HORTIS VI – Gynecologic Radionecrosis
The genital organs are among the most common sites of cancer in women. Major areas include the uterine corpus and cervix, vagina and vulva. Radiation is used as an adjunct to surgery in uterine corpus and vulvar cancers. Radiation is also employed in small volume and early stage cervix and vaginal cancers, but has a long history of limited success in more advanced and larger volume malignancies.
Radiation – induced injuries following treatment for gynecologic malignancies ranges from 2-4%, invariably involving tissue necrosis. The lesion often requires narcotics for pain, and the patient may become socially isolated secondary to continuous malodorous discharge. The nature of the complication is one of progression, ulcers and fistulae result, and frequently involve surrounding organs.
Topical agents have been generally disappointing, and surgical management frequently is required. Adequate debridement may require diverting the urinary or G.I tract. Attempts at tissue flaps to repair the defect are often difficult, if not impossible.
Hyperbaric oxygen therapy has been reported as helpful. It has been employed primarily for vaginal vault necrosis, or as a peri-operative adjunct. The supporting level of evidence is modest, however, so HORTIS VI will represent an important element of the scientific scrutinity of the treatment of this condition.