Two cases of fatal necrosis of the lesser pelvis in patients treated with combined radiotherapy and hyperthermia for cervical carcinoma

Abstract

This study reports two cases of fatal necrosis of the lesser pelvis in patients with advanced cervical carcinoma, who had received combined radiotherapy and hyperthermia. The necrosis reached far from the high dose area, in one of the cases even outside the radiation portals. Both patients initially had treatment-related morbidity which responded well to surgical treatment. After a disease-free interval, a rapidly progressive necrosis developed. Necrosis to this extent after combined modality treatment has, to the authors' knowledge, not been described.

Editorial

“…However, case reports role is to reveal new relations and put forward hypotheses to be further explored. In the current issue an interesting paper by Wiggenraad et al [1] present two patients exhibiting unexpected severe late therapy reactions manifested as intestinal damage followed by massive necrosis of the pelvis. The authors state that it is most probably related to a combination of hyperthermia and radiation as such severe reactions are rare after radiation alone.…”

Current status of antivascular therapy and targeted treatment in the clinic

“…In a study of advanced rectal cancer, addition of hyperthermia to radiation therapy had no detrimental effect on the patient's quality of life [189]. However, severe neurological side effects and tissue necrosis have been described in some adult patients after regional heating [190,191], and avascular femoral osteonecrosis appeared in 14% of children less than 5 years after multiple hyperthermia sessions [192]. The neurological damage is probably determined by the sensitivity of the nerve vasculature which should be kept under a dose of 30 min at 44 C or equivalent.…”