Unravelling post-radiation cervical necrosis in carcinoma cervix: Case series of clinical dilemmas and outcomes from a single institute

Cervical carcinoma is the second most common life-threatening malignancy diagnosed in Indian women. The treatment of Cervical carcinoma is multimodal and includes surgery, chemotherapy and radiotherapy specially for the locally advanced cervical cancers. Chemoradiotherapy is associated with many early and late complications. However, one of the rare complications is radiation necrosis. The Cervix, vault and vagina are the most vulnerable sites to develop radiation induced necrosis and it can occasionally mimic disease recurrence. This article discusses the diagnostic and management dilemma of this rare complication. It is a retrospective case series analysing the radiation induced cervicovaginal necrosis in locally advanced cases of cervical cancer. A total of 146 women with histologically proven Carcinoma cervix received chemoradiation with a curative intent during the study period. Out of these patients only 4 (2.7%) presented with Radiation Necrosis. All 4 patients were histologically squamous cell carcinoma with FIGO stage IIB and III. One patient was symptomatic and had pelvic symptoms as early as 3 months while all other were asymptomatic. For asymptomatic patients, the mean time for diagnosis of RN after CTRT was 9.66 months (range 8 - 12 months). All the patients were initially managed conservatively, but two of them ultimately underwent salvage hysterectomy. Despite being a rare complication there is a need for extra caution in patients who are known to be at higher risk of developing RN. Regular and careful post radiation follow up and clinical examination is the key for early detection and complete recovery.