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Case Reports
. 2024 Jun 2;16(6):e61544.
doi: 10.7759/cureus.61544. eCollection 2024 Jun.

Dramatic Radiographic Response of Pelvis-Filling Locally Advanced Cervical Cancer Treated With Radiation and Chemotherapy

Mannat Bedi  1 , Aria Kieft  1 , Michael Joiner  1 , Steven Miller  1
Affiliations
Case Reports

Dramatic Radiographic Response of Pelvis-Filling Locally Advanced Cervical Cancer Treated With Radiation and Chemotherapy

Mannat Bedi et al. Cureus. .

Abstract

Locally advanced cervical cancers are often treated with palliative intent due to concerns that the tumor is too far advanced or too large to be treated curatively. Also, patients greater than 65 years of age with cervical cancer are sometimes regarded as being too old or too frail to be cured with combined radiation and chemotherapy. These patients are often treated with radiation alone or with palliative therapy. Understanding the treatment modalities for cervical cancer is essential, as they can be complex and unique to each patient's specific diagnosis. This case report aims to describe the dramatic response to treatment with combined radiation and chemotherapy for a patient greater than 65 years of age with pelvis-filling cervical cancer with right-sided hydronephrosis. After a five-week course of concurrent chemoradiation, the cervical mass radiographically completely disappeared, with no evidence of disease noted on pelvic MRI.

Keywords: concurrent chemoradiation therapy; gynecology-oncology; hdr (high dose rate) brachytherapy; intensity modulated radiation therapy (imrt); locally advanced cervical cancer.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Axial MRI of the cervical lesion at diagnosis
The tumor measures approximately 11.2 cm in AP x 6.8 cm in axial dimension. The arrow points at the area of possible rectal involvement.
Figure 2
Figure 2. Sagittal MRI at diagnosis reveals a large pelvic mass measuring 9.7 cm by 7.8 cm, compressing the uterus, rectum, and bladder
The arrow is pointing to what remains of the normal cervix.
Figure 3
Figure 3. PET scan with a green arrow pointing to the large cervical mass
No involved lymph nodes were noted on PET. The yellow arrow points to the physiological uptake seen in the right kidney and bowel, which is not consistent with the disease. PET: positron emission tomography
Figure 4
Figure 4. Dose-volume histogram (DVH): the planning target volume (PTV) is in red, the bladder is in black, and the right and left kidneys are purple and orange. The bowel is contoured in blue.
Figure 5
Figure 5. Axial MRI showing complete response to therapy with no radiographic evidence of the cervical mass
Orange arrow: bladder, Yellow arrow: Cervix with no disease seen, Blue arrow: Rectum
Figure 6
Figure 6. Sagittal MRI showing complete radiographic response after radiation and chemotherapy
The cervical cancer is not visible but a Smit sleeve that was placed through the cervical os and into the uterus for brachytherapy is present (yellow arrow).
Figure 7
Figure 7. HDR brachytherapy treatment showing the tandem and ring in the axial, sagittal, and coronal planes; a dose volume histogram (DVH) displaying the dose to the organs at risk
See this image and copyright information in PMC

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