Locally advanced cervical cancer in renal transplant patients: A dilemma between control and toxicity

Abstract

Treatment of locally advanced cervical cancer in patients with a renal graft requires precautions. The graft is usually in a pelvic position, close to the clinical target volume (CTV). Preserving the graft while ensuring local control is a challenge we have faced in two occasions. We report our experience. We report the cases of 2 patients treated at our institution with a modified workup and therapeutic approach compared with our standard approach. The clinical and technical aspects of both treatments were systematically reviewed and contrasted with reports previously cited in the literature. The first patient received external beam conformal radiotherapy (total dose: 30 Gy in the pelvis) followed by two sessions of MRI-guided brachytherapy (2 × 15 Gy to 90% of the intermediate risk CTV). The second one received pelvic intensity-modulated radiation therapy (total dose: 45 Gy) followed by MRI-guided brachytherapy delivering 15 Gy to 90% of the intermediate risk CTV. Both patients had a complete response and were still in remission more than 2 years after treatment while retaining their graft. No severe late toxicity was reported. External beam radiotherapy followed by brachytherapy is feasible in locally advanced cervical cancer, despite the presence of a kidney graft near the targets. Image-guided adaptive brachytherapy allowed an accurate evaluation of the dose distribution, reaching the recommended treatment thresholds with optimal protection of the graft.