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Total Vaginal Necrosis: A Representative Example of Underreporting Severe Late Toxic Reaction After Concomitant Chemoradiation for Cervical Cancer
  1. Uwe Güth, MD*,,
  2. Wendy A. Ella, MD,
  3. Adeola Olaitan, MD*,
  4. Richard J. Hadwin, MD*,
  5. Rupali Arora, MD§ and
  6. Mary Mccormack, MD
  1. *Department of Gynaecological Oncology, University College London Hospital (UCLH), London, United Kingdom;
  2. Department of Gynaecology and Obstetrics, University Hospital Basel, Basel, Switzerland; and
  3. Radiooncology, Departments of Oncology, and
  4. §Histopathology, UCLH, London, United Kingdom.
  1. Address correspondence and reprint requests to Uwe Güth, MD, Department of Gynaecological Oncology, University College London Hospital, 250 Euston Rd, London NW1 2 PG, United Kingdom. E-mail: ugueth{at}


Introduction: There is paucity of information regarding a late toxic reaction after chemoradiation for locally advanced cervical cancer. We discuss this problem with special consideration to total vaginal necrosis (TVN), an underreported severe late complication of chemoradiation.

Methods: The records of 98 cervical cancer patients who received chemoradiation at the Department of Oncology of the University College London Hospital between January 2004 and May 2008 were reviewed.

Results: Eight women (8.2%) developed a severe late toxic reaction. From these, 3 patients (3.1% of the entire cohort and 37.5% of the patients with a severe late toxic reaction), who were 44 to 60 years old, developed a TVN 6 to 18 months after completion of chemoradiation. In all the TVN cases, surgical debridement was necessary to alleviate the symptoms. This was followed by an extensive period (up to 24 months) of consolidation. Heavy smoking (P = 0.022) was found to be a significant contributing factor for TVN.

Conclusions: Total vaginal necrosis is an underreported but serious late complication after chemoradiation and leads to considerable chronic morbidity. Radiologic examinations and biopsies are required to exclude recurrent disease. Microvascular damage from radiation combined with heavy cigarette smoking is likely to be pivotal etiologic factors in the development of TVN. For radiotherapy-induced late toxic effects to step out of the gray area of oncologic literature, the clinical pictures should be reported in a more detailed manner. It might be a promising approach to work out a toxicity scale that combines the existing objectifiable grading systems with subjective quality-of-life assessments.

  • Cervical cancer
  • Chemoradiation
  • Late toxic reaction
  • Radiation necrosis

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  • The authors received no funding for this work from any of the following organizations: National Institutes of Health (NIH), Wellcome Trust, Howard Hughes Medical Institute, or others.