Laser and radiofrequency for treating genitourinary syndrome of menopause in breast cancer survivors: A systematic review of randomized controlled trial

Abstract

Background: Breast cancer survivors (BCS) often experience more severe symptoms of genitourinary syndrome of menopause (GSM). As estrogen-based hormonal therapy is generally avoided in BCS, physical energy methods may offer promising non-hormonal alternatives. However, the efficacy and safety of these treatments remain controversial.

Objectives: To evaluate the efficacy and safety of physical energy methods (laser and radiofrequency) for treating GSM in BCS.

Search strategy: The databases PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, SciELO, LILACS, and Clinical Trial databases were searched from their inception to July 2024, with no language restrictions.

Selection criteria: We included randomized controlled trials (RCTs) that assessed the efficacy and safety of any physical energy methods for treating GSM in BCS.

Data collection and analysis: Two authors independently selected studies based on titles, abstracts, and full texts to meet the inclusion criteria. Due to heterogeneity in methodologies and outcomes, a meta-analysis was not possible, so a narrative synthesis was conducted. Data were extracted, and the risk of bias was assessed using the Cochrane risk-of-bias tool (RoB 2). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the strength of the evidence.

Main results: Three RCTs involving 185 participants, and three different physical methods (microablative fractional CO₂ laser, erbium photothermal yttrium-aluminum-garnet laser, and radiofrequency) met the inclusion criteria for this systematic review. Laser and radiofrequency treatments improved GSM symptoms in BCS, with improvements in dyspareunia, the Vaginal Health Index, and quality of life in the short term, with minimal adverse events. Overall, only one study had a low risk of reporting bias, whereas two studies raised concerns due to critical weaknesses. Confidence in the evidence is low and critical across all studies.

Conclusions: Physical energy methods show short-term safety in treating GSM in BCS. However, limited blinded clinical trials result in uncertain efficacy.

Keywords: atrophy; breast neoplasms; cancer survivors; genitourinary syndrome of menopause (GSM); laser therapy; radiofrequency therapy.