Late urological complications and malignancies after curative radiotherapy for gynecological carcinomas: a retrospective analysis of 10,709 patients

Abstract

Purpose: A retrospective study was done to analyze late urological complications following curative radiotherapy of primary gynecological carcinomas. All patients were treated at a single center and with the same radiotherapeutic regimen. The incidence of other carcinomas in these patients was also evaluated.

Materials and methods: A total of 10,709 patients was treated using combined telebrachytherapy (dosage 67.5 Gy.) during an observation period of 22 years.

Results: Severe late complications were seen in 1.24% (133 of 10,709) of the patients, including irradiated bladder (65 cases, mean interval since treatment 6.7 years). Complications required surgery in 118 of 133 patients with a perioperative mortality of 4.2% (5 of 118). Overall in 4.27% (457 of 10,709) of the patients another malignancy developed after (29.1%), during (26.3%) and before (44.6%) radiotherapy. Subsequent malignancies after treatment were predominantly seen in the genital region (88.4%) but they were also in the irradiated nongenital area (0.13%, 14 of 10,709). Of the latter patients 6 had urothelial bladder cancer, which represents a relative risk of 4.66 (based on the Austrian female population) to develop bladder cancer after radiotherapy for gynecological cancer.

Conclusions: Late urological complications after radiotherapy of the pelvis are rare but severe. Surgical therapy of irradiated tissues has a higher complication rate compared to surgery on nonirradiated tissue.