Can We Predict Vesicovaginal or Rectovaginal Fistula Formation in Patients With Stage IVA Cervical Cancer?

Biewenga, Petra; Mutsaerts, Meike; Stalpers, Lukas J.A.; Buist, Marrije R.; Schilthuis, Marten S.; Velden, J. van der

doi:10.1111/igc.0b013e3181d224c8

Cited by 43 publications

(32 citation statements)

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“…Several researchers reported the outcome for Stage IVA patients treated with RT alone or CCRT. Those reports showed that survival rates for Stage IVA disease were between 10% and 42%, and LC rates were between 18% and 61% [3, 23–26]. In the present study of C-ion RT, 3yOS and 3yLC for Stage IVA patients were 47% and 66%, respectively.…”

Section: Discussionsupporting

confidence: 42%

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Carbon-ion radiotherapy for locally advanced cervical cancer with bladder invasion

Shiba

Wakatsuki

Kato

et al. 2016

Journal of Radiation Research

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The purpose of this study was to evaluate the efficacy and toxicities of carbon-ion radiotherapy (C-ion RT) for locally advanced cervical cancer with bladder invasion by a subset analysis of pooled data from eight prospective clinical trials at the National Institute of Radiological Sciences. Between June 1995 and January 2014, 29 patients with locally advanced cervical cancer with bladder invasion were identified. The median age was 56 years old (range 31–79 years old). The median tumor size at diagnosis on magnetic resonance imaging was 6.7 cm (range 3.5–11.0 cm). Histologically, 20 patients had squamous cell carcinoma and 9 had adenocarcinoma. C-ion RT was performed as a dose-escalation study in the initial trials. All patients received prophylactic whole-pelvic or extended-field irradiation and local boost. The total dose to the cervical tumor was 52.8–74.4 Gy (relative biological effectiveness) in 20 or 24 fractions. Weekly cisplatin (40 mg/m2/week, five cycles) was concurrently given to four patients. The median follow-up of all patients was 28.6 months (range 8.8–238.6 months). Grade 2 or higher late complications in the bladder were observed in eight patients, with seven developing vesicovaginal fistula. Six patients had Grade 2 or higher complications in the rectosigmoid colon. The 3-year overall survival rate was 47%, the 3-year local control rate was 66%, and the 3-year disease-free survival rate was 28%. In this study, C-ion RT showed favorable local control with reasonable toxicities, but the results were still unsatisfactory. We have the expectation of improvement of therapeutic effects by using C-ion RT with concurrent chemotherapy.

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Section: Discussionsupporting

confidence: 42%

“…Biewenga et al . reported that 22% of treated patients developed vesicovaginal fistula at a median time of 9 months [23], and Moore et al . reported that 48% developed vesicovaginal fistula at a median time of 2.9 months [25].…”

Section: Discussionmentioning

confidence: 99%

Carbon-ion radiotherapy for locally advanced cervical cancer with bladder invasion

Shiba

Wakatsuki

Kato

et al. 2016

Journal of Radiation Research

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“…As a result of symptoms including leaking urine or stools, persistent bleeding, vulnerability to infection and unbearable pain, patients may suffer significant physical, social and psychological distress which negatively impacts on their quality of life [ 24 , 25 ]. The incidence of radiation-induced fistulas was estimated as between 1 % and 4 % for all-comers, while this number can be as high as 22–48 % for more advanced stages, which is similar to our findings [ 24 , 26 ]. In the current series, the incidence of fistula and SCRP (as the main symptoms of patients who underwent surgery) in the RRT group was significantly higher than that in the RS + RT group (17.4 % vs 5.8 % [ p = 0.020] and 10.9 % vs 1.7 % [ p = 0.027], respectively).…”

Section: Discussionsupporting

confidence: 92%

“…They observed an incidence of recto-sigmoid morbidity of < 4 % with doses below 75 Gy and 9 % with higher doses; for the small intestine the incidence of morbidity was < 1 % after a total dose of ≤50 Gy, 2 % after 50–60 Gy and 5 % after higher doses. Previous series have noted a variety of risk factors for severe late toxicities, but common predictors tend to include advancing tumour stage, previous pelvic radiotherapy, the use of RS, an active smoking habit and elevated RT doses [ 29 , 11 , 26 ]. The poor wound-healing characteristics that increase susceptibility to fistula development can largely be attributed to sclerosis in small and medium sized blood vessels, relative tissue hypoxia and soft tissue fibrosis that occurs following RT [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical features, outcome and risk factors in cervical cancer patients after surgery for chronic radiation enteropathy

et al. 2015

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BackgroundRadical hysterectomy and radiotherapy have long been mainstays of cervical cancer treatment. Early stage cervical cancer (FIGO stage IB1–IIA) is traditionally treated using radical surgery combined with radiotherapy, while locally advanced cervical cancer is treated using radiotherapy alone or chemoradiotherapy. In this retrospective study, we describe and analyse the presenting clinical features and outcomes in our cohort and evaluate possible risk factors for postoperative morbidity in women who underwent surgery for chronic radiation enteropathy (CRE).MethodsOne hundred sixty-six eligible cervical cancer patients who underwent surgery for CRE were retrospectively identified between September 2003 and July 2014 in a prospectively maintained database. Among them, 46 patients received radical radiotherapy (RRT) and 120 received radical surgery plus radiotherapy (RS + RT). Clinical features, postoperative morbidity and mortality, and risk factors for postoperative morbidity were analysed.ResultsRS + RT group patients were more likely to present with RTOG/EORTC grade III late morbidity (76.1 % vs 92.5 %; p = 0.004), while RRT group patients tended to show RTOG/EORTC grade IV late morbidity (23.9 % vs 7.5 %; p = 0.004). One hundred forty patients (84.3 %) were treated with aggressive resection (anastomosis 57.8 % and stoma 26.5 %). Overall and major morbidity, mortality and incidence of reoperation in the RRT and RS + RT groups did not differ significantly (63 % vs 64.2 % [p = 1.000], 21.7 % vs 11.7 % [p = 0.137], 6.5 % vs 0.8 % [p = 0.065] and 6.5 % vs 3.3 % [p = 0.360], respectively). However, incidence of permanent stoma and mortality during follow-up was higher in the RRT group than in the RS + RT group (44.2 % vs 12.6 % [p = 0.000] and 16.3 % vs 3.4 % [p = 0.004], respectively). In multivariate analysis, preoperative anaemia was significantly associated with overall morbidity (p = 0.015), while severe intra-abdominal adhesion (p = 0.017), ASA grades III–V (P = 0.022), and RTOG grade IV morbidity (P = 0.018) were predicators of major morbidity.ConclusionsRadiation-induced late morbidity tended to be severe in the RRT group with more patients suffering RTOG/EORTC grade IV morbidity, while there were no significant differences in postoperative morbidity, mortality and reoperation. Aggressive resection was feasible with acceptable postoperative outcomes. Severe intra-abdominal adhesion, ASA grades III–V and RTOG/EORTC grade IV late morbidity contributed significantly to major postoperative morbidity.

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“…Elles concernent environ 10 % des patients. Les fistules vésico-vaginales sont rares et le risque est d'autant plus important que la tumeur initiale envahissait la vessie et/ou le rectum (stade FIGO IVA) [49]. Exceptionnelles, les sténoses urétérales peuvent se manifester par une douleur lombaire liée à l'hydronéphrose en amont.…”

Section: Toxicité Urinaireunclassified

Suivi après radiothérapie pour un cancer du col utérin

Cao¹,

Mazeron²,

Barillot³

2015

Cancer/Radiothérapie

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Can We Predict Vesicovaginal or Rectovaginal Fistula Formation in Patients With Stage IVA Cervical Cancer?

Abstract: The risk to develop vesicovaginal and/or rectovaginal fistulae is high after curative radiotherapy with or without chemotherapy and/or hyperthermia in patients with stage IVA cervical cancer. We could not identify further pretreatment factors that might have predicted fistula formation.

Cited by 43 publications

References 19 publications

Carbon-ion radiotherapy for locally advanced cervical cancer with bladder invasion

Carbon-ion radiotherapy for locally advanced cervical cancer with bladder invasion

Clinical features, outcome and risk factors in cervical cancer patients after surgery for chronic radiation enteropathy

Suivi après radiothérapie pour un cancer du col utérin

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