Abstract
BackgroundWe encountered a woman with vaginal cancer that was associated with complete uterine prolapse and complicated by severe intrauterine adhesions. In this case report, we describe the clinical course and successful treatment of this rare condition.Case presentationA 78-year-old woman (gravida 10, para 2, abortion 8) with a 10-year history of uterine prolapse presented for evaluation of bleeding from an ulceration on the surface of the irreducibly prolapsed uterus. Biopsy of a mass on her vaginal wall led to a diagnosis of keratinizing squamous cell carcinoma. Her history of eight abortion procedures had resulted in severe intrauterine adhesions, preventing tandem insertion and intracavitary brachytherapy. She was also ineligible for surgery under general anesthesia + chemotherapy because of her advanced age and presence of arrhythmia. Therefore, we devised an extensive treatment plan involving high-dose-rate interstitial brachytherapy. This treatment successfully eliminated the squamous cell carcinoma as confirmed by biopsy with no recurrence or severe late complications.ConclusionsWe found that high-dose-rate interstitial brachytherapy may be a very effective therapeutic strategy for this condition with few adverse effects.
Highlights
We encountered a woman with vaginal cancer that was associated with complete uterine prolapse and complicated by severe intrauterine adhesions
We found that high-dose-rate interstitial brachytherapy may be a very effective therapeutic strategy for this condition with few adverse effects
The patient had a history of several abortion procedures, and the resultant severe intrauterine adhesions prevented insertion of the tandem
Summary
Among various types of pelvic organ prolapse, uterine prolapse is occasionally observed in parous women and women of advanced age. We planned high-dose-rate (HDR) interstitial BT (ISBT), in which plastic needles were directly inserted under direct visual observation to surround the margin of the ulcerated lesion of the vaginal cancer associated with complete uterine prolapse. Very few reports have described detailed irradiation procedures for radiation therapy (RT) in the treatment of vaginal or uterine cervical cancer associated with uterine prolapse [8,9,10] This is the first reported case of this condition complicated by intrauterine adhesions. ISBT was planned, in which plastic needles would be directly inserted into the margin of the ulcerated lesion on the surface of the completely prolapsed uterus under direct visual observation. Three months after additional HDR ISBT, no recurrence or rectal and urinary toxicity had occurred
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