Evidence-Based Treatment Paradigms for Management of Invasive Cervical Carcinoma

Acute extraperitoneal spontaneous bladder rupture in cervical cancer patient undergoing chemoradiation: A case report and review of the literature

“…A search was performed in PubMed with the terms “spontaneous bladder rupture AND cervical cancer” yielding 14 results through April 2020. In February 1999, the National Cancer Institute (NCI) alerted oncologists that concomitant chemotherapy and radiotherapy should be considered for all patients with invasive cervical cancer ( Tewari and Monk, 2019 ). Therefore, studies were included if they detailed clinical information on individual patients with a history and timeline of treatment after 1999 with SBR.…”

“…Cervical cancer remains a relatively rare diagnosis in the United States. However, it is a preventable cancer which accounts for 4,000 deaths a year ( Tewari and Monk, 2019 ). Locally advanced cervical cancer, which includes FIGO Stage IB3 through IVA, is primarily treated with pelvic radiotherapy, sensitizing cisplatin and intracavitary brachytherapy ( Rose et al, 1999 , Morris et al, 1999 ).…”

“…Locally advanced cervical cancer, which includes FIGO Stage IB3 through IVA, is primarily treated with pelvic radiotherapy, sensitizing cisplatin and intracavitary brachytherapy ( Rose et al, 1999 , Morris et al, 1999 ). The addition of cisplatin to radiation as well as the advent of modern radiation techniques have shown incremental benefits in survival and pelvic control ( Tewari and Monk, 2019 , Rose et al, 1999 ). However, this treatment paradigm is associated with urologic complications due to the anatomic proximity of these organs to the cervix.…”

“…However, this treatment paradigm is associated with urologic complications due to the anatomic proximity of these organs to the cervix. Typically, urologic toxicities are low-grade, with the majority of patients experiencing minimal or no adverse effects ( Tewari and Monk, 2019 , Rose et al, 1999 ). High-grade toxicities increase over time after completion of treatment, most commonly involving ureteric stricture formation, vesicovaginal fistulas, or hemorrhagic cystitis at rates ranging from 1.8 to 14.5% at 3 years post therapy ( Lobo et al, 2018 ).…”

Results of an early safety analysis of a study of the combination of pembrolizumab and pelvic chemoradiation in locally advanced cervical cancer

“…Although a number of ongoing trials are testing immunotherapy in combination with radiation therapy, there are no published data regarding the safety of ICIs in combination with pelvic CRT. 3,4 The main concern with concurrent use is the potential for overlapping toxicity, particularly in the gastrointestinal (GI) tract in the case of pelvic CRT, and the difficulty in distinguishing immunological GI effects from the acute toxicity of pelvic CRT alone presents an investigational challenge. 5 In fact, GI toxicity with pelvic CRT alone is common; in one study, it occurred in 38% of patients receiving treatment, and 10% of these cases were grade 3 or 4.…”