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Open Access Case report

Should helical tomotherapy replace brachytherapy for cervical cancer? Case report

Chen-Hsi Hsieh14, Ming-Chow Wei2, Yao-Peng Hsu3, Ngot-Swan Chong1, Yu-Jen Chen4567, Sheng-Mou Hsiao2, Yen-Ping Hsieh8, Li-Ying Wang10 and Pei-Wei Shueng19*

Author Affiliations

1 Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan

2 Departments of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Taipei, Taiwan

3 Departments of Anatomic Pathology, Far Eastern Memorial Hospital, Taipei, Taiwan

4 Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

5 Department of Radiation Oncology, Mackay Memorial Hospital, Taipei, Taiwan

6 Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan

7 Graduate Institute of Sport Coaching Science, Chinese Culture University, Taipei, Taiwan

8 Department of Healthcare Administration, Asia University, Taichung, Taiwan

9 Department of Radiation Oncology, National Defense Medical Center, Taipei, Taiwan

10 School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

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BMC Cancer 2010, 10:637  doi:10.1186/1471-2407-10-637

Published: 23 November 2010

Abstract

Background

Stereotactic body radiation therapy (SBRT) administered via a helical tomotherapy (HT) system is an effective modality for treating lung cancer and metastatic liver tumors. Whether SBRT delivered via HT is a feasible alternative to brachytherapy in treatment of locally advanced cervical cancer in patients with unusual anatomic configurations of the uterus has never been studied.

Case Presentation

A 46-year-old woman presented with an 8-month history of abnormal vaginal bleeding. Biopsy revealed squamous cell carcinoma of the cervix. Magnetic resonance imaging (MRI) showed a cervical tumor with direct invasion of the right parametrium, bilateral hydronephrosis, and multiple uterine myomas. International Federation of Gynecology and Obstetrics (FIGO) stage IIIB cervical cancer was diagnosed. Concurrent chemoradiation therapy (CCRT) followed by SBRT delivered via HT was administered instead of brachytherapy because of the presence of multiple uterine myomas with bleeding tendency. Total abdominal hysterectomy was performed after 6 weeks of treatment because of the presence of multiple uterine myomas. Neither pelvic MRI nor results of histopathologic examination at X-month follow-up showed evidence of tumor recurrence. Only grade 1 nausea and vomiting during treatment were noted. Lower gastrointestinal bleeding was noted at 14-month follow-up. No fistula formation and no evidence of haematological, gastrointestinal or genitourinary toxicities were noted on the most recent follow-up.

Conclusions

CCRT followed by SBRT appears to be an effective and safe modality for treatment of cervical cancer. Larger-scale studies are warranted.