The value of magnetic resonance imaging in predicting vesicovaginal fistula in cervical cancer with bladder invasion treated with definitive chemoradiotherapy.

OBJECTIVES

To assess the predictive value of magnetic resonance imaging for vesicovaginal fistula development in cervical cancer patients with bladder invasion treated with definitive chemoradiotherapy.

METHODS

A retrospective review was conducted of the medical records of 43 cervical cancer patients with bladder invasion between 1999 and 2015. Bladder invasion was confirmed through magnetic resonance imaging (scores ≥3) or cystoscopic findings, with or without biopsy. Treatment included weekly cisplatin plus pelvic external beam radiotherapy, with extended-field radiotherapy. After external beam radiotherapy, patients received intracavitary brachytherapy or an external beam boost. Vesicovaginal fistula was diagnosed based on reported symptoms and relevant imaging tests during follow-up.

RESULTS

The median follow-up period was 67.4 months. The 5-year disease-free and overall survival rates were 66.4 %, and 71.8 %, respectively. Vesicovaginal fistula developed in five patients (12.8 %), with three cases occurring within 1 year post-treatment and two others at 16.7 and 64.5 months, respectively. In multivariate analysis, the height of bladder wall involvement on magnetic resonance imaging was the only significant predictor of vesicovaginal fistula (p = 0.041). Specifically, Vesicovaginal fistula occurred in 25 % of cases when bladder wall involvement was ≥20.3 mm, in 50 % of cases at ≥31.1 mm, and in 75 % of cases at ≥41 mm.

CONCLUSIONS

The height of bladder wall involvement on magnetic resonance imaging is a significant predictor of vesicovaginal fistula formation in cervical cancer patients with bladder invasion. This finding can aid clinicians in better predicting this complication, improving patient counseling and management strategies.