Cervical necrosis after chemoradiation for cervical cancer: case series and literature review.
BACKGROUND
The aim of this study was to assess the management of cervical necrosis (CN) following radiotherapy (RT) and the impact of smoking status. This rare complication mimics a neoplastic recurrence, and causes concern among attending physicians.


METHODS
Between July 2008 and March 2013, 5 women on 285 with localized cervical cancer had a CN following RT. Patients were treated with concomitant chemoradiation. The medical records were reviewed to abstract demographic and clinical information until March 2013.


RESULTS
1.75% (95% confidence interval: 0.23 to 3.28%) developed CN. All patients were smokers with a mean of 19.5 pack-years (range: 7.5-45 pack-years). All patients were treated with weekly Cisplatin chemotherapy and external beam radiation to the pelvis, 45 Gy in 25 fractions. Four patients received an extra boost with a median dose of 7.2 Gy (range: 5.4-10 Gy). All patients had intracavitary brachytherapy (range: 27.9 to 30 Gy). Clinical presentation was similar for all the cases: vaginal discharge associated with pain. Mean time for time post-radiation therapy to necrosis was 9.3 months (range: 2.2-20.5 months). Standard workup was done to exclude cancer recurrence: biopsies and radiologic imaging. Conservative treatment was performed with excellent results. Resolution of the necrosis was complete after a few months (range: 1 to 4 months). Median follow-up until March 2013 was 19 months. All the patients were alive with no clinical evidence of disease.


CONCLUSIONS
This study, the largest to date, shows that conservative management of CN after RT is effective, and should be attempted. This complication is more common in smokers, and counseling intervention should result in fewer complications of CN.
Department of Radiation Oncology and Gynecologic Oncology, Notre-Dame Hospital, University of Montreal Hospital Center (CHUM), Montreal, Canada. tvnh58@gmail.com.
Ziad Simon
ZS
Fawaz
Maroie
M
Barkati
Marie-Claude
MC
Beauchemin
Philippe
P
Sauthier
Philippe
P
Gauthier
Thu Van
TV
Nguyen
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D059248:Chemoradiotherapy / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D012907:Smoking / Q000009:adverse effects; D002577:Uterine Cervical Diseases / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000628:therapy*
D000970:Antineoplastic Agents; D002945:Cisplatin