Management of Locally Advanced Cervical Cancer Presenting with Spontaneous Uterine Rupture

Background: The recommended treatment for patients with locally advanced cervical cancer is primary chemoradiation, which consists of platinum-based chemotherapy, external-beam radiation therapy (EBRT) to the pelvis, and cervical brachytherapy. Case: The patient was a 50-year-old woman had a large, fungating cervical mass. Pathology testing showed that it was a poorly differentiated squamous carcinoma. Computed tomography (CT) and magnetic resonance imaging showed a 14-cm, complex, central endometrial mass that perforated the superior uterine fundus and extended into a 13x10.4-cm abscess. An examination under anesthesia with diagnostic laparoscopy revealed a 5-cm cervical mass with extension to the left parametria but not extending to the side wall. There were also significant adhesions in the pelvis, making evaluation of it or drainage of the collection impossible. Definitive chemoradiation was considered. It was proceeded by CT-guided drainage of the abdominal abscess. She underwent EBRT with concurrent cisplatin. A repeat CT scan showed resolution of the cervical mass, but the anterior wall of the uterus was still perforated. Standard tandem/ring cervical brachytherapy for definitive chemoradiation was not safe in the presence of the uterine perforation. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy 1 month after completion of her EBRT. Following surgery, the vaginal cuff was treated with intracavitary brachytherapy. Results: Repeat CT scans and surveillance examinations have shown no evidence of recurrence. Conclusions: For locally advanced cervical cancer, EBRT with concurrent chemotherapy, followed by surgery and vaginal-cuff brachytherapy is a reasonable option for patients in whom tandem and ring intracavitary brachytherapy is not possible.