Total vaginal necrosis: a representative example of underreporting severe late toxic reaction after concomitant chemoradiation for cervical cancer.
BACKGROUND
There is paucity of information regarding a late toxic reaction after chemoradiation for locally advanced cervical cancer. We discuss this problem with special consideration to total vaginal necrosis (TVN), an underreported severe late complication of chemoradiation.


METHODS
The records of 98 cervical cancer patients who received chemoradiation at the Department of Oncology of the University College London Hospital between January 2004 and May 2008 were reviewed.


RESULTS
Eight women (8.2%) developed a severe late toxic reaction. From these, 3 patients (3.1% of the entire cohort and 37.5% of the patients with a severe late toxic reaction), who were 44 to 60 years old, developed a TVN 6 to 18 months after completion of chemoradiation. In all the TVN cases, surgical debridement was necessary to alleviate the symptoms. This was followed by an extensive period (up to 24 months) of consolidation. Heavy smoking (P = 0.022) was found to be a significant contributing factor for TVN.


CONCLUSIONS
Total vaginal necrosis is an underreported but serious late complication after chemoradiation and leads to considerable chronic morbidity. Radiologic examinations and biopsies are required to exclude recurrent disease. Microvascular damage from radiation combined with heavy cigarette smoking is likely to be pivotal etiologic factors in the development of TVN. For radiotherapy-induced late toxic effects to step out of the gray area of oncologic literature, the clinical pictures should be reported in a more detailed manner. It might be a promising approach to work out a toxicity scale that combines the existing objectifiable grading systems with subjective quality-of-life assessments.
Department of Gynaecological Oncology, University College London Hospital, 250 Euston Rd, London NW1 2 PG, United Kingdom. ugueth@uhbs.ch
Uwe
U
Güth
Wendy A
WA
Ella
Adeola
A
Olaitan
Richard J
RJ
Hadwin
Rupali
R
Arora
Mary
M
McCormack
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy* / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000009:adverse effects; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008875:Middle Aged; D009336:Necrosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011832:Radiation Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D014621:Vagina / Q000473:pathology*; D014623:Vaginal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology