Late urological complications and malignancies after curative radiotherapy for gynecological carcinomas: a retrospective analysis of 10,709 patients.

Abstract

A retrospective study was done to analyze late urological complications following curative radiotherapy of primary gynecological carcinomas. All patients were treated at a single center and with the same radiotherapeutic regimen. The incidence of other carcinomas in these patients was also evaluated. A total of 10,709 patients was treated using combined telebrachytherapy (dosage 67.5 Gy.) during an observation period of 22 years. Severe late complications were seen in 1.24% (133 of 10,709) of the patients, including irradiated bladder (65 cases, mean interval since treatment 6.7 years). Complications required surgery in 118 of 133 patients with a perioperative mortality of 4.2% (5 of 118). Overall in 4.27% (457 of 10,709) of the patients another malignancy developed after (29.1%), during (26.3%) and before (44.6%) radiotherapy. Subsequent malignancies after treatment were predominantly seen in the genital region (88.4%) but they were also in the irradiated nongenital area (0.13%, 14 of 10,709). Of the latter patients 6 had urothelial bladder cancer, which represents a relative risk of 4.66 (based on the Austrian female population) to develop bladder cancer after radiotherapy for gynecological cancer. Late urological complications after radiotherapy of the pelvis are rare but severe. Surgical therapy of irradiated tissues has a higher complication rate compared to surgery on nonirradiated tissue.