Cervical necrosis after chemoradiation for cervical cancer: case series and literature review

Z.S. Fawaz1, Maroie Barkati1, Marie-Claude Beauchemin1, Philippe Sauthier1, Philippe Gauthier1, Thu Van Nguyen1
1Department of Radiation Oncology and Gynecologic Oncology, Notre-Dame Hospital, University of Montreal Hospital Center (CHUM), Montreal, Canada

Tóm tắt

Abstract Background The aim of this study was to assess the management of cervical necrosis (CN) following radiotherapy (RT) and the impact of smoking status. This rare complication mimics a neoplastic recurrence, and causes concern among attending physicians. Methods Between July 2008 and March 2013, 5 women on 285 with localized cervical cancer had a CN following RT. Patients were treated with concomitant chemoradiation. The medical records were reviewed to abstract demographic and clinical information until March 2013. Results 1.75% (95% confidence interval: 0.23 to 3.28%) developed CN. All patients were smokers with a mean of 19.5 pack-years (range: 7.5-45 pack-years). All patients were treated with weekly Cisplatin chemotherapy and external beam radiation to the pelvis, 45 Gy in 25 fractions. Four patients received an extra boost with a median dose of 7.2 Gy (range: 5.4-10 Gy). All patients had intracavitary brachytherapy (range: 27.9 to 30 Gy). Clinical presentation was similar for all the cases: vaginal discharge associated with pain. Mean time for time post-radiation therapy to necrosis was 9.3 months (range: 2.2-20.5 months). Standard workup was done to exclude cancer recurrence: biopsies and radiologic imaging. Conservative treatment was performed with excellent results. Resolution of the necrosis was complete after a few months (range: 1 to 4 months). Median follow-up until March 2013 was 19 months. All the patients were alive with no clinical evidence of disease. Conclusions This study, the largest to date, shows that conservative management of CN after RT is effective, and should be attempted. This complication is more common in smokers, and counseling intervention should result in fewer complications of CN.

Từ khóa


Tài liệu tham khảo

Dunst J, Haensgen G: Simultaneous radiochemotherapy in cervical cancer: recommendations for chemotherapy. Strahlenther Onkol 2001,177(12):635-640. 10.1007/PL00002376

Strauss HG, Kuhnt T, Laban C, Puschmann D, Pigorsch S, Dunst J, Koelbl H, Haensgen G: Chemoradiation in cervical cancer with cisplatin and high-dose rate brachytherapy combined with external beam radiotherapy. Results of a phase-II study. Strahlenther Onkol 2002,178(7):378-385. 10.1007/s00066-002-0956-1

Thomas GM: Improved treatment for cervical cancer–concurrent chemotherapy and radiotherapy. N Engl J Med 1999,340(15):1198-1200. 10.1056/NEJM199904153401509

Vale C, Tierney JF, Stewart LA, Brady M, Dinshaw K, Jakobsen A, Parmar MK, Thomas G, Trimble T, Alberts DS, Chen H, Cikaric S, Eifel PJ, Garipagaoglu M, Keys H, Kantardzic N, Lal P, Lanciano R, Leborgne F, Lorvidhaya V, Onishi H, Pearcey RG, Pras E, Roberts K, Rose PG, Thomas G, Whitney CW: Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol 2008,26(35):5802-5812.

Eifel PJ, Levenback C, Wharton JT, Oswald MJ: Time course and incidence of late complications in patients treated with radiation therapy for FIGO stage IB carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 1995,32(5):1289-1300. 10.1016/0360-3016(95)00118-I

Kirwan JM, Symonds P, Green JA, Tierney J, Collingwood M, Williams CJ: A systematic review of acute and late toxicity of concomitant chemoradiation for cervical cancer. Radiother Oncol 2003,68(3):217-226. 10.1016/S0167-8140(03)00197-X

Gellrich J, Hakenberg OW, Oehlschläger S, Wirth MP: Manifestation, latency and management of late urological complications after curative radiotherapy for cervical carcinoma. Onkologie 2003,26(4):334-340. 10.1159/000072091

Hermans TJ, Delaere KP, Mens JW, Paffen ML: Necrotic bladder following radiotherapy for cervical carcinoma. Ned Tijdschr Geneeskd 2012,155(35):A4951.

Matthews KS, Rocconi RP, Straughn JM Jr: Complete uterine necrosis following chemoradiation for advanced cervical cancer: a case report. Gynecol Oncol 2007,106(1):265-267. Epub 2007 May 10 10.1016/j.ygyno.2007.04.001

Marnitz S, Köhler C, Füller J, Hinkelbein W, Schneider A: Uterus necrosis after radiochemotherapy in two patients with advanced cervical cancer. Strahlenther Onkol 2006,182(1):45-51. 10.1007/s00066-006-1455-6

Güth U, Ella WA, Olaitan A, Hadwin RJ, Arora R, McCormack M: Total vaginal necrosis: a representative example of underreporting severe late toxic reaction after concomitant chemoradiation for cervical cancer. Int J Gynecol Cancer 2010,20(1):54-60. 10.1111/IGC.0b013e3181c4a63f

Rhomberg W, Eiter H: Radiation-induced vaginal necrosis. Strahlenther Onkol 1988,164(9):527-530.

De Muylder X, Corman J, Giroux L, Methot Y, Poljicak M, Péloquin A, Audet-Lapointe P, Smeesters C, Beland G, Falardeau M: Complications of the treatment of cervix neoplasms by radiotherapy. Can J Surg 1986,29(4):267-272.

Barchet S, Janovski NA: Massive uterine necrosis following irradiation for early cervical carcinoma in pregnancy. Med Ann Dist Columbia 1966,35(2):71-74.

Rahman MM, Laher I: Structural and functional alteration of blood vessels caused by cigarette smoking: an overview of molecular mechanisms. Curr Vasc Pharmacol 2007,5(4):276-292. 10.2174/157016107782023406

Csordas A, Bernhard D: The biology behind the atherothrombotic effects of cigarette smoke. Nat Rev Cardiol 2013,10(4):219-230. 10.1038/nrcardio.2013.8

Barkati M, Fortin I, Mileshkin L, Bernshaw D, Carrier JF, Narayan K: Hemoglobin level in cervical cancer: a surrogate for an infiltrative phenotype. Int J Gynecol Cancer 2013,23(4):724-729. 10.1097/IGC.0b013e31828a0623

Fink D, Chetty N, Lehm JP, Marsden DE, Hacker NF: Hyperbaric oxygen therapy for delayed radiation injuries in gynecological cancers. Int J Gynecol Cancer 2006,16(2):638-642. 10.1111/j.1525-1438.2006.00388.x