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Gynecological radio-induced secondary malignancy after a gynecological primary tumor: a rare entity and a challenge for oncologists
  1. Amelia Barcellini1,
  2. Mattia Dominoni2,3,
  3. Barbara Gardella2,3,
  4. Giorgia Mangili4 and
  5. Ester Orlandi1
  1. 1 Radiation Oncology, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
  2. 2 Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
  3. 3 Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  4. 4 Obstetrics & Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
  1. Correspondence to Dr Amelia Barcellini, Radiation Oncology, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy; amelia.barcellini{at}


The management of radiation-induced secondary malignancies in the female genital tract after pelvic radiation treatment for a primary gynecological tumor is a challenge for multidisciplinary teams that follow survivors. Considering the lack of data on the incidence of this disease and the absence of guidelines for its management, in this review, the available literature is analyzed to determine the characteristics and the clinical management of gynecological radiation-induced secondary malignancies. Gynecological radiation-induced secondary malignancies were found to be predominantly more aggressive, poorly differentiated, and had rare histologic types compared with sporadic tumors. The management is influenced by previous radiation doses and the localization of the radiation-induced secondary malignancies. Surgery, when feasible, was the cornerstone; re-irradiation was an option when a surgical approach was not feasible and high-dose conformal techniques should be preferred considering the need to spare previously irradiated surrounding normal tissues. Clinical outcomes, when reported, were poor in terms of local control and survival. Given the difficulty in managing these uncommon malignancies, a centralization of care in sites that are connected to research networks actively partaking in international discussions and with higher expertise in complicated surgery or radiotherapy should be considered to improve clinical outcomes.

  • neoplasms, second primary
  • radiation injuries
  • radiotherapy

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  • Contributors Conceptualization and project development: AB and EO; methodology: AB, MD, BG, EO; data collection: AB and MD; writing: AB; review and editing: MD, BG, GM, EO; supervision: GM, EO. All Authors have read and agreed to the published version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.