Radiological changes in the gastrointestinal and genitourinary tract following radiotherapy for carcinoma of the cervix

Manifestation, Latency and Management of Late Urological Complications after Curative Radiotherapy for Cervical Carcinoma

“…In the latter, radiotherapy is the treatment of choice for FIGO stages IIB-IV, while comparable results are achieved by radical surgery or radiotherapy in cases up to stage IIA [10]. Radiotherapy achieves good cure and survival rates but it is inevitable that pelvic non-target organs will be affected to some degree [11]. The aim of modern radiotherapy is to reduce the rate of radiogenic complications of neighboring non-target organs while maintaining high cure rates.…”

“…Our series represents a relatively large series of patients with late urological complications and allows an estimation of the latency period as well as of the typical problems encountered by urologists in patients with late urological sequelae after radiotherapy for cervical carcinoma. Due to their anatomical vicinity to the female reproductive tract, the intestines and the lower urinary tract are most frequently affected by radiogenic complications after pelvic radiotherapy for gynecological carcinoma [11]. The lower urinary tract is less radiosensitive than small bowel and has therefore generally a lower rate of radiogenic complications [17].…”

“…In the end stages, tissue necrosis and progressive fibrosis as well as sclerosis of connective tissue occur [20,21]. Due to the relatively low radiosensitivity of urinary bladder and ureter and the tolerability of up to 60-70 Gy [22], radiogenic alterations in the parametrial tissues with resulting extrinsic ureteric obstruction are also discussed in addition to disturbances of ureteral motility as the pathogenic mechanism of radiogenic ureteric obstruction [10,11]. However, in our series tumor progression was the most frequent cause of ureteral obstruction (55/93 cases).…”

“…However, in our series tumor progression was the most frequent cause of ureteral obstruction (55/93 cases). The differentiation between benign and malignant ureteric obstruction is often not possible with radiological and endourological methods alone so that histological verification is required in some cases [11]. In patients with advanced malignant disease, extrinsic neoplastic uereteric compression is more likely than intrinsic radiogenic stenosis and the occurrence of ureteric obstruction within the first two years after radiotherapy is more likely to be indicative of tumor progression [23].…”

“…They may, however, also affect the intramural ureter or a longer segment of the distal ureter distal to the pelvic brim [17]. Ureteral obstruction above the pelvic brim is most likely due to extrinsic obstruction caused by lymph node enlargement [11]. The occurrence of late morbidity after radiotherapy for cervical carcinoma is only rarely associated with mortality and was reported not to be correlated with stage, treatment center size, previous surgery or the radiotherapeutic approach used [24].…”