Table 3 Diagnosis, management and follow-up of the cervical necrosis
From: Cervical necrosis after chemoradiation for cervical cancer: case series and literature review
Characteristics | 1 | 2 | 3 | 4 | 5 |
|---|---|---|---|---|---|
Clinical presentation, necrosis | Abdominal pain, vaginal discharge and minimal bleeding ×1 mo | Low back pain with vaginal discharge, no bleeding ×3 wk | Pelvic pain with significant vaginal discharge ×3 wk | Pelvic pain with foul vaginal discharge ×4 mo | Vaginal discharge with brown clots, stench ×1 wk |
Date of necrosis dx | 2009-01-09 | 2011-11-01 | 2012-09-06 | 2012-09-13 | 2013-01-22 |
Time post-RT before necrosis (months) | 5.6 | 2.2 | 20.5 | 9.0 | 9.2 |
Cervical biopsy | Yes | Yes | Yes | Yes | Yes |
Cervical biopsy (results) | Necroinflammatory exudate with reactive atypia | Necroinflammatory exudate with reactive atypia | Necroinflammatory exudate | Necroinflammatory exudate, post-radiotherapy changes | Necroinflammatory exudate with reactive atypia |
Imaging (MRI or PET scan) | Yes (MRI, PET) | Yes (MRI, PET) | Yes (MRI, PET) | Yes (PET) | Yes (PET) |
Treatment | Counseling for smoking cessation; Metronidazole | Counseling for smoking cessation; Morphine PRN; Pregabalin; Amitriptyline | Counseling for smoking cessation; Metronidazole; Morphine PRN | Counseling for smoking cessation; Vaginal douching; Morphine PRN | Counseling for smoking cessation; Metronidazole; Vaginal douching; Hydromorphone PRN |
Time to clinical improvement of the necrosis after treatment (months) | 1 | 1 | 4 | 1 | 1 |
Smoking cessation after counseling | No | No | No | Temporary (×3 mo) | No |
Post-coital bleeding | Yes (FU 2 y) | Yes (FU 1 y) | Yes (FU 4 mo) | No | Yes (FU 1 mo) |
Time of follow-up (months) | 56 | 19 | 27 | 15 | 11 |
Status in March 2013 | Alive, NED | Alive, NED | Alive, NED | Alive, NED | Alive, NED |