Ureteral stricture as a late complication of radiotherapy for stage IB carcinoma of the uterine cervix

Abstract

Background. Ureteral stricture is a rare late complication of curative radiotherapy for carcinoma of the cervix. A retrospective study was performed to determine the incidence and latency of radiation‐induced ureteral stricture, to investigate possible contributing factors, and to compare the time course and presenting characteristics of ureteral compromise caused by late radiation injury or tumor recurrence. Methods. The records of 1784 patients with FIGO stage IB carcinoma of the cervix treated with radiotherapy at The University of Texas M. D. Anderson Cancer Center between 1960 and 1989 were reviewed. The characteristics of patients who developed ureteral stricture as a first manifestation of recurrent disease or without evidence of pelvic recurrence were compared. The risk of ureteral compromise was calculated actuarially. Results. There were 29 patients with severe radiation‐induced ureteral stricture. The overall incidences of severe ureteral stenosis were 1.0, 1.2, 2.2, and 2.5% at 5, 10, 15, and 20 years, respectively, reflecting a continuous actuarial risk increase of approximately 0.15% per year. Four patients died of complications from bilateral ureteral stricture. Patients who were treated with centrally blocked external fields or who received more than two transvaginal radiation treatments were at increased risk for developing ureteral stenosis. The risk was similar for patients treated with radiation alone or followed by extrafascial hysterectomy. Conclusions. During the first 5 years after treatment, tumor recurrence is the most common cause of ureteral stricture in patients treated with radiotherapy for carcinoma of the cervix. However, radiation injury to the ureter, although rare, may not become apparent for many years, necessitating continued vigilance throughout the lives of these patients. Cancer 1995; 75:836‐43.

Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution

“…Radiationinduced ureteric strictures have been reported in the medical literature since the 1920s. 6 Interestingly, in 1987, Dauplat et al looked at brachytherapy radiation doses to the ureter in 16 patients treated for cervical cancer by inserting a radiopaque stent in their ureters. 7 He found that 44% of these Ureteral stricture disease patients had higher radiation doses to the ureter than the bladder or rectum.…”

A Population-Based Assessment of Urologic Procedures and Operations After Surgery or Pelvic Radiation for Cervical Cancer

“…This conclusion is supported by an analysis of 1784 patients with stage 1B cervical cancer who were treated with radiation and had a much lower rate of ureteral stricture (2.5% at 20 years). 26 Enteric or vesical fistulas to the bladder were uncommon (1.8%) in a series of 2096 patients with cervical cancer between 1985 and 1995, and only 1 in 4 underwent an attempted surgical repair. 27 We found that surgical treatment of cervical cancer (radical hysterectomy with or without radiation) was associated with an increased risk of stress incontinence surgery; this increased risk has also been observed after hysterectomy for benign disease 28 and in our study could be due to an increased access to surgical treatment of incontinence because of postoperative follow-up with a gynecologist as opposed to a radiation oncologist.…”

Ureteral stent insertion for gynecologic interstitial high-dose-rate brachytherapy

“…Recurrent cancer is the most common cause of ureteral obstruction after definitive radiation therapy of cervical cancer, and it usually occurs with in the first 5 years after treatment (6). Radiation therapy also can cause ureteral injury and stricture formation.…”