Radiotherapy is an important treatment of cervical cancer,the treatment of locally advanced cervical cancer mainly depends on external beam radiotherapy and brachytherapy.However,in the process of the cervical cancer radiotherapy,the vagina has an ambivalent role in the treatment of cervical cancer,being as well a target organ (upper vagina) as an organ at risk.Vaginal radiation-induced injury will appear when it received high doses of radiation.And sexual dysfunction caused by radiation-induced injury has become an important problem cervical cancer survivor.In this article,recent vaginal dose and vaginal radiation injury-related studies have been summarized to unravel the pathophysiological changes,clinical symptoms,clinical diagnosis and treatment of vaginal radiation-induced injury.

Objective To investigate the occurrence and degree of radiation-induced injury in vagina after radical radiotherapy of cervical cancer.Methods A total of 282 cases of patients with cervical cancer were collected from November 2016 to September 2017.All of the above patients underwent radical radiotherapy from 2008 to 2017 in the First Affiliated Hospital of Xi′an Jiaotong University.The patients′International Federation of Gynecology and Obstetrics(FIGO)staging(2009),brachytherapy dose,whether receive synchronous chemotherapy or not,age and body mass index(BMI)for the occurrence and severity of vaginal radiation injury at different time periods were analyzed by cross-sectional survey method.The single factor would be analyzed by the method of Chi-square test and the multiple factors would be analyzed by logistic regression method to checkout. Results Of the 282 patients, the incidence of radiation-injury in vaginal was 84.4%(238/282), with the incidence rate of degree Ⅰ,Ⅱ and Ⅲradiation injury were respectively 50.7%(143/282),29.8%(84/282)and 3.9%(11/282;χ2=153.375,P<0.05),and there was no degree Ⅳ. Until the end of the follow-up time, the incidence of radiation-induced injury in vaginal after completing the treatment within 1 year,1-2 years,>2-<5 years and≥5 years were respectively 80.0%(24/30), 87.2%(102/117), 88.2%(60/68)and 77.6%(52/67; χ2=4.231, P=0.238). There were 30 cases be followed within 1 year after treatment,the incidence rate of degreeⅠ,ⅡandⅢof radiation injury in vagina was 60.0%(18/30), 20.0%(6/30)and 0, respectively (χ2=28.636, P<0.05). There were 117 cases be followed between 1- 2 years after treatment, the incidence rate of degree Ⅰ, Ⅱ and Ⅲ vaginal radiation-induced injury were 54.7%(64/117),29.9%(35/117)and 2.6%(3/117),respectively(χ2=77.198, P<0.05).There were 68 cases be followed between>2-<5 years after treatment,the incidence rate of degreeⅠ,Ⅱ and Ⅲ vaginal radiation-induced injury were 51.5%(35/68),33.8%(23/68)and 2.9%(2/68), respectively(χ2=39.525,P<0.05).There were 67 cases be followed≥5 years after treatment,the incidence rate of degreeⅠ,ⅡandⅢvaginal radiation injury were 38.8%(26/67),29.9%(20/67)and 9.0%(6/67), respectively(χ2=16.395, P<0.05). The single-factor analysis result indicated that the brachytherapy dose had an obvious effect on vaginal radiation-induced injury(χ2=5.344,P=0.021);however,other factors,such as age, BMI, FIGO stages and synchronous chemotherapy, had no obvious effect on vaginal radiation-induced injury(all P>0.05). The multifactor analysis indicated that the brachytherapy dose was an independent factor affecting the occurrence of vaginal radiation-induced injury(P=0.043). Conclusion After the radical radiotherapy of cervical cancer, the vaginal radiation-induced injury is associated with the dose of brachytherapy.