Locally advanced cervical cancer with bladder invasion: clinical outcomes and predictive factors for vesicovaginal fistulae

// Roger Sun 1, 2 , Ines Koubaa 3 , Elaine Johanna Limkin 1, 2 , Isabelle Dumas 4 , Enrica Bentivegna 5 , Eduardo Castanon 6 , Sebastien Gouy 5 , Cynthia Baratiny 1 , Fyo Monnot 1 , Pierre Maroun 1 , Samy Ammari 3 , Elise Zareski 3 , Corinne Balleyguier 3 , Eric Deutsch 1, 2, 7 , Philippe Morice 5, 7 , Christine Haie-Meder 1 and Cyrus Chargari 1, 2, 8, 9 1 Department of Radiotherapy, Gustave Roussy Cancer Campus, Villejuif, France 2 INSERM U1030 Molecular Radiotherapy, Gustave Roussy Cancer Campus, Villejuif, France 3 Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France 4 Department of Medical Physics, Gustave Roussy Cancer Campus, Villejuif, France 5 Department of Surgery, Gustave Roussy Cancer Campus, Villejuif, France 6 Department of Drug development, Gustave Roussy Cancer Campus, Villejuif, France 7 Universite Paris Sud, Universite Paris-Saclay, Le Kremlin-Bicetre, France 8 Institut de Recherche Biomedicale des Armees, Bretigny-sur-Orge, France 9 French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France Correspondence to: Cyrus Chargari, email: cyrus.chargari@gustaveroussy.fr Keywords: cervical cancer; locally advanced; brachytherapy; bladder invasion; vesicovaginal fistula Received: August 29, 2017      Accepted: January 01, 2018      Published: January 18, 2018 ABSTRACT Objective: We report outcomes of cervical cancer patients with bladder invasion (CCBI) at diagnosis, with focus on the incidence and predictive factors of vesicovaginal fistula (VVF). Results: Seventy-one patients were identified. Twenty-one (30%) had para-aortic nodal involvement. Eight had VVF at diagnosis. With a mean follow-up time of 34.2 months (range: 1.9 months–14.8 years), among 63 patients without VVF at diagnosis, 15 (24%) developed VVF. A VVF occurred in 19% of patients without local relapses (9/48) and 40% of patients with local relapse (6/15). Two-year overall survival (OS), disease-free survival (DFS) and local control rates were 56.4% (95% CI: 44.1–67.9%), 39.1% (95% CI: 28.1–51.4%) and 63.8% (95% CI: 50.4–75.4%), respectively. Para-aortic nodes were associated with poorer OS (adjusted HR = 3.78, P -value = 0.001). In multivariate analysis, anterior tumor necrosis on baseline MRI was associated with VVF formation (63% vs 0% at 1 year, adjusted-HR = 34.13, 95% CI: 4.07–286, P -value = 0.001), as well as the height of the bladder wall involvement of >26 mm (adjusted-HR = 5.08, 95% CI: 1.38–18.64, P -value = 0.014). Conclusions: A curative intent strategy including brachytherapy is feasible in patients with CCBI, with VVF occurrence in 24% of the patients. MRI patterns help predicting VVF occurrence. Methods: Patients with locally advanced CCBI treated with (chemo)radiation ± brachytherapy in our institute from 1989 to 2015 were analyzed. Reviews of baseline magnetic resonance imaging (MRI) scans were carried out blind to clinical data, retrieving potential parameters correlated to VVF formation (including necrosis and tumor volume).