Vesicovaginal fistula formation in patients with Stage IVA cervical carcinoma

To evaluate the rate of vesicovaginal fistula formation and mortality in women with Stage IVA cervical carcinoma.

Data were abstracted from the clinical records of women diagnosed with Stage IVA cervical cancer at the time of examination under anesthesia, cystoscopy, and proctoscopy (EUA/C/P) at a single institution from 1994 to 2004. Demographic and treatment characteristics were compared using either Fisher's exact test or Student's t-test, as appropriate. Survival was calculated using the Kaplan-Meier method.

Twenty-three patients were diagnosed with Stage IVA cervical cancer. All were diagnosed with extension of disease into the bladder; one patient had rectal involvement as well. Concurrent chemotherapy and radiation was used in 60.8%, while 30.4% received radiation alone and 8.7% elected no treatment. Fifty-six percent of the patients were smokers. Eleven patients (47.8%) developed a fistula at a median time of 2.9 months from cancer diagnosis. Fistula formation was significantly increased among smokers as compared to non-smokers (73 vs 27%; p=0.03). Two patients (8.7%) are alive without evidence of disease at a median follow-up of 19 months. The disease-specific survival is 23.1 months. Patients who developed a vesicovaginal fistula had a median survival of 11.2 months after fistula formation.

High rates of vesicovaginal fistula formation can be expected when treating women with extension of cervical cancer into the bladder, particularly among women who smoke. The routine use of EUA/C/P at the time of initial diagnosis aids in counseling women about the likelihood of this complication. Novel strategies for managing vesicovaginal fistulae after chemoradiation are needed.