{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T13:53:19Z","timestamp":1772891599825,"version":"3.50.1"},"reference-count":26,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T00:00:00Z","timestamp":1644364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014810","name":"Fondazione di Sardegna","doi-asserted-by":"publisher","award":["2021.1517"],"award-info":[{"award-number":["2021.1517"]}],"id":[{"id":"10.13039\/100014810","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Concurrent platinum-based chemoradiation (CCRT) is the established treatment for locally advanced cervical cancer and has an acceptable toxicity. Radiation-induced necrosis of the uterus and pelvic tissue is a rare and usually late potential complication. Limited data are available about its management. Here, we describe a case of a patient affected by a locally advanced cervical cancer (stage IVA) who received CCRT, obtaining a partial response with persistence of bladder and rectal infiltration. Unfortunately, after the first brachytherapy dose, the patient developed a worsening clinical picture with fever and altered laboratory data indicative of sepsis; the computed tomography revealed a massive necrosis of the uterus with pelvic abscess and peritonitis. We performed a laparoscopic emergency surgery with removal of the necrotic tissue, supracervical hysterectomy, bilateral-oophorectomy, and abscess drainage. Thereafter, once the severe inflammatory condition was resolved, the patient underwent pelvic exenteration with palliative\/curative intent. The postoperative PET\/CT was negative for residual disease. However, the patient needed further hospitalization for re-occurrence of peritonitis with multiple abscesses. A careful diagnosis is crucial in locally advanced cervical cancer patients who, after CCRT, present persistent pain and problematic findings at imaging and laboratory parameters. In these cases, radiation-induced necrosis of the pelvis should be suspected. This case helps to clarify the central role of surgery, especially when actinic necrosis leads to complications such as abscess, fistulae, and extensive tissue destruction that cannot be conservatively medically handled. Laparoscopy represents an ideal approach to realizing the correct diagnosis, as well as enabling the performance of important therapeutic surgical procedures.<\/jats:p>","DOI":"10.3390\/diagnostics12020440","type":"journal-article","created":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T21:19:06Z","timestamp":1644441546000},"page":"440","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Diagnostic Framework of Pelvic Massive Necrosis with Peritonitis following Chemoradiation for Locally Advanced Cervical Cancer: When Is the Surgery Not Demandable? A Case Report and Literature Review"],"prefix":"10.3390","volume":"12","author":[{"given":"Elisabetta","family":"Sanna","sequence":"first","affiliation":[{"name":"Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, 09100 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giacomo","family":"Chiappe","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, 09100 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Lavra","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, 09100 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia","family":"Nemolato","sequence":"additional","affiliation":[{"name":"Department of Pathology, ARNAS G. Brotzu, 09100 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Oppi","sequence":"additional","affiliation":[{"name":"Hematology and Transplant Center, A. Businco Hospital, ARNAS G. Brotzu, 09100 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0577-7217","authenticated-orcid":false,"given":"Antonio","family":"Macci\u00f2","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, 09100 Cagliari, Italy"},{"name":"Department of Surgical Sciences, University of Cagliari, 09100 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clelia","family":"Madeddu","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.ygyno.2017.01.033","article-title":"Concurrent chemoradiotherapy vs. radiotherapy alone in locally advanced cervix cancer: A systematic review and meta-analysis","volume":"145","author":"Datta","year":"2017","journal-title":"Gynecol. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1038\/ncponc0486","article-title":"Concurrent chemotherapy and radiation therapy as the standard of care for cervical cancer","volume":"3","author":"Eifel","year":"2006","journal-title":"Nat. Clin. Pract. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S0167-8140(03)00197-X","article-title":"A systematic review of acute and late toxicity of concomitant chemoradiation for cervical cancer","volume":"68","author":"Kirwan","year":"2003","journal-title":"Radiother. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"54","DOI":"10.4274\/uob.978","article-title":"Long-Term Outcomes of Patients Who Underwent Ureterocutaneostomy","volume":"17","author":"Kizilay","year":"2018","journal-title":"Bull. Urooncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1590\/s1677-5538.ibju.2020.0892","article-title":"Bricker ileal conduit vs. Cutaneous ureterostomy after radical cystectomy for bladder cancer: A systematic review","volume":"48","author":"Korkes","year":"2022","journal-title":"Int. Braz. J. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/S0140-6736(01)05965-7","article-title":"Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: A systematic review and meta-analysis","volume":"358","author":"Green","year":"2001","journal-title":"Lancet."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration (2008). Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: A systematic review and meta-analysis of individual patient data from 18 randomized trials. J. Clin. Oncol., 26, 5802\u20135812.","DOI":"10.1200\/JCO.2008.16.4368"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1111\/IGC.0b013e3181c4a63f","article-title":"Total vaginal necrosis: A representative example of underreporting severe late toxic reaction after concomitant chemoradiation for cervical cancer","volume":"20","author":"Ella","year":"2010","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1002\/cncr.20734","article-title":"Long-term results of high-dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix","volume":"103","author":"Nakano","year":"2005","journal-title":"Cancer"},{"key":"ref_10","first-page":"487","article-title":"Analysis of late adverse events and their chronological changes after radiation therapy for cervical cancer","volume":"80","author":"Yamada","year":"2018","journal-title":"Nagoya J. Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1038\/nrc1950","article-title":"Preventing or reducing late side effects of radiation therapy: Radiobiology meets molecular pathology","volume":"6","author":"Bentzen","year":"2006","journal-title":"Nat. Rev. Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.ygyno.2007.04.001","article-title":"Complete uterine necrosis following chemoradiation for advanced cervical cancer: A case report","volume":"106","author":"Matthews","year":"2007","journal-title":"Gynecol. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/j.ijrobp.2018.11.006","article-title":"Risk factors for ureteral stricture after radi-ochemotherapy including image guided adaptive brachytherapy in cervical cancer: Results from the EMBRACE studies","volume":"103","author":"Fokdal","year":"2019","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.radonc.2021.01.019","article-title":"Risk factors and dose-effects for bladder fistula, bleeding and cystitis after radiotherapy with imaged-guided adaptive brachytherapy for cervical cancer: An EM-BRACE analysis","volume":"158","author":"Spampinato","year":"2021","journal-title":"Radiother. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1007\/s00423-016-1539-4","article-title":"Radiation-induced rectovaginal fistulas in locally advanced gynaecological malignancies-new patients, old problem?","volume":"402","author":"Zelga","year":"2017","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"9299","DOI":"10.18632\/oncotarget.24271","article-title":"Locally advanced cervical cancer with bladder invasion: Clinical outcomes and predictive factors for vesicovaginal fistulae","volume":"9","author":"Sun","year":"2018","journal-title":"Oncotarget."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1148\/rg.2016150117","article-title":"Post-Radiation Therapy Imaging Appearances in Cervical Carcinoma","volume":"36","author":"Papadopoulou","year":"2016","journal-title":"Radiographics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1097\/IGC.0000000000001094","article-title":"Preoperative Chemoradiotherapy in Locally Advanced Bulky Squamous Cell Carcinoma of the Uterine Cervix","volume":"27","author":"Nakao","year":"2017","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/j.ygyno.2020.11.025","article-title":"Vaginal necrosis: A rare late toxicity after radiation therapy","volume":"160","author":"Jia","year":"2021","journal-title":"Gynecol. Oncol."},{"key":"ref_20","first-page":"267","article-title":"Complications of the treatment of cervix neoplasms by radiotherapy","volume":"29","author":"DeMuylder","year":"1986","journal-title":"Can. J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s00066-006-1455-6","article-title":"Uterus necrosis after radiochemotherapy in two patients with advanced cervical cancer","volume":"182","author":"Marnitz","year":"2006","journal-title":"Strahlenther. Onkol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.ygyno.2005.12.007","article-title":"Pelvic radiation necrosis and osteomyelitis following chemoradiation for advanced stage vulvar and cervical carcinoma","volume":"101","author":"Micha","year":"2006","journal-title":"Gynecol. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1186\/1748-717X-8-220","article-title":"Cervical necrosis after chemoradiation for cervical cancer: Case series and literature review","volume":"8","author":"Fawaz","year":"2013","journal-title":"Radiat. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2919","DOI":"10.21873\/anticanres.13421","article-title":"Should We Cease to Perform Salvage Hysterectomy After Chemoradiation and Brachytherapy in Locally Advanced Cervical Cancer?","volume":"39","author":"Gosset","year":"2019","journal-title":"Anticancer Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.3802\/jgo.2018.29.e25","article-title":"Impact of adjuvant hysterectomy on prognosis in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy: A meta-analysis","volume":"29","author":"Shim","year":"2018","journal-title":"J. Gynecol. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/j.ajog.2004.05.076","article-title":"Completion hysterectomy after radiation therapy for bulky cervical cancer stages IB, IIA, and IIB: Complications and survival rates","volume":"191","author":"Decker","year":"2004","journal-title":"Am. J. Obstet. Gynecol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/2\/440\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:16:37Z","timestamp":1760134597000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/2\/440"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,9]]},"references-count":26,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["diagnostics12020440"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12020440","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,9]]}}}