Cervical Stump Cancer Treated With Radiotherapy Using Computed Tomography-Guided Brachytherapy

Abstract

Cervical stump cancer, which arises in the remaining uterine cervix of a woman with a history of supravaginal hysterectomy, accounts for 1.6-4.4% of all cervical cancers. The close proximity of the rectosigmoid colon to the primary tumor, which is due to the absence of the uterine corpus, should be considered carefully in the treatment planning of brachytherapy. Although three-dimensional image-guided brachytherapy (3D-IGBT) is used widely to treat cervical cancer in those with an intact uterine corpus, the safety and efficacy of 3D-IGBT for cervical stump cancer remains unclear. Here, we report a case of cervical stump cancer (T3bN1M0) treated successfully with definitive radiotherapy, which combined external beam radiotherapy and computed tomography (CT)-based IGBT. By applying the dose prescription concept used for definitive brachytherapy of cervical cancer with an intact uterine corpus, IGBT achieved satisfactory dose conformity to the tumor while sparing the adjacent rectosigmoid colon. This led to local tumor control for three years and eight months, with no late adverse effects. This case suggests that radiotherapy using CTbased IGBT is a safe and effective treatment for cervical stump cancer.

Combined intra-cavitary and interstitial image-guided adaptative brachytherapy for cervical stump carcinomas: technical and clinical results of six patients

“…To the best of our knowledge, only one case report of IGABT has been published to date. The technique used and the results are comparable to ours [ 4 ]. Six retrospective studies have evaluated brachytherapy in cervical stump cancer [ 7 - 12 ].…”

“…Previous studies have reported the efficacy and feasibility of brachytherapy with cesium or radium sources, but to the best of our knowledge, there are very scarce data with modern image-guided brachytherapy [ 4 ].…”

The application of 3D brachytherapy in cervical stump cancer: A retrospective study

“…In 2021, Okada et al . reported a case of cervical stump cancer (T3bN1M0) successfully treated by combining external beam radiotherapy and CT-based IGBT [ 13 ]. Using tandem and ovoid applicators in brachytherapy, an EQD 2 of 69.6 Gy was delivered to the patient for HR-CTV.…”

Subtotal hysterectomy reviewed: a stable or aperture for stump cervical malignancy. A referral hospital experience

“…Personal preferences should be made by women once informed with the correct information by her service provider, including the occurrence of a future cancerous tumour or its presence during the first surgery, the difficulty and complexity of a second surgery if needed, the presence of health complications including present and future, especially that of late diagnosis, the type of tumour, the degree of its distinctiveness, the health condition of the woman, and the difficulty in classifying the disease stage to develop the appropriate ideal treatment plan, which would deprive her of the ideal plan for her condition. Perhaps, the existence of therapeutic alternatives gives this category of patient treatment opportunities, such as radiotherapy and chemotherapy, or both [ 29 , 30 ]. The high percentage of health problems of the cervix is a warning bell and a warning signal that ought to be respected and taken into account, and the priorities of the surgical decision to treat uterine problems must be reviewed and rehabilitated within the surgical skills, provided that the speed factor does not involve conducting the operation, so posting the health problems of the future makes it more difficult, and adherence to the surgical and therapeutic foundations, line facilitate its way of healing and open a path to a renewed confidence.…”