Reduced Radiotherapy Volumes for Cervical Cancer in a Second Trimester Gravid Patient: A Case Report

Patricia Ong, Mark Dumago, Carl Jay Jainar, Vannesza Hendricke Chua, Kelvin Ken Yu, Jocelyn Mariano, Warren Bacorro

Oct 2025 DOI 10.35460/2546-1621.2025-0211     Access   

Abstract

Purpose: To report the technical details and outcomes of a case of cervical cancer in pregnancy treated with reduced standard radiation volume via Intensity Modulated Radiation Therapy (IMRT).

Methods: A 33-year-old G4P3 (3003) was diagnosed with cervical squamous cell carcinoma at 17 weeks of gestation. She had a 5-year history of intermittent post-coital bleeding and an incidental finding of a cervical mass during prenatal ultrasound. Internal examination revealed a 6-cm mass with no extension to the upper vagina and pliable bilateral parametria, leading to a staging of IB3. A multidisciplinary meeting with a gynecologic oncologist, radiation oncologist, medical ethicist and the patient was held wherein different treatment options were discussed. She consented to definitive external beam radiation therapy (EBRT) with concurrent cisplatin and was administered during 19-25 weeks of gestation using IMRT. A prescribed dose of 45 Gy in 25 fractions was delivered to the entire cervix with a 1-cm geometric expansion covering the lower uterus, and upper vagina as well as the pelvic lymph nodes, followed by four fractions of brachytherapy.

Results: The patient tolerated treatment with only grade 1 gastrointestinal and genitourinary adverse effects. After completion of concurrent chemoradiation, she underwent induction of labor and delivered a nonviable fetus. Three months post-treatment, MRI found no evidence of disease. At 15 months follow-up, she remains asymptomatic with no palpable disease.

Conclusion: This report demonstrates that treating only the involved uterus may be considered in cases wherein giving the full radiation dose to the whole uterus may lead to significant toxicities and eventual treatment interruption.

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin [Internet]. 2021;71(3):209–49. Available from: https://doi.org/10.3322/caac.21660
  2. Cervical cancer coverage: A top priority of PhilHealth in Universal Health Care [Internet]. Philippine Health Insurance Corporation. Manila: Department of Health; 2022 [cited 2025 Apr 1]. Available from: https://www.philhealth.gov.ph/news/2023/cervical_coverage.pdf
  3. Le Guévelou J, Selleret L, Laas E, Lecuru F, Kissel M. Cervical cancer associated with pregnancy: Current challenges and future strategies. Cancers (Basel) [Internet]. 2024;16(7):1341. Available from: https://doi.org/10.3390/cancers16071341
  4. Amant F, Berveiller P, Boere IA, Cardonick E, Fruscio R, Fumagalli M, et al. Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting. Ann Oncol [Internet]. 2019;30(10):1601–12. Available from: https://doi.org/10.1093/annonc/mdz228
  5. Morice P, Uzan C, Gouy S, Verschraegen C, Haie-Meder C. Gynaecological cancers in pregnancy. Lancet [Internet]. 2012;379(9815):558–69. Available from: https://doi.org/10.1016/S0140-6736(11)60829-5
  6. Cibula D, Raspollini MR, Planchamp F, Centeno C, Chargari C, Felix A, et al. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - Update 2023. Int J Gynecol Cancer [Internet]. 2023;33(5):649–66. Available from: https://doi.org/10.1136/ijgc-2023-004429
  7. Dembo AJ, Bush RS, Beale FA, Bean HA, Pringle JF, Sturgeon J, et al. Ovarian carcinoma: improved survival following abdominopelvic irradiation in patients with a completed pelvic operation. Am J Obstet Gynecol. 1979;134(7):793–800.
  8. Smith JP. Postoperative treatment of early cancer of the ovary: A random trial between postoperative irradiation and chemotherapy. In: Symposium on Ovarian Carcinoma [held at Reston, Virginia, November 15 and 16, 1974]. Vol. 42. No. 42. Bethesda: US Department of Health, Education, and Welfare, Public Health Service, National Institutes of Health, National Cancer Institute; 1975.
  9. Firat S, Murray K, Erickson B. High-dose whole abdominal and pelvic irradiation for treatment of ovarian carcinoma: long-term toxicity and outcomes. Int J Radiat Oncol Biol Phys [Internet]. 2003;57(1):201–7. Available from: https://doi.org/10.1016/s0360-3016(03)00510-8
  10. Mahantshetty U, Jamema S, Engineer R, Deshpande D, Sarin R, Fogliata A, et al. Whole abdomen radiation therapy in ovarian cancers: a comparison between fixed beam and volumetric arc based intensity modulation. Radiat Oncol [Internet]. 2010;5(1). Available from: https://doi.org/10.1186/1748-717x-5-106
  11. Hong L, Alektiar K, Hunt M, Leibel S. Intensity modulated radiotherapy for soft tissue sarcoma of thigh. Int J Radiat Oncol Biol Phys [Internet]. 2002;54(2):139–40. Available from: https://doi.org/10.1016/s0360-3016(02)03298-4
  12. Rochet N, Sterzing F, Jensen A, Dinkel J, Herfarth K, Schubert K, et al. Helical tomotherapy as a new treatment technique for whole abdominal irradiation. Strahlenther Onkol [Internet]. 2008;184(3):145–9. Available from: https://doi.org/10.1007/s00066-008-1772-z
  13. Monk BJ, Tian C, Rose PG, Lanciano R. Which clinical/pathologic factors matter in the era of chemoradiation as treatment for locally advanced cervical carcinoma? Analysis of two Gynecologic Oncology Group (GOG) trials. Gynecol Oncol [Internet]. 2007;105(2):427–33. Available from: https://doi.org/10.1016/j.ygyno.2006.12.027
  14. Lee HC, Jeong JW, Lee JH, Kim SH, Park DC, Yoon JH, et al. High-dose (60 Gy) intensity-modulated radiotherapy with concurrent weekly cisplatin followed by intracavitary radiation in locally advanced cervical cancer: A phase II prospective clinical trial. Gynecol Oncol [Internet]. 2023;177:142–9. Available from: https://doi.org/10.1016/j.ygyno.2023.08.018

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