Should helical tomotherapy replace brachytherapy for cervical cancer? Case report.

BACKGROUND: Stereotactic body radiation therapy (SBRT) administered via a helical tomotherapy (HT) system is an effective modality for treating lung cancer and metastatic liver tumors. Whether SBRT delivered via HT is a feasible alternative to brachytherapy in treatment of locally advanced cervical cancer in patients with unusual anatomic configurations of the uterus has never been studied. CASE PRESENTATION: A 46-year-old woman presented with an 8-month history of abnormal vaginal bleeding. Biopsy revealed squamous cell carcinoma of the cervix. Magnetic resonance imaging (MRI) showed a cervical tumor with direct invasion of the right parametrium, bilateral hydronephrosis, and multiple uterine myomas. International Federation of Gynecology and Obstetrics (FIGO) stage IIIB cervical cancer was diagnosed. Concurrent chemoradiation therapy (CCRT) followed by SBRT delivered via HT was administered instead of brachytherapy because of the presence of multiple uterine myomas with bleeding tendency. Total abdominal hysterectomy was performed after 6 weeks of treatment because of the presence of multiple uterine myomas. Neither pelvic MRI nor results of histopathologic examination at X-month follow-up showed evidence of tumor recurrence. Only grade 1 nausea and vomiting during treatment were noted. Lower gastrointestinal bleeding was noted at 14-month follow-up. No fistula formation and no evidence of haematological, gastrointestinal or genitourinary toxicities were noted on the most recent follow-up. CONCLUSIONS: CCRT followed by SBRT appears to be an effective and safe modality for treatment of cervical cancer. Larger-scale studies are warranted.

Pararenal vena cava leiomyosarcoma versus leiomyomatosis: difficult diagnosis.

Inferior vena cava (IVC) leiomyosarcoma is a rare cancer treated with wide surgical resection. IVC leiomyomatosis is a benign tumor treated with open caval excision. A patient with an IVC tumor with iliocaval thrombosis was treated with thrombolysis and iliac stents. The patient was sent 1 year later to our institution with an IVC mass. Transvenous biopsy was consistent with leiomyomatosis. At surgery, the lesion was adherent, resected and the IVC reconstructed. Pathologic evaluation documented well-differentiated leiomyosarcoma not leiomyomatosis. Thorough evaluation of iliocaval thrombosis is recommended before endovascular management. Diagnostic modalities may be inadequate to differentiate leiomyosarcoma from leiomyomatosis.