Marnitz Simone, Köhler Christhardt, Füller Jürgen, Hinkelbein Wolfgang, Schneider Achim
Department of Radiooncology, Charité Universitätsmedizin, Berlin, Germany.
Strahlenther Onkol. 2006 Jan;182(1):45-51. doi: 10.1007/s00066-006-1455-6.
Simultaneous platinum-based radiochemotherapy is the standard of care for patients with advanced or node-positive cancer of the uterine cervix. A large body of literature concerning therapy-related acute and late morbidity is available. Chemoradiation-associated necrosis of the uterus has not been described so far.
Two patients are reported who were treated by combined chemoradiation between 2004 and 2005 for histologically confirmed cervical cancer following laparoscopic staging. Both patients were diagnosed with squamous cell cancer of the cervix FIGO stage IIB (T2b pN1 pM1 LYM G2) and FIGO IIIA (T3a pN1 M0 G2), respectively. External-beam radiotherapy was applied in a 3-D-planned four-field technique, covering pelvic lymph nodes and primary tumor. Patient #1 received additional paraaortic irradiation. Patient #2 underwent 5 x 5 Gy brachytherapy covering the tumor. Simultaneously, cisplatin was given to both patients. Following chemoradiation, both patients developed pelvic pain and an elevation of C-reactive protein (CRP) in the presence of a normal leukocyte count. Both patients underwent relaparoscopy, and necrosis of the uterus combined with partial necrosis of the bladder was diagnosed in patient #1. Patient #1 underwent total supralevatoric exenteration and patient #2 laparoscopically assisted hysterectomy with bilateral salpingo-oophorectomy.
In patients with persisting or incident pelvic pain, questionable findings in imaging techniques and/or elevated inflammation parameters following completion of chemoradiation for cervical cancer, differential diagnosis should include radiogenic necrosis of the uterus and other pelvic organs. Laparoscopy is an ideal technique to exclude or confirm this diagnosis.
同步铂类放化疗是晚期或淋巴结阳性宫颈癌患者的标准治疗方法。目前已有大量关于治疗相关急性和晚期发病率的文献。但迄今为止，尚未有关于放化疗相关性子宫坏死的报道。
报告了两名患者，他们在2004年至2005年间接受了腹腔镜分期后，因组织学确诊的宫颈癌接受了联合放化疗。两名患者分别被诊断为子宫颈鳞状细胞癌，国际妇产科联盟（FIGO）分期为IIB期（T2b pN1 pM1 LYM G2）和IIIA期（T3a pN1 M0 G2）。采用三维计划四野技术进行体外放疗，覆盖盆腔淋巴结和原发肿瘤。患者1接受了额外的腹主动脉旁照射。患者2接受了5次，每次5 Gy的近距离放疗，覆盖肿瘤。同时，两名患者均接受了顺铂治疗。放化疗后，两名患者均出现盆腔疼痛，白细胞计数正常但C反应蛋白（CRP）升高。两名患者均接受了再次腹腔镜检查，患者1被诊断为子宫坏死合并膀胱部分坏死。患者1接受了全盆腔脏器清除术，患者2接受了腹腔镜辅助子宫切除术及双侧输卵管卵巢切除术。
对于宫颈癌放化疗后持续或新发盆腔疼痛、影像学检查结果可疑和/或炎症参数升高的患者，鉴别诊断应包括子宫及其他盆腔器官的放射性坏死。腹腔镜检查是排除或确诊该诊断的理想技术。
