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Case Reports
. 2019 Apr;11(2):180-188.
doi: 10.5114/jcb.2019.84506. Epub 2019 Apr 29.

Concurrent chemoradiotherapy for locally advanced squamous cell carcinoma of the cervix in a uterus didelphys with vaginal septum

Yuko Kaneyasu  1   2 , Iemasa Koh  3 , Hisaya Fujiwara  4 , Eiji Hirata  3 , Yoshiki Kudo  3 , Koji Arihiro  5 , Norio Miharu  6 , Tomio Nakagawa  1 , Ippei Takahashi  2 , Yuki Takeuchi  2 , Nobuki Imano  2 , Ikuno Nishibuchi  2 , Takeo Nakashima  7 , Daisuke Kawahara  7 , Yoshimi Ohno  7 , Yasushi Nagata  2
Affiliations
Case Reports

Concurrent chemoradiotherapy for locally advanced squamous cell carcinoma of the cervix in a uterus didelphys with vaginal septum

Yuko Kaneyasu et al. J Contemp Brachytherapy. 2019 Apr.

Abstract

In November 2011, a 61-year-old woman was diagnosed with squamous cell carcinoma (SCC) of the cervix in a uterus didelphys with vaginal septum. The patient was diagnosed with Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) stage IIB because of infiltration to the left parametrium without infiltration to the pelvic wall. The patient was treated with external-beam radiotherapy (EBRT) and brachytherapy (BT), using concomitant chemotherapy with cisplatin. A total of 50 Gy were delivered (2 Gy/fraction/day) to the pelvis, with a central shield after 40 Gy. The patient was treated four times with BT (6 Gy × 4 fractions), with tandem and ovoid applicators inserted once to the left side; tandem to the left side and ovoid bilaterally were inserted twice; and tandem to the right side and ovoid bilaterally were inserted once. Six years and 8 months after the start of treatment, the patient had had no relapse or severe late adverse effects. For accurate diagnosis and optimal treatment of the uterus didelphys, careful interview and pelvic examination at initial diagnosis of a patient are very important.

Keywords: brachytherapy; cervical cancer; concurrent chemoradiotherapy; uterus didelphys; vaginal septum.

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Conflict of interest statement

Authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
A) Macroscopic findings of the right and left uterine cervices at Cusco’s examination. B) Findings on hysteroscopy. B-1) Uterine body (right and left): Each tumor had not invaded the uterine body. B-2) Uterine cervix: The left tumor is larger than the right one. The tumor at the left cervix was circumferential, the tumor at the right cervix was on the left side of the deviation. C) Bilateral vagina with ovoid applicator insertion. These two arrowheads point to the vaginal septum extending to the introitus
Fig. 2
Fig. 2
Pelvic magnetic resonance imaging (MRI) before treatment. A-1) Right uterine tumor is confined to the cervix (arrow). A-2) Tumor of the right cervix. B-1) Left uterine tumor invades to the surrounding tissue beyond the cervix. B-2) Tumor of the left cervix
Fig. 3
Fig. 3
MRI before and during treatment. A) Right uterine body to the fundus. B) Left uterine body to the fundus. C) Bilateral vaginas
Fig. 4
Fig. 4
Dose distributions of each of the four brachytherapy. The small schemas on the upper left side of the figures were drawn, modified using reference [7]
Fig. 5
Fig. 5
MRI taken at 4 months after the treatment. A) Right uterus. B) Left uterus
See this image and copyright information in PMC

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