title: Should helical tomotherapy replace brachytherapy for cervical cancer? Case report.
abstract: BACKGROUND
  Stereotactic body radiation therapy (SBRT) administered via a helical tomotherapy (HT) system is an effective modality for treating lung cancer and metastatic liver tumors. Whether SBRT delivered via HT is a feasible alternative to brachytherapy in treatment of locally advanced cervical cancer in patients with unusual anatomic configurations of the uterus has never been studied.
  
  
  METHODS
  A 46-year-old woman presented with an 8-month history of abnormal vaginal bleeding. Biopsy revealed squamous cell carcinoma of the cervix. Magnetic resonance imaging (MRI) showed a cervical tumor with direct invasion of the right parametrium, bilateral hydronephrosis, and multiple uterine myomas. International Federation of Gynecology and Obstetrics (FIGO) stage IIIB cervical cancer was diagnosed. Concurrent chemoradiation therapy (CCRT) followed by SBRT delivered via HT was administered instead of brachytherapy because of the presence of multiple uterine myomas with bleeding tendency. Total abdominal hysterectomy was performed after 6 weeks of treatment because of the presence of multiple uterine myomas. Neither pelvic MRI nor results of histopathologic examination at X-month follow-up showed evidence of tumor recurrence. Only grade 1 nausea and vomiting during treatment were noted. Lower gastrointestinal bleeding was noted at 14-month follow-up. No fistula formation and no evidence of haematological, gastrointestinal or genitourinary toxicities were noted on the most recent follow-up.
  
  
  CONCLUSIONS
  CCRT followed by SBRT appears to be an effective and safe modality for treatment of cervical cancer. Larger-scale studies are warranted.
authors.affiliation: Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Chen-Hsi
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Ming-Chow
authors.initials: MC
authors.lastname: Wei
authors.forename: Yao-Peng
authors.initials: YP
authors.lastname: Hsu
authors.forename: Ngot-Swan
authors.initials: NS
authors.lastname: Chong
authors.forename: Yu-Jen
authors.initials: YJ
authors.lastname: Chen
authors.forename: Sheng-Mou
authors.initials: SM
authors.lastname: Hsiao
authors.forename: Yen-Ping
authors.initials: YP
authors.lastname: Hsieh
authors.forename: Li-Ying
authors.initials: LY
authors.lastname: Wang
authors.forename: Pei-Wei
authors.initials: PW
authors.lastname: Shueng
mesh_terms: D001706:Biopsy; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D000075202:Contraindications; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007044:Hysterectomy; D018231:Leiomyomatosis / Q000150:complications / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016634:Radiosurgery; D050397:Radiotherapy, Intensity-Modulated; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D014592:Uterine Hemorrhage / Q000209:etiology / Q000628:therapy; D014626:Vaginal Smears