Locally-advanced vaginal cancer with complete utero-vaginal prolapse

• Published in: International journal of gynecological cancer Vol. 30; no. 5; pp. 705 - 708
• Main Authors: Buda, Alessandro, Yaprak, Esra, MIlani, Rodolfo, Frigerio, Matteo, Perego, Rosangela, Jaconi, Marta, Meregalli, Sofia
• Format: Journal Article
• Language: English
• Published: England by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology 01.05.2020; BMJ Publishing Group LTD
• Subjects: Aged, 80 and over; Bladder; Brachytherapy; Cancer therapies; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - surgery; Carcinoma, Squamous Cell - therapy; Cervix; Dissection; Female; Genital cancers; Humans; Hysterectomy; Lymphatic system; Magnetic Resonance Imaging; Medical imaging; Metastasis; Morbidity; Neoplasm Invasiveness; Pelvic organ prolapse; Positron Emission Tomography Computed Tomography; Radiation therapy; Surgery; Surgical outcomes; Uterine Prolapse - diagnostic imaging; Uterine Prolapse - radiotherapy; Uterine Prolapse - surgery; Uterine Prolapse - therapy; Uterus; Vagina; Vaginal Neoplasms - diagnostic imaging; Vaginal Neoplasms - radiotherapy; Vaginal Neoplasms - surgery; Vaginal Neoplasms - therapy; vulvar and vaginal cancer; brachytherapy; surgery
• DOI: 10.1136/ijgc-2020-001326
• ISSN: 1048-891X

(C) Fused positron emission tomography/computed tomography (PET/CT) images shows the hypermetabolic uptake in the vaginal wall, the maximum intensity projection (MIP) image, and the fused PET-images showing no distant metastasis. Radiotherapy including brachytherapy is the treatment of choice for the majority of patients as organ-sparing surgery with negative resection margins is difficult to achieve.3,4 3 4 The American Brachytherapy Society recommends exclusive interstitial brachytherapy for cervical cancer cases, such as in the presence of bulky lesions, narrow vaginal apex, inability to enter the cervical ostium, extension to the lateral parametria, or to the pelvic sidewall, and lower vaginal extension.5 5 However, there are no specific guidelines specifying how to deliver radiotherapy in complex cases such as the one we presented. [...]the surgical approach should be evaluated well through a multidisciplinary approach considering risk and benefit as it pertains to the clinical and anesthesia risks of the patient. Para-rectal dissection is limited compared with both sacrospinous and iliococcygeus fascia fixations. [...]it does not involve the risk of ureteral injury typical of uterosacral suspension.