Medical Radiology and Radiation Safety. 2026. Vol. 71. № 2

DOI:10.33266/1024-6177-2026-71-2-129-134

I.V. Sycheva¹, S.A. Ivanov^{1, 2}, A.D. Kaprin^{2, 3, 4}

Treatment of Total Necrosis of the Vagina with Vulvar Necrosis (Grade Iv) after Chemoradiotherapy of Cervical Cancer

¹ A.F. Tsyb Medical Radiological Research Centre, Obninsk, Russia

² P. Lumumba Рeoples Friendship University of Russia, Moscow, Russia

³ National Medical Research Radiological Centre, Obninsk, Russia

⁴ P.A. Hertsen Moscow Oncology Research Institute, Moscow, Russia

Contact person: I.V. Sycheva, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract

Relevance: Radiation therapy (RT) is widely used for the treatment of cervical cancer, however, a number of patients develop radiation complications of nearby organs with the development of late radiation cystitis, urethritis, proctitis and late radiation epithelitis of the vagina and vulva, which worsen the quality of life. There are very few scientific publications in Russia and abroad on late radiation ulcerative necrotic epithelitis of the vagina and vulva, with a small number of clinical cases. There are still no uniform standards for the treatment of this disease worldwide. Often, patients after RT have a combination of late radiation injuries (RI) to the pelvic organs (vagina and vulva, rectum, bladder). 

Purpose: To demonstrate the successful comprehensive conservative treatment of late radiation ulcerative necrotic epithelitis of the vagina and vulva (total ulceration and necrosis of the vagina with vulvar necrosis, grade IV toxicity according to the RTOG/EORTC classification). Remission was obtained after 11 months and persists to the present (6 years). There were no complications in the treatment of necrosis. This disease developed after complex treatment with type IIA1 breast cancer (pT₂a₁N₀M₀). CRT + Wertheim’s operation in 2012. EBRT TFD 30 Gy. Metastasis to the lower third of the vagina in 2017. CRT. TFD: BT 30 Gy and EBRT 18 Gy. Conservative therapy during the treatment of necrosis was performed every 3 months, then for late radiation proctitis, grade II cystitis ‒ every six months. In January 2023, metastasis to the left inguinal lymph node was detected, and surgery was performed: left-sided inguinal lymphadenectomy, crossectomy for thrombosis of the large saphenous vein on the left. 9 lymph nodes were removed, 1 of which has metastasis of squamous cell carcinoma. Next, the patient received 6 cycles of polychemotherapy (carboplatin + paclitaxel) on the background of anticoagulants. The patient is currently in remission of RI in our department. 

Conclusion: Total necrosis of the vagina is a rare disease, the description of which is extremely rare in the literature. It is necessary to raise awareness about late-stage RI, further study of this pathology and new approaches in the treatment of this category of patients. In this clinical case, he was successfully treated and received remission for 6 years without complications. Pronounced late local RI are not a guarantee of the absence of recurrence or progression of the underlying cancer in the future. 

Keywords: cervical cancer, radiation therapy, radiation complications, radiation ulcerative-necrotic epithelitis of the vagina and vulva, radiation proctitis, radiation cystitis

For citation: Sycheva IV, Ivanov SA, Kaprin AD. Treatment of Total Necrosis of the Vagina with Vulvar Necrosis (Grade Iv) after Chemoradiotherapy of Cervical Cancer. Medical Radiology and Radiation Safety. 2026;71(2):129–134. DOI:10.33266/1024-6177-2026-71-2-129-134

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Conflict of interest. The authors declare no conflict of interest.

Financing. The study had no sponsorship.

Contribution. Article was prepared with equal participation of the authors.

Article received: 20.01.2026. Accepted for publication: 25.02.2026.