Standardizing female sexual structure contours to limit radiation therapy toxicity

Purpose: Sexual health and functioning after completion of radiation therapy (RT) for pelvic area tumors are recognized as quality-of-life measures. Negative side effects are heavily considered during treatment planning for male pelvic cancers. Clinicians contour erectile and other sexual functioning tissues to target RT for optimized male sexual health outcomes. However, little attention is given to female sexual functioning after treatment and limited data exists to precisely define female sexual structures. We aim to standardize female sexual structure contouring and illustrate radiation impact on female erectile tissues over time. Further research can identify erectile-tissue specific dosimetric predictors of tissue damage and sexual dysfunction to assist in the development of targeted radiation procedures to mitigate radiation damage and improve quality of life after cancer treatment.

Methods/Materials: Using MIM software, a RT planning CT scan for a 55yo F with FIGO stage 2 Grade 3 endometrial cancer was fused with her diagnostic MRI to assist with contour delineation. Contours were created according to existing data and experienced clinician input.

Results: Female sexual structures in the supine position are contoured in a RT planning non-contrast CT scan and represented in a fused diagnostic MRI. The following contours were created: bulboclitorus, vagina, lower vagina, R and L IPAs, urethra, uterocervix, and R and L ovaries. Guidelines were created with detailed elaboration of steps for future reproducibility.

Conclusions: Sexual functioning after RT is recognized as a quality-of-life measure and must be normalized with equitable distribution of research and technology for female patients. Our contour atlas and guidelines are a first step to close the gap in targeted therapies with the goal of limited sexual toxicity for female patients.