Intensity modulated radiotherapy and brachytherapy for a cervical cancer after renal transplantation

Radiotherapy and surgery are important radical treatment options for cervical cancer, but the presence of a pelvic kidney complicates the situation. Fine radiation technique can help avoiding side effects. Radiation to the modified pelvis using intensity modulated radiotherapy (IMRT) followed by brachytherapy, while avoiding the renal allograft is technically feasible which ensures adequate target volume and reduces side effects. Here, the authors report a 45-year-old patient with invasive cervical cancer with a pelvic kidney who was treated by pelvic IMRT in combination with high-dose rate brachytherapy. There was no evidence of disease and with normal kidney function currently at 12 months.

Brachytherapy; Cervical cancer; Intensity modulated radiation therapy; Pelvic radiotherapy; Renal transplantation.

[1] Kessler M., Jay N., Molle R., Guillemin F.: “Excess risk of cancer in renal transplant patients”. Transpl. Int., 2006, 19, 908.

[2] Vajdic C.M., McDonald S.P., McCredie M.R., van Leeuwen M.T., Stewart J.H., Law M., et al.: “Cancer incidence before and after kidney transplantation”. JAMA. 2006, 296, 2823.

[3] Kasiske B.L., Snyder J.J., Gilbertson D.T., Wang C.: “Cancer after kidney transplantation in the United States”. Am. J. Transplant, 2004, 4, 905.

[4] Veroux M., Corona D., Scalia G., Garozzo V., Gagliano M., Giuffrida G., et al.: “Surveillance of human papilloma virus infection and cervical cancer in kidney transplant recipients: preliminary data”. Transplant. Proc. 2009, 41, 1191.

[5] Brown M.R., Noffsinger A., First M.R., Penn I., Husseinzadeh N.: “HPV subtype analysis in lower genital tract neoplasms of female renal transplant recipients”. Gynecol. Oncol., 2000, 79, 220.

[6] Buell J.F., Gross T.G., Woodle E.S.: “Malignancy after transplantation”. Transplantation, 2005, 80, S254.

[7] Meeuwis K.A., van Rossum M.M., van de Kerkhof P.C., Hoitsma A.J., Massuger L.F., de Hullu J.A.: “Skin cancer and (pre)malignancies of the female genital tract in renal transplant recipients”. Transpl. Int., 2010, 23, 191.

[8] Hinten F., Meeuwis K.A., van Rossum M.M., de Hullu J.A.: “HPVrelated (pre)malignancies of the female anogenital tract in renal transplant recipients”. Crit. Rev. Oncol. Hematol., 2012, 84, 161.

[9] Roth T.M., Woodring C.T., McGehee R.P.: “Stage II-B carcinoma of the cervix complicated by bilateral pelvic kidneys”. Gynecol. Oncol., 2004, 92, 376.

[10] Rosenshein N.B., Lichter A.S., Walsh P.C.: “Cervical cancer complicated by a pelvic kidney”. J. Urol., 1980, 123, 766.

[11] Abouna G.M., Micaily B., Lee D.J., Kumar M.S., Jahshan A.E., Lyons P.: “Salvage of a kidney graft in a patient with advanced carcinoma of the cervix by reimplantation of the graft from the pelvis to the upper abdomen in preparation for radiation therapy”. Transplantation, 1994, 58, 520.

[12] Bakri Y.N., Mansi M., Sundin T.: “Stage IIB carcinoma of the cervix complicated by an ectopic pelvic kidney”. Int. J. Gynaecol. Obstet., 1993, 42, 174.

[13] Ripley D., Levenback C., Eifel P., Lewis R.M.: “Adenocarcinoma of the cervix in a renal transplant patient”. Gynecol. Oncol., 1995, 59, 151.

[14] Castilho M.S.., Jacinto A.A., Viani G.A., Campana A., Carvalho J., Ferrigno R., et al.: “Intensity Modulated Radiotherapy (IMRT) in the postoperative treatment of an adenocarcinoma of the endometrium complicated by a pelvic kidney”. Radiat. Oncol., 2006, 1, 44.

[15] Mohiuddin M.M., Mahmood U., Hall A.A., Rosenshein N.: “Adjuvant pelvic irradiation for cervical cancer in the setting of a transplanted pelvic kidney”. J. Cancer Res. Ther., 2012, 8, 427.