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

Abstract

We report a case of congenital abnormality of bicornuate bicollis uterus in a patient who developed FIGO (International Federation of Gynecology and Obstetrics) stage IIB invasive carcinoma of the cervix in 2006. She was managed with radical concurrent chemoradiotherapy using an external photon beam of 50 Gy in 25 fractions and a weekly infusion of cisplatin, followed by low dose rate intracavity brachytherapy of 18 Gy to Manchester point A over two fractions. Intra-uterine afterloading brachytherapy catheters were inserted into both uterine cavities. Treatment was well tolerated with manageable acute toxicities. Complete response was achieved with therapy. The patient remains well on follow up with no clinical evidence of disease recurrence two years after initial treatment.

Figure 1

T₂ weighted MRI images of the pelvis. (a) and (b) Cross-section slices through cervices and uterine cavities. (c) Sagittal slice through cervix and uterus with bulky tumour at the cervix extending into the upper vagina. (d) Coronal slice through tumour with view of both uterine cavities and septum.

Figure 2

Four-field radiotherapy technique for external photon beam treatment. Field localisation was done with CT simulation.

Figure 3

Diagrammatic representation of positions of right and left A points as determined from CT data. Fraction 1 (a), fraction 2 (b). U represents an active interuterine tube. M represents a marker wire. A points are drawn with a perpendicular at 2 cm to define the points of their respective positions for each fraction.