Reirradiation for Recurrent Cervical Cancer Within the Previous Radiation Field Using a Bioabsorbable Spacer: A Case Report

TL;DR

A bioabsorbable spacer enabled safe reirradiation for a cervical cancer recurrence in a previously treated area, avoiding severe side effects.

Contribution

This is the first reported case of using a bioabsorbable spacer for reirradiation in cervical cancer recurrence.

Findings

The spacer reduced radiation dose to the rectum and other organs, allowing safe reirradiation.

The patient remained disease-free six months after treatment with only mild, temporary side effects.

The technique shows promise for selected patients with in-field cervical cancer recurrence.

Abstract

Reirradiation for cervical cancer recurrence in previously irradiated fields is challenging due to dose limitations. To our knowledge, this is the first case report describing successful reirradiation using a bioabsorbable spacer for vaginal cuff recurrence after initial concurrent chemoradiotherapy (CCRT) and hysterectomy. A 70‐year‐old woman with cervical cancer Stage IIIC2r initially received CCRT and chemotherapy. Three years later, uterine recurrence led to hysterectomy. Eighteen months post‐surgery, vaginal cuff recurrence was diagnosed by imaging and tumor biopsy. A bioabsorbable spacer was surgically placed around the vaginal cuff tumor via an open abdominal approach. Reirradiation (55 Gy in 22 fractions) was started 23 days postoperatively. Use of the spacer provided adequate dose reduction to the small bowel, sigmoid colon, and rectum, with the rectal D1cc reduced to 37.9 Gy. Mild paralytic ileus occurred, but resolved conservatively, and there were no severe complications. The patient remains disease‐free at 6 months post‐treatment. In this case, bioabsorbable spacer placement allowed safe reirradiation for cervical cancer vaginal cuff recurrence. This technique may represent a promising approach for selected patients with in‐field recurrent cervical cancer, although further accumulation of cases and longer follow‐up are required.

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