer surgery and their impact on sexual, emotional, and quality of life issues. J Sex Med. 2013 Feb;10 Suppl 1:21–34. https://doi.org/10.1111/jsm.12002

7. Menopause and menopause in women. Clinical recommendations. Мoscow, 2021.

8. British Gynaecological Cancer Society and British Menopause Society guidelines Management of menopausal symptoms following treatment of gynaecological cancer. Available at: https://www.bgcs.org.uk/wp-content/uploads/2024/09/BGCS-BMS-Guidelines-on-Management-of-Menopausal-Symptoms-after-Gynaecological-Cancer-09.09.24.pdf Accessed: 25.07.2025.

9. Faubion SS, Larkin LC, Stuenkel CA, Bachmann GA, Chism LA, Kagan R, et al. Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women's Sexual Health. Menopause. 2018 Jun;25(6):596–608. https://doi.org/10.1097/gme.0000000000001121

10. Sánchez-Prieto M, Pingarrón C, Bergamaschi L, Bermúdez JC, Subiris González J, Sánchez Sánchez R, et al. Prospective, multicenter, uncontrolled study on the effectiveness and safety of a hyaluronic acid water-based vaginal lubricant in alleviating vaginal dryness and dyspareunia. Gynecol Endocrinol. 2024 Mar 5;40(1):2317268. https://doi.org/10.1080/09513590.2024.2317268

11. De Seta F, Caruso S, Di Lorenzo G, Romano F, Mirandola M, Nappi RE. Efficacy and safety of a new vaginal gel for the treatment of symptoms associated with vulvovaginal atrophy in postmenopausal women: A double-blind randomized placebo-controlled study. Maturitas. 2021 May;147:34–40. https://doi.org/10.1016/j.maturitas.2021.03.002

12. Mkrtchian LS, Kukosh MYu, Bychkova AE, Apolikhina IA, Ivanov SA, Kaprin AD, Zamulaeva IA. The use of hyaluronic acid in vulvovaginal atrophy in women after antitumor therapy. Obstetrics and Gynecology (Moscow). 2025;8:26–35. https://doi.org/10.18565/aig.2025.191

13. Mkrtchian LS, Kukosh MYu, Bychkova AE, Apolikhina IA, Ivanov SA, Kaprin AD, Zamulaeva IA. Hyaluronic acid in the correction of genitourinary syndrome of menopause in women after anticancer treatment. Obstetrics and Gynecology (Moscow). 2025;10:20–28. https://doi.org/10.18565/aig.2025.192

14. Heinemann K, Ruebig A, Potthoff P, Schneider HP, Strelow F, Heinemann LA, Do MT. The Menopause Rating Scale (MRS) scale: a methodological review. Health Qual Life Outcomes. 2004 Sep 2;2:45. https://doi.org/10.1186/1477-7525-2-45

15. Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C. A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct. 2003 Aug;14(3):164–168; discussion 168. https://doi.org/10.1007/s00192-003-1063-2 Erratum in: Int Urogynecol J Pelvic Floor Dysfunct. 2004 May-Jun;15(3):219.

16. Patent No. 2646453 C1 Russian Federation, МПК A61K 31/047, A61K 31/728, A61P 15/12. Method of treatment of atrophic vaginitis: No. 2017104744: application 15.02.2017: published 05.03.2018. Krikunova LI, Mkrtchyan LS, Galkin VN, et al.; applicant "National Medical Research Radiological Center". EDN ZEDLGX

17. Hofsjö A, Bergmark K, Blomgren B, Jahren H, Bohm-Starke N. Radiotherapy for cervical cancer - impact on the vaginal epithelium and sexual function. Acta Oncol. 2018 Mar;57(3):338–345. https://doi.org/10.1080/0284186x.2017.1400684

18. Dos Santos CCM, Uggioni MLR, Colonetti T, Colonetti L, Grande AJ, Da Rosa MI. Hyaluronic Acid in Postmenopause Vaginal Atrophy: A Systematic Review. J Sex Med. 2021 Jan;18(1):156–166. https://doi.org/10.1016/j.jsxm.2020.10.016

19. Carter J, Goldfarb S, Baser RE, Goldfrank DJ, Seidel B, Milli L, et al. A single-arm clinical trial investigating the effectiveness of a non-hormonal, hyaluronic acid-based vaginal moisturizer in endometrial cancer survivors. Gynecol Oncol. 2020 Aug;158(2):366– 374. https://doi.org/10.1016/j.ygyno.2020.05.025

20. Ribeiro LDS, Silveira RCCP, Vasques CI, de Menêses AG, Dos Reis PED, Ferreira EB. Hyaluronic acid to manage radiotoxicities in gynecological cancer patients: a scoping review. Support Care Cancer. 2024 Jun 18;32(7):439. https://doi.org/10.1007/s00520-024-08614-z

21. Varytė G, Bartkevičienė D. Pelvic Radiation Therapy Induced Vaginal Stenosis: A Review of Current Modalities and Recent Treatment Advances. Medicina (Kaunas). 2021 Apr 1;57(4):336. https://doi.org/10.3390/medicina57040336