Squamous cell carcinoma of the cervix: report of an unusual case of bicornuate bicollis uterus treated with bilateral intracavity brachytherapy

Loo, H W; Locks, S M

doi:10.1259/bjr/98391292

Cited by 14 publications

(21 citation statements)

References 8 publications

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“…To the best of our knowledge, there have been only four reported cases (17)(18)(19)(20) of BT in patients with uterine anomalies (Table II). No dose-volume histogram comparisons with insertion of the tandem implant into the right versus left uterine canals were reported in any of those cases.…”

Section: Discussionmentioning

confidence: 99%

“…One reported case involved a bicornuate uterus. In that case, a mold was inserted vaginally, and from there a radiation source was inserted into one uterine canal, whereas a marker was inserted into the other uterine canal and the position of the marker of point A of the other side was calculated; this process was repeated for the opposite canal (18). The fourth patient had a partial septate uterus.…”

Section: Discussionmentioning

confidence: 99%

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Brachytherapy for cervical cancer in septate uterus: Dose-volume differences with tandem implant placement in right vs. left uterine canal: A case report

et al. 2018

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Abstract. Brachytherapy is a standard treatment modality for locally advanced cervical cancer. In patients with uterine anomalies, the radiation dose to the target volume and the organs at risk can vary depending on the positioning of the brachytherapy tandem implant. However, there have been few reports concerning the use of brachytherapy in patients with uterine anomalies. The present study reports the case of a 55-year-old woman with locally advanced squamous cell carcinoma of the cervix and complete septate uterus. The patient was treated with external-beam radiation therapy, cisplatin chemotherapy, and brachytherapy. Computed tomography-based planning was performed for image-guided brachytherapy with the tandem implant alternately in the right and left uterine canals and using the right and left point A. A comparison of the resulting dose-volume histograms revealed wide variations in the projected dose to the clinical target volume and organs at risk. Tandem implant positioning for brachytherapy was chosen to optimize the dose-volume distribution. At the point of writing, the patient has not experienced local recurrence. IntroductionThe standard treatment for locally advanced cervical cancer is pelvic external beam radiation therapy (EBRT) with concurrent cisplatin chemotherapy and brachytherapy (BT) (1-3).Recently, 3D image-guided brachytherapy (IGBT), which uses computed tomography (CT) or magnetic resonance imaging (MRI) to obtain images of inserted applicators, has come into widespread use (4-6). The present study reports the use of BT in a patient with locally advanced cervical cancer involving a complete septate uterus with right and left uterine canals. Prior to treatment, CT images were obtained with a tandem implant inserted alternately into the right and left uterine canals. A treatment-planning system was used to compare the resulting dose volumes; the uterine canal that was associated with optimal distribution of the dose volume was chosen for BT. There have been only a few reports of BT in patients with uterine anomalies. To the best of our knowledge, this is the first case in which the dose-volume difference between tandem implant placement in the right versus left uterine canal was examined. Case report Patient presentation and diagnosis.A 55-year-old woman presented with a 1-month history of general malaise. A high creatinine level of 2.26 mg/dl (normal range, 0.46-0.79 mg/dl) was found upon hematological examination; CT revealed that a cervical tumor was causing bilateral hydronephrosis involving the bilateral ureters. Therefore, bilateral ureteral stents were inserted. Tissue biopsy of the cervical tumor led to a diagnosis of squamous cell carcinoma. MRI revealed that the endometrial cavity was separated into right and left canals by a septum on the cranial side of the cervical tumor (Fig. 1A and B). The septum reached the level of the internal cervical os, indicating a complete septate uterus corresponding to class V of the American Society of Reproductive Medicine classification (7) and ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Brachytherapy for cervical cancer in septate uterus: Dose-volume differences with tandem implant placement in right vs. left uterine canal: A case report

et al. 2018

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“…The development of female urogenital tract in utero starts around the sixth week of embryological life. Three main structures are involved as genital ridge, Wolffian (mesonephric) ducts, and Müllerian (paramesonephric) ducts [ 17 ]. Although, there is no universally accepted and interpreted classification scheme for uterine anomalies, one of the most commonly used classification scheme is the American Fertility Society Classification, which was established in 1988 [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Loo et al . reported a case of FIGO stage IIB squamous cell carcinoma with congenital abnormality of bicornuate bicollis uterus, which is a class IV Müllerian duct anomaly [ 17 ]. They inserted intra-uterine BRT applicator into both uterine cavities.…”

Section: Discussionmentioning

confidence: 99%

Locally advanced squamous cell cervical cancer in a patient with septate uterus

Yavaş¹,

Yavaş²,

Inan³

2017

jcb

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A 33-year-old premenopausal multiparous woman with the history of septate uterus was referred to the hospital with menorrhagia and inter-menstrual bleeding occurring for the last 6 months. Work-up revealed a stage IIB cervical cancer. The patient underwent curative chemo/radiotherapy. The patient’s septate uterus presented several difficulties during application. Brachytherapy was applied using standard computed tomography-compatible tandem and ovoids. The high-risk clinical target volume (HR-CTV), intermediate risk CTV, and organs at risk were contoured according to the Groupe Européen de Curiethérapie – European Society for Radiology and Oncology (GEC-ESTRO) guidelines. Treatment was performed via 3-dimensional high-dose-rate technique with 192Ir, with brachytherapy dose of 28 Gy in 4 fractions/7 Gy each, prescribed to the HR-CTV. Treatment was well tolerated with manageable acute toxicities. To the best of our knowledge, the current case is the second case of septate uterus with locally advanced cervical carcinoma. Due to the lack of guidelines about brachytherapy applications in patients with uterine anomaly and owing to the anatomical anomaly, brachytherapy application is challenging in this patients population.

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“…The second report published by Loo et al [24]. described a patient with bicornuate bicollis uterus with carcinoma involving both cervices.…”

Section: Treatment Of Cervical Carcinoma Among Patients With Mülleriamentioning

confidence: 97%

Műllerian duct anomalies and their effect on the radiotherapeutic management of cervical cancer

Rastogi¹,

Revannasiddaiah²,

Thakur³

et al. 2013

Chin J Cancer

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Radiotherapy plays a major role in the treatment of cervical cancer. A successful radiotherapy program integrates both external beam and brachytherapy components. The principles of radiotherapy are strongly based on the anatomy of the organ and patterns of local and nodal spread. However, in patients with distorted anatomy, several practical issues arise in the delivery of optimal radiotherapy, especially with brachytherapy. Müllerian duct anomalies result in congenital malformations of the female genital tract. Though being very commonly studied for their deleterious effects on fertility and pregnancy, they have not been recognized for their potential to interfere with the delivery of radiotherapy among patients with cervical cancer. Here, we discuss the management of cervical cancer among patients with Müllerian duct anomalies and review the very sparse amount of published literature on this topic.

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Squamous cell carcinoma of the cervix: report of an unusual case of bicornuate bicollis uterus treated with bilateral intracavity brachytherapy

Cited by 14 publications

References 8 publications

Brachytherapy for cervical cancer in septate uterus: Dose-volume differences with tandem implant placement in right vs. left uterine canal: A case report

Brachytherapy for cervical cancer in septate uterus: Dose-volume differences with tandem implant placement in right vs. left uterine canal: A case report

Locally advanced squamous cell cervical cancer in a patient with septate uterus

Műllerian duct anomalies and their effect on the radiotherapeutic management of cervical cancer

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