Abstract
BackgroundThe 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.MethodsBetween 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.Results1.75% (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.ConclusionsThis 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.
Highlights
The aim of this study was to assess the management of cervical necrosis (CN) following radiotherapy (RT) and the impact of smoking status
Intracavitary brachytherapy consisted of high-dose rate (HDR) brachytherapy and was usually started during external beam radiotherapy (EBRT)
Of the 285 women treated during this period, 5 (1.75%, 95% confidence interval: 0.23 to 3.28%) developed CN after chemoradiation for cervical carcinoma
Summary
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. Since 1986, 5 case reports, the largest of which consisted of 3 patients, have been published in further support of CN following RT for a total of only 12 cases described in the literature [9,10,11,12,13] Interest in this field comes from more than half a century ago with a case report on uterine necrosis following irradiation for cervical carcinoma [14]. Radiation therapy treatment has changed since and limited information in the oncologic literature is available for the clinicians on the management of this complication, with most of the studies suggesting laparoscopic examination and surgical intervention
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