Abstract
Enteric and urinary fistulae secondary to chemoradiation for carcinoma of the uterine cervix are devastating uncommon conditions with a significant impact in quality of life. They can also originate multiple disturbances and complications, mainly recurrent infections. We present two women with locally advanced cervical cancer treated with radiation who presented myositis and osteomyelitis secondary to pelvic infections due to radiation-induced fistulae. Recognizing and managing these complications need a high level of suspicion. Treatment is based on a multimodal approach which includes antimicrobial therapy, nutritional support, and surgical intervention. Revision of the literature is presented.
Highlights
Some of the major causes of morbidity and mortality in locally advanced cervical cancer survivors are derived directly or indirectly from late toxic effects of their treatments
We present two women with locally advanced cervical cancer who developed myositis and osteomyelitis from pelvic infections secondary to radiotherapy-related fistulae
External bean radiotherapy with concomitant Cisplatin chemotherapy plus intracavitary brachytherapy is standard of care for locally advanced cervical cancer, achieving local control rates of 60–70% and 67–80% fiveyear overall survival [1,2,3]
Summary
Some of the major causes of morbidity and mortality in locally advanced cervical cancer survivors are derived directly or indirectly from late toxic effects of their treatments. In 2014, 18 years after these treatments, and with no evidence of malignant relapse, the patient complained of vaginal flow leakage and pelvic pain She was diagnosed by pelvic examination and image studies of vaginal introit necrosis and vesicovaginal fistula. She started suffering recurrent urinary tract infections and needed hospital admission due to a severe pelvic infection. She presented sudden and massive vaginal bleeding that caused hemorrhagic shock requiring Intensive Care Unit admission, strong hemodynamic support, blood transfusions, and uterine right artery embolization Once recovered, she developed severe pain and inflammation on her left thigh. She has a good performance status despite her metastatic bone relapse, but she can not receive a new chemotherapy line due to her severe renal impairment, so she is being followed by Palliative Care Unit
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