Abstract
Surgical treatment is preferred therapy of early-stage cervical carcinoma. In the risk of cancer recurrence surgery is often followed by adjuvant radiotherapy. In our retrospective study we aimed at identifying late (≥6 months) and very late (≥5 years) radiation adverse effects on imaging scans as CT, PET/CT and MRI in patients who underwent successful treatment for cervical carcinoma by radical surgery combined with radiotherapy ± chemotherapy. We correlated imaging results with clinical manifestations. We selected young and middle-aged patients with long life expectancy, as late radiation-related toxicities may significantly affect their quality of life. Patients were selected from those who were primary diagnosed and treated between the years 1987–2011 and regularly visited our Oncology department in years 2011–2012. Following inclusion criteria were applied: age ≤55 years at diagnosis, clinical follow-up ≥5 years and at least one tomography scan ≥3 years after finished treatment. One hundred and three subjects were reviewed: 73 patients met all inclusion criteria, while 30 patients fulfilled the inclusion criteria except for available tomography scan ≥3 years after therapy. The mean imaging follow-up was 11.2 ± 7.6 years and the mean clinical follow-up was 15.0 ± 6.9 years. In 20 (27%) subjects 27 cases grade I radiation-related toxicities were found; 9 (33%) of those 27 cases were clinically silent. In 14 (19%) females only grade I toxicities were observed. Grade III-IV toxicities were found in 5 (6.8%) subjects. No grade V toxicities were observed. We concluded that severe late side effects caused by radiotherapy were exceedingly rare in females successfully treated for early-stage cervical carcinoma, only 1 bilateral osteonecrosis, 2 cases of ileus, and 2 potentially radiation-induced tumors were found. The majority of radiation-related comorbidities found on imaging scans were clinically silent.
Highlights
Cervical carcinoma is serious health problem worldwide, is the fourth most common cancer in females and the seventh most common cancer overall[1,2]
We showed very late radiationrelated comorbidities after radical RT for advanced cervical cancer and suggested that if successfully treated females present with abdominal/pelvic complaints more than 5 years after RT, it is highly probable that tomography scans will show late radiation-related side effects, which probably influence the quality of patient’s lives[9]
All available medical records of 103 females treated for early-stage cervical cancer that survived more than 5 years from diagnosis were reviewed; 73 patients met all inclusion criteria, while 30 patients were followed by ultrasonography and chest X-ray and were excluded from the radiology imaging study
Summary
Cervical carcinoma is serious health problem worldwide, is the fourth most common cancer in females and the seventh most common cancer overall[1,2]. Despite of current progress in diagnosis and treatment, cervical carcinoma still remains the most common cause of tumor-related death in women under the age of 35 years[1,2]. There is evidence of declining incidence in developed countries in recent years due to cervical screening programs and HPV vaccination efforts[1,2]. The International Federation of Gynecology and Obstetrics (FIGO) system is commonly used for cervical carcinoma staging[2]. Radical surgery is commonly used for the treatment of early stages up to IB2 and IIA1. In younger patients with early-stage disease, fertility-sparing surgery such as conization and trachelectomy is considered. IIB and higher, chemotherapy and combined external beam radiation therapy (EBRT) and intracavitary brachytherapy (BRT) are the main treatment options[2]
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