Medical Radiology and Radiation Safety. 2019. Vol. 64. No. 4. P. 41–47
DOI: 10.12737/article_5d1108af5d48d3.68800561
A.V. Boyko1, E.A. Dunaeva1, L.V. Demidova1, B.Yа. Alekseev2, A.V. Leont’ev1,
O.B. Dubovetskaya1, L.G. Serova1
Radiotherapy for Patients with Hydronephrosis–Induced Cervical Cancer
1. P.A. Hersen Moscow Oncology Research Center, Moscow, Russia. E-mail:
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;
2. N.A. Lopatkin Research Institute of Urology and Interventional Radiology, Moscow, Russia
A.V. Boyko – Head of Dep., Prof., Dr. Sci. Med., ESTRO Member;
E.A. Dunaeva – Senior Researcher, PhD Med.;
L.V. Demidova – Leading Researcher, Dr. Sci. Med.;
B.Yа. Alekseev – Deputy Director, Dr. Sci. Med., Prof., EAU Member, SIU Member;
A.V. Leont’ev – Head of Dep., PhD Med., EANM Member;
O.B. Dubovetskaya – Research Worker, PhD Med.;
L.G. Serova – Oncologist, PhD Med.
Abstract
Purpose: To justify the expansion of indications for radiation or chemoradiation therapy in patients with primary or recurrent cervical cancer complicated by hydronephrosis by eliminating obstruction of the ureters.
Material and methods: The study included 24 patients who received radiation or chemoradiotherapy from 2012 to 2018. 17 patients among them had primary cervical cancer and the other 7 had a relapse of cervical cancer in small pelvis. In accordance with FIGO and TNM classification (2009), stage IIIB was diagnosed (сT3bN0–1M0) in 16 patients and stage IVB (cT3bN1M1, metastasis in para-aortic lymph nodes) in 1 patient. Prior to the start of special treatment, in all patients was detected one- or two-sided hydronephrosis associated with a neoplastic process and accompanied by varying degrees of impaired parenchymal-excretory function of one of the kidneys.
Results: 11 patients had unilateral stenting, 3 patients had bilateral ureteral stenting, nephrostomy was performed in 9 patients and 1 woman had an ureteral stent installed on one side, nephrostomy was performed on the other side. In 70.8 % (17) patients, the irradiation course was performed without interruption. From 5 to 3 weeks (due to cystitis, endometritis, anemia). In 2 patients, it was not possible to complete the full course of radiotherapy because of the intractable effects of pyelonephritis, they were operated on. In the observation period up to 77 months (average observation time 29 months) 16 patients are alive, 12 of them are without signs of disease recurrence. In 6 patients, the natural passage of urine was restored. In 4 patients, the nephrostomy was replaced with a ureteral stent. In 3 patients with ureteral stents they are replaced. Three patients remain with nephrostomy. Eight women died from the progression of the underlying disease, of these, 6 patients are with recurrent cervical cancer in the pelvis. Note that in all 6 patients, as a result of the irradiation, a pronounced palliative effect was achieved in the form of relief of pain and bleeding.
Conclusion: Performing adequate drainage of the ureter(s) allows to expand the indications for radiotherapy or chemoradiation therapy under the radical program in patients with primary or recurrent cervical cancer.
Key words: radiotherapy, cervical cancer, locally advanced and recurrent, hydronephrosis, urine diversion
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For citation: Boyko AV, Dunaeva EA, Demidova LV, Alekseev BYа, Leont’ev AV, Dubovetskaya OB, Serova LG. Radiotherapy for Patients with Hydronephrosis-Induced Cervical Cancer. Medical Radiology and Radiation Safety. 2019;64(4):41–47. (Russian).
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