Use of topical benzydamine in gynecology. Prevention of vaginal stenosis in patients following vaginal brachytherapy. Topical benzydamine in the treatment of vaginal radiomucositis. Postirradiation vaginitis. An evaluation of prophylaxis with topical estrogen.
To evaluate the topical anti-inflammatory activity of benzydamine when used as 0.1% solution for vaginal douche, a double blind, parallel group, randomized clinical trial was carried out on 30 patients with vaginitis following internal radiotherapy for carcinoma of the uterus. The patients were divided into 3 groups, one being treated with 0.1% benzydamine plus tricetol as preservative, one with 0.1% benzydamine alone, and one with placebo. Treatment began 12-24 hours after radiotherapy. Benzydamine was found to be significantly superior to placebo in its overall topical anti-inflammatory activity both after 5 and 15 days of treatment. Tricetol did not interfere with the therapeutic effect of benzydamine. The assessment of patients following intracavitary irradiation administered as part of the treatment of gynaecological malignancy reveals vaginal stenosis in the majority. Vaginal dilators are available for daily insertion in an attempt to prevent the formation of adhesions. However, the design of the dilator neglects the fact that the vagina is the most distensible in the upper third and hence many patients develop stenosis of the upper vagina. Many clinicians have abandoned the use of dilators and instead advise patients to have sexual intercourse to prevent the problem. In 1994, we designed a new vaginal stent, which was given to all patients who had received intracavitary irradiation with full instructions about its use. This stent was designed to suit better the true anatomy of the vagina and hence, with correct use, should prevent vaginal stenosis. A retrospective study was undertaken to look at the incidence of vaginal stenosis and this was compared with the incidence in patients using the new stent. The study revealed that 57% of the patients who were advised to have sexual intercourse had stenosis, whereas 11% of the patients using the stent had evidence of stenosis, which, however, was related to their incorrect use of the stent. In those who used the stent correctly there was no evidence of vaginal stenosis. Details of the design of the stent and the problems relating to those who used the stent incorrectly are presented. The findings of this study strongly support the continued use of this vaginal stent in patients who have undergone intracavitary irradiation as a means of preventing this common complication. Radiotherapy for invasive cervical cancer involves a high risk of local complications. Classically, the critical structures are the rectum, the bladder and the bony ring of the pelvis. However, endocavitary curietherapy is an important component in the radiological treatment since it delivers the highest dose to the vaginal mucosa. The anti-inflammatory efficacy of benzydamine in gynaecology, already well documented, was investigated in our controlled clinical study (benzydamine vs. placebo) involving 32 consecutive unselected patients treated by endocavitary curietherapy with 137caesium sources, alone, after radical surgery, or in association with megavoltage external irradiation. In the group with topical benzydamine, we have observed a statistically significant improvement of subjective symptomatology and colposcopic view. On the contrary in the placebo group a worsening of all the clinical parameters considered became evident. nan
These findings reflect the quality of published data regarding interventions for this aspect of the management of radiation induced complications. Although there is grade IC evidence, these studies are not recent, the allocation concealment is unclear in the text, and overall there is a variable level of assessment of the response, emphasising the need for more studies to be conducted with improved designs to clarify the investigative process and support the final result.