[Complications of the treatment of cervix neoplasms by radiotherapy]

Of 939 patients treated by radiotherapy for carcinoma of the cervix at the hôpital Notre-Dame in Montreal, between 1979 and 1981, 275 (29.3%) had digestive, urologic, gynecologic, vascular, osseous and cutaneous complications. Surgery was necessary to treat 73 complications in 55 patients (5.9%): 42 digestive (25 occlusions, 13 fistulas and 4 perforations); 22 urologic (16 occlusions, 5 fistulas, 1 hemorrhage); 6 gynecologic (3 hemorrhage and 3 uterine necrosis); 1 cutaneous, 1 vascular and 1 osseous necrosis. No direct correlation was found between the incidence of the complications and certain predisposing factors such as the type of radiotherapy, patients' age, stage of the disease and gynecologic surgery before radiotherapy. However, there was a strong correlation between the incidence of complications and the dose of radiotherapy and the need for gynecologic surgery after radiotherapy. High morbidity was observed in the 55 patients treated surgically: they had to undergo a mean of 2.36 operations each, 2.98 general anesthetics, 1.81 hospitalizations (mean duration 75.7 days); 21 had one or more definitive stomas. The death rate was 5.45%. Surgical treatment was individualized. Limited resections were performed for occlusions, fistulas and perforations whenever it was technically feasible to treat digestive and urologic complications. A bypass procedure was used when resection would have been too extensive or dangerous. The majority of rectal lesions were treated by colostomy and a Hartmann procedure.