title: Pelvic radiation necrosis and osteomyelitis following chemoradiation for advanced stage vulvar and cervical carcinoma.
abstract: BACKGROUND
  The treatment regimen indicated for most advanced stage vulvar, vaginal, and cervical cancer usually involves adjuvant chemoradiation therapy. Although the risk of complications is low, there have been reported cases of radiation necrosis and osteomyelitis following treatment for vulvar, vaginal, and cervical cancer.
  
  
  METHODS
  We present a vulvar cancer patient and a cervical cancer patient, both of whom were treated with radical surgery and postoperative chemoradiation. Following therapy, they were afflicted with pelvic radiation necrosis and osteomyelitis. The patients underwent surgery to resect the necrotic bone tissue and long-term antibiotic therapy to treat their osteomyelitis. They have since recovered and are followed closely by their gynecologic oncology and infectious disease physicians.
  
  
  CONCLUSIONS
  The radiotherapy utilized to treat advanced stage gynecologic cancer can cause intestinal, vaginal, and urologic complications from micro-vascular damage to the organs. Pelvic bone osteonecrosis is a rare but disabling complication of pelvic radiation. Fortunately, with aggressive therapy, these patients may do well clinically.
authors.affiliation: Gynecologic Oncology Associates, Hoag Memorial Hospital Cancer Center, 351 Hospital Road, Suite 507, Newport Beach, CA 92663, USA. bram@gynocology.com
authors.forename: John P
authors.initials: JP
authors.lastname: Micha
authors.forename: Bram H
authors.initials: BH
authors.lastname: Goldstein
authors.forename: Mark A
authors.initials: MA
authors.lastname: Rettenmaier
authors.forename: James T
authors.initials: JT
authors.lastname: Caillouette
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Fee
authors.forename: John V
authors.initials: JV
authors.lastname: Brown
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008875:Middle Aged; D009336:Necrosis; D009367:Neoplasm Staging; D010019:Osteomyelitis / Q000139:chemically induced / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D010388:Pelvis / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D011832:Radiation Injuries / Q000139:chemically induced / Q000209:etiology* / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D014846:Vulvar Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery