Cervical Stump Cancer Treated With Radiotherapy Using Computed Tomography-Guided Brachytherapy.

Kohei Okada,Nobuteru Kubo,Ken Ando,Tatsuya Ohno,Takahiro Oike

doi:10.7759/cureus.13789

Abstract

Cervical stump cancer, which arises in the remaining uterine cervix of a woman with a history of supravaginal hysterectomy, accounts for 1.6-4.4% of all cervical cancers. The close proximity of the rectosigmoid colon to the primary tumor, which is due to the absence of the uterine corpus, should be considered carefully in the treatment planning of brachytherapy. Although three-dimensional image-guided brachytherapy (3D-IGBT) is used widely to treat cervical cancer in those with an intact uterine corpus, the safety and efficacy of 3D-IGBT for cervical stump cancer remains unclear. Here, we report a case of cervical stump cancer (T3bN1M0) treated successfully with definitive radiotherapy, which combined external beam radiotherapy and computed tomography (CT)-based IGBT. By applying the dose prescription concept used for definitive brachytherapy of cervical cancer with an intact uterine corpus, IGBT achieved satisfactory dose conformity to the tumor while sparing the adjacent rectosigmoid colon. This led to local tumor control for three years and eight months, with no late adverse effects. This case suggests that radiotherapy using CT-based IGBT is a safe and effective treatment for cervical stump cancer.

Highlights

Cervical stump cancer occurs in the remaining uterine cervix of a woman who has undergone supravaginal hysterectomy for benign diseases such as uterine fibroids, benign ovarian tumors, and postpartum hemorrhage
The entire cervix and the surrounding tumor infiltrate were delineated as the high risk-clinical target volume (HR-CTV), and treatment plans were created with the goal of delivering 6 Gy or greater to the HR-CTV per session while minimizing the dose delivered to the rectosigmoid colon and bladder (Figure 2B, 2C) [11]
If we focus on studies that use central shielding techniques for external body radiotherapy (EBRT), Ohno et al reported the outcome of definitive chemoradiotherapy using computed tomography (CT)-based IGBT for 80 patients with locally advanced cervical cancer [11]

Summary

Introduction

Cervical stump cancer occurs in the remaining uterine cervix of a woman who has undergone supravaginal hysterectomy for benign diseases such as uterine fibroids, benign ovarian tumors, and postpartum hemorrhage. In patients with cervical stump cancer, the rectosigmoid colon is located in close proximity to the primary tumor due to the absence of the uterine corpus. The entire cervix and the surrounding tumor infiltrate were delineated as the high risk-clinical target volume (HR-CTV), and treatment plans were created with the goal of delivering 6 Gy or greater to the HR-CTV per session while minimizing the dose delivered to the rectosigmoid colon and bladder (Figure 2B, 2C) [11]. The total equivalent dose in 2 Gy-fractions for external beam radiotherapy plus brachytherapy (EQD2) was calculated using an a/b ratio of 10 and 3 for the HR-CTV and for the organs at risk, respectively. At three years and eight months after radiotherapy, the patient shows no evidence of recurrence or late adverse effects (e.g., the gastrointestinal or genitourinary hemorrhage, edema of the lower extremities, and pelvic bone fracture)

Discussion

Findings

Conclusions

Disclosures