# Lenvatinib-Associated Vaginal Necrosis and Rectovaginal Fistula After Brachytherapy

## TL;DR

A 63-year-old woman with endometrial cancer developed vaginal necrosis and a rectovaginal fistula after receiving lenvatinib following brachytherapy.

## Contribution

Highlights a rare but serious side effect of lenvatinib in patients with prior brachytherapy.

## Key findings

- Lenvatinib may cause vaginal necrosis in patients previously treated with brachytherapy.
- The condition can rapidly progress to a rectovaginal fistula.
- Physicians should be cautious when prescribing lenvatinib to such patients.

## Abstract

Lenvatinib and radiotherapy, including brachytherapy, are treatment options for patients with endometrial cancer. However, it is unclear if lenvatinib can induce ulceration and necrosis in patients who have previously received brachytherapy. Here, we describe the case of a 63-year-old woman with endometrial cancer who developed postoperative vaginal wall recurrence and received brachytherapy. One year later, she was given lenvatinib, and two months later, she developed radiation-induced vaginal necrosis, which rapidly progressed to rectovaginal fistula. This case shows that physicians should be aware of the possibility of vaginal necrosis in the administration of lenvatinib to patients who have previously undergone radiotherapy including brachytherapy for the uterus or vagina.