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Background: Simultaneous platin-based radiochemotherapy is the standard treatment for patients with advanced or nodal positive cancer of the uterine cervix. There is a large body of literature on therapy-related acute and late morbidity. Chemoradiation-associated necrosis of the uterus has not been described so far. Material, Methods and Results: We report on a patient who was treated by combined chemoradiation for histologically confirmed cervical cancer following laparoscopic staging. The patient was diagnosed with squamous cell cancer of the cervix FIGO IIIA (T3a pN1 M0 G2). External beam radiotherapy was applied using a 3-D-planned four-field technique, covering the pelvic lymph nodes and the primary tumour. The patient was given brachytherapy (single dosis of 5 Gy, covering the tumour, total dose 25 Gy). Cisplatin was simultaneously administered. Following chemoradiation the patient developed pelvic pain and an elevation of CRP in the presence of a normal leukocyte count. On MRI, recurrence was suspected. The patient underwent re-laparoscopy and necrosis of the uterus was diagnosed without any evidence of recurrence. Laparoscopic assisted hysterectomy with bilateral salpingoophorectomy was performed. Conclusion: In patients with persistent or incident pelvic pain, questionable findings in imaging techniques and/or elevated inflammation parameters following completion of chemoradiation for cervical cancer differential diagnosis should include examination for radiogenic necrosis of the uterus and other pelvic organs. Laparoscopy is an ideal technique to exclude or confirm this diagnosis.
Background: Simultaneous platin-based radiochemotherapy is the standard treatment for patients with advanced or nodal positive cancer of the uterine cervix. There is a large body of literature on therapy-related acute and late morbidity. Chemoradiation-associated necrosis of the uterus has not been described so far. Material, Methods and Results: We report on a patient who was treated by combined chemoradiation for histologically confirmed cervical cancer following laparoscopic staging. The patient was diagnosed with squamous cell cancer of the cervix FIGO IIIA (T3a pN1 M0 G2). External beam radiotherapy was applied using a 3-D-planned four-field technique, covering the pelvic lymph nodes and the primary tumor. The patient was given brachytherapy (single dosis of 5 Gy, covering the tumor, total dose 25 Gy). Cisplatin Following chemoradiation the patient developed pelvic pain and an elevation of CRP in the presence of a normal leukocyte count. On MRI, recurrence was suspected. The patient underwent re-laparoscopy and necrosis of the uterus was diagnosed without any evidence of recurrence. Laparoscopic assisted hysterectomy with bilateral salpingoophorectomy was performed. Conclusion: In patients with persistent or incident pelvic pain, questionable findings in imaging techniques and / or elevated inflammation parameters following completion of chemoradiation for cervical cancer differential diagnosis should include for radiogenic necrosis of the uterus and other pelvic organs. Laparoscopy is an ideal technique to exclude or confirm this diagnosis.