Radiotherapy for Vaginal Bleeding Caused by Advanced Pelvic Neoplasms: Review of the Literature and Eight Own Cases

INTRODUCTION Vaginal hemorrhage as a known symptom of advanced pelvic neoplasms can be treated by local tamponade, surgery or embolization of the local vessels. In the case of a relapse, local radiotherapy can be successful. The purpose of this paper is to compare data from the literature with our own results and to show the usefulness of radiotherapy as an option in palliative care. PATIENTS AND METHODS In a retrospective study of the time period 1992-2007, 8 patients with advanced gynecological neoplasms and untreatable hemorrhages were referred for radiotherapy. Five patients were applied one radiotherapy course, in the remaining 3 a second course was applied after a relapse of hemorrhage. Radiotherapy was performed using endovaginal brachytherapy (EBT) and external beam radiotherapy (EBRT), the total dose ranging from 10-28 Gy / 0.5 cm tissue depth using EBT and from 22-50.4 Gy using EBRT. A literature search was perfomed using Medline™ looking for papers dealing with „vaginal hemorrhage and radiotherapy”. RESULTS In 7 / 8 patients, the hemorrhage could be controlled completely, in the remaining one partially. The patients' general condition improved dramatically. No intense side effects were noticed. The literature search showed 13 relevant papers within the past 30 years. In the majority of publications, an external beam radiotherapy using few high single fractions was performed. Data concerning brachytherapy were rare. Hemorrhage could be stopped in 60-90 % of the patients. CONCLUSION The data taken from the literature indicate that radiotherapy should be considered for patients with vaginal tumor hemorrhage. Our data support this recommendation.