J Gynecol Oncol.  2012 Jul;23(3):197-200. 10.3802/jgo.2012.23.3.197.

Radiation sigmoiditis mimicking sigmoid colon cancer after radiation therapy for cervical cancer: the implications of three-dimensional image-based brachytherapy planning

• Lee H
• Huh SJ
• Oh D
• Jeong BK
• Ju SG

• KMID: 2245179
• DOI: http://doi.org/10.3802/jgo.2012.23.3.197

Abstract

External-beam radiation therapy with intracavitary high-dose-rate brachytherapy is the standard treatment modality for advanced cervical cancer; however, late gastrointestinal complications are a major concern after radiotherapy. While radiation proctitis is a well-known side effect and radiation oncologists make an effort to reduce it, the sigmoid colon is often neglected as an organ at risk. Herein, we report two cases of radiation sigmoiditis mimicking sigmoid colon cancer after external-beam radiation therapy with intracavitary high-dose-rate brachytherapy for uterine cervical cancer with dosimetric consideration.

Keyword

Radiation complication; Radiation therapy; Sigmoiditis; Uterine cervical carcinoma

MeSH Terms

Brachytherapy
Colon, Sigmoid
Proctitis
Sigmoid Neoplasms
Uterine Cervical Neoplasms

Figure

• 

  Fig. 1 Case 1: Lateral view (A) of a barium enema study shows a stricture (between arrows) of the sigmoid colon and endoscopy shows luminal narrowing and friable hyperemic nodular mucosal changes (B). A close sigmoid-to-tandem distance may cause a high sigmoid dose, which could lead to the development of sigmoiditis (C).

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  Fig. 2 Case 2: Endoscopy revealed luminal narrowing, hemorrhage and hyperemic mucosal nodularities with mucosal edema of the sigmoid colon (A). A CT scan of the abdomen and pelvis showed diffuse submucosal thickening of the sigmoid wall (arrow) infiltrating into the adjacent mesenteric fat, but no evidence of malignancy was seen (B).

• 

  Fig. 3 Treatment planning with three dimensional (3D) image-based brachytherapy. The reconstruction image of dose distribution (blue) using traditional planning based on point A (A) shows a closer proximity to the sigmoid colon compared to 3D planning (B). applicator, sky blue; clinical target volume, red; rectum and sigmoid colon, purple.

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