Carbon dioxide laser treatment for vulvovaginal atrophy in women treated for breast cancer: Preliminary results of the feasibility EPIONE trial

Contexte et objectif: La préservation de la qualité de vie après un traitement anticancéreux est un défi majeur pour les survivantes du cancer du sein. Environ 42 à 70 % des patients qui reçoivent une thérapie systémique pour le cancer du sein, y compris une thérapie endocrinienne, développeront une atrophie vulvo-vaginale (AVV). Pour ces patientes, les traitements à base de gel couramment proposés pour les applications topiques sont restrictifs. Récemment, des approches thérapeutiques innovantes et non hormonales, telles que la thérapie laser, ont fait leur apparition. L'objectif de cette étude de faisabilité est d’étudier la sécurité et l'efficacité de la thérapie au laser CO2 chez les femmes ayant des antécédents de cancer du sein. Matériel et méthodes: Cette étude monocentrique prospective a porté sur 20 patientes atteintes d'AVV qui ont été traitées à l'hôpital universitaire Henri Mondor entre 2017 et 2018. Nous avons inclus des patientes ayant un indice de santé vaginale (IHV) 11, et à M6, seuls 15 % avaient un score de détresse sexuelle féminine > 11. Aucun effet secondaire n'a été signalé lors du suivi. Conclusion: Cette étude de faisabilité pilote a montré que le traitement par laser au dioxyde de carbone semble être une méthode efficace et sûre pour améliorer la trophicité et diminuer la sécheresse de la muqueuse vaginale chez les femmes atteintes d'atrophie vulvo-vaginale qui s'est développée après un traitement systémique du cancer du sein

Carbon dioxide laser treatment for vulvovaginal atrophy in women treated for breast cancer: Preliminary results of the feasibility EPIONE trial

International audienceBackground and objective: Quality of life preservation after anti-cancer therapy is a major challenge for breast cancer survivors. Approximately 42-70% of patients who receive systemic therapy for breast cancer, including endocrine therapy, will develop vulvovaginal atrophy (VVA). For these patients, the commonly proposed gel-based treatments for topical applications are restrictive. Recently, innovative, non-hormonal therapeutic approaches, such as laser therapy, have emerged. The purpose of this feasibility study is to investigate the safety and efficacy of CO2 laser therapy in women with a history of breast cancer.Material and methods: This prospective monocentric study included 20 patients with vulvovaginal atrophy who were treated at Henri Mondor University Hospital between 2017 and 2018. We included patients with a vaginal health index (VHI) score11, and at M6, only 15% had a female sexual distress score>11. No side effects were reported during follow-up.Conclusion: This pilot feasibility study showed that carbon dioxide laser treatment appears to be an effective and safe method to improve the trophicity and decrease vaginal mucosal dryness in women with vulvovaginal atrophy that developed after systemic breast cancer therapy

Maternal asthma in relation to infant size and body composition

BACKGROUND: Asthma affects 10% of pregnancies and may influence offspring health, including infant size and body composition, through hypoxic and inflammatory pathways. OBJECTIVE: We sought to determine associations between maternal asthma and asthma phenotypes during pregnancy and infant size and body composition. METHODS: The B-WELL-Mom study (2015-19) is a prospective cohort of 418 pregnant persons with and without asthma recruited in the first trimester of pregnancy from 2 US obstetric clinics. Exposures were maternal self-reported active asthma (n = 311) or no asthma (n = 107), and asthma phenotypes were classified on the bases of atopy, onset, exercise induced, control, severity, symptomology, and exacerbations. Outcomes were infant weight, length, head circumference, and skinfold measurements at birth and postnatal follow-up, as well as fat and lean mass assessed by air displacement plethysmography at birth. Adjusted multivariable linear regression examined associations of maternal asthma and asthma phenotypes with infant outcomes. RESULTS: Offspring were born at a mean ± SD of 38 ± 2.3 weeks\u27 gestation and were 18 ± 2.2 weeks of age at postnatal follow-up. Infants of participants with asthma had a mean ± SD fat mass of 11.0 ± 4.2%, birth weight of 3045.8 ± 604.3 g, and postnatal follow-up weight of 6696.4 ± 964.2 g, which were not different from infants of participants without asthma (respectively, β [95% confidence interval]: -0.1 [-1.4, 1.3], -26.7 [-156.9, 103.4], and 107.5 [-117.3, 332.3]). Few associations were observed between asthma or asthma phenotypes and infant size or body composition. CONCLUSIONS: In a current obstetric cohort, maternal asthma during pregnancy was not associated with differential infant size or body composition