PMC9934871_01
(a-c): Treatment plan in axial (a), coronal (b) and sagittal (c) views with VMAT technique.
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A non-conventional approach with concomitant chemoradiotherapy (cisplatin 40 mg/day, unique cycle, 6 weeks: days 1, 8, 15, 22, 29, 36) and volumetric modulated arc therapy (VMAT) technique external radiotherapy, total dose of 54 Gy in fractions of 1.8 Gy, a sequential schedule planning target volume 1 (PTV1) (45 Gy) and a boost on PTV11 (9 Gy) was proposed (Figure 1).
Comparison of CT images. (a-d): (Upper row, a-d) Before radiotherapy, uterus measures were 85.2 x 95.8 x 10.4 mm. (e-h): (Lower row, e-h) After radiotherapy, uterus measures were 43.4 x 60.7 x 62.7 mm.
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After submitting the patient to concomitant chemo-radiotherapy, a favourable clinical response was achieved, bleeding ceased and control images showed a reduction of approximately 60% of the tumour (Figure 2).
Macroscopic view of the sample (uterus + adnexa). (a): Uterus, fallopian tubes and ovaries after surgical procedure. (b): Longitudinal incision of the sample with evidence of tumoral mass coming from posterior uterine wall.
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Douglas cul-de-sac, parametrial, uterus sacral ligaments and rectovaginal septum were free from gross lesion (Figure 3).