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Case Reports
. 2010 Nov 23:10:637.
doi: 10.1186/1471-2407-10-637.

Should helical tomotherapy replace brachytherapy for cervical cancer? Case report

Chen-Hsi Hsieh  1 , Ming-Chow Wei, Yao-Peng Hsu, Ngot-Swan Chong, Yu-Jen Chen, Sheng-Mou Hsiao, Yen-Ping Hsieh, Li-Ying Wang, Pei-Wei Shueng
Affiliations
Case Reports

Should helical tomotherapy replace brachytherapy for cervical cancer? Case report

Chen-Hsi Hsieh et al. BMC Cancer. .

Abstract

Background: Stereotactic body radiation therapy (SBRT) administered via a helical tomotherapy (HT) system is an effective modality for treating lung cancer and metastatic liver tumors. Whether SBRT delivered via HT is a feasible alternative to brachytherapy in treatment of locally advanced cervical cancer in patients with unusual anatomic configurations of the uterus has never been studied.

Case presentation: A 46-year-old woman presented with an 8-month history of abnormal vaginal bleeding. Biopsy revealed squamous cell carcinoma of the cervix. Magnetic resonance imaging (MRI) showed a cervical tumor with direct invasion of the right parametrium, bilateral hydronephrosis, and multiple uterine myomas. International Federation of Gynecology and Obstetrics (FIGO) stage IIIB cervical cancer was diagnosed. Concurrent chemoradiation therapy (CCRT) followed by SBRT delivered via HT was administered instead of brachytherapy because of the presence of multiple uterine myomas with bleeding tendency. Total abdominal hysterectomy was performed after 6 weeks of treatment because of the presence of multiple uterine myomas. Neither pelvic MRI nor results of histopathologic examination at X-month follow-up showed evidence of tumor recurrence. Only grade 1 nausea and vomiting during treatment were noted. Lower gastrointestinal bleeding was noted at 14-month follow-up. No fistula formation and no evidence of haematological, gastrointestinal or genitourinary toxicities were noted on the most recent follow-up.

Conclusions: CCRT followed by SBRT appears to be an effective and safe modality for treatment of cervical cancer. Larger-scale studies are warranted.

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Figures

Figure 1
Figure 1
Photomicrograph of cervical biopsy specimen before treatment shows nests of moderately differentiated squamous carcinoma cells invading deeply into the fibrous stroma (H-E 200X). The arrows indicate the tumor nests.
Figure 2
Figure 2
MR image of the pelvis before treatment shows direct invasion of the cervical tumor into the right parametrium, bilateral hydronephrosis, and multiple uterine myomas. The solid arrows indicate the parametrium invasion, the uterine myomas, the tumor, and the uterine cavity. The dotted arrow indicates adenomyosis.
Figure 3
Figure 3
Pelvic MRI after concurrent chemoradiation therapy and HT-guided SBRT shows multiple uterine myomas and adenomyosis without local recurrence or pelvic lymphadenopathy.
Figure 4
Figure 4
Photomicrograph of cervical biopsy specimen taken after concurrent chemoradiation therapy followed by HT-guided SBRT shows only scattered nests of mononuclear inflammatory cells (H-E 200X).
Figure 5
Figure 5
At 14-month follow-up, ulceration and mucositis in the rectal area were noted. The arrows indicate the ulceration and mucositis in the rectal area.
Figure 6
Figure 6
The dose distribution of stereotactic body radiation therapy (SBRT) for the final boost for cervical cancer.
See this image and copyright information in PMC

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