EC Gynaecology

Prospective recording of acute and late complications of radiation therapy for cervical cancer is essential to optimize management and minimize the adverse effects of radiotherapy. Uro-genital and genito-digestive fistulas are relatively rare late complications of radiotherapy and are responsible for a significant decline in the quality of life of patients. Their diagnosis is primarily radiological after clinical suspicion or during post-therapeutic surveillance. We present a retrospective study of 30 cases of uro-genital and genito-digestive fistulas following radiation for cervical cancer, diagnosed at the Radiology Department of the National Institute of Oncology between January 2020 and June 2023. MRI was the gold standard for diagnosis, and all cases involved squamous cell carcinoma of the cervix. We observed 43.3% vesico-vaginal fistulas, 16.6% cervico-vesical fistulas, 20% recto-vaginal fistulas, 16.6% combined fistulas (recto-vagino-vesical, vesico-vagino-sigmoid, and vesico-utero-rectal fistulas), 3% vulvo-perineal fistulas, and 3% parametrial fistulas. An advanced FIGO tumor stage was found to be a promoting factor for fistula formation, and treatment with brachytherapy did not increase the risk of fistula compared to exclusive radiochemotherapy. Compared to a study conducted at the University of Kentucky in the United States between 1997 and 2010, a higher frequency of post-radiation cervical cancer fistulas is observed in Morocco. Thus, uro-genital and genito-digestive fistulas constitute a significant complication in cervical cancer radiotherapy, with vesico-vaginal fistulas being the most common type, easily diagnosed through pelvic MRI.

 Keywords: Uro-Genital; Genito-Digestive Fistulas; Radiation; Cervical Cancer

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