Pregnancy after sugery and brachytherapy for vaginal cancer

INTRODUCTION: Primary vaginal cancer is infrequent, corresponding to 1–2% of all female genital tract cancer diagnoses. Treatment for vaginal cancer varies depending on tumor histology, size, location and staging, and may include one or more of the following: surgical excision, radiation therapy and/or chemotherapy. All treatments negatively affect fertility/pregnancy outcomes. Pelvic radiation therapy, even in doses < 2 Gy, may extinguish up to 50% of immature oocytes. In addition, radiotherapy may cause modifications in cervical length, loss of uterine junctional zone anatomy and lead to myometrial atrophy and fibrosis, increasing the risk for adverse pregnancy outcomes. METHODS: Case report of a patient who carried a pregnancy to term after surgery and brachytherapy for vaginal cancer. RESULTS: A 28 year-old woman, presented with a 3 cm right midvagina wall tumor, diagnosed as grade 2, vaginal squamous cell carcinoma - FIGO 2009, stage IB. Computed tomography showed no evidence of lymph node involvement or distant metastasis. The patient underwent surgery followed by 4 fractions of vaginal brachytherapy, once a week, with a dose of 6 Gy at a 5 mm depth, amounting to a total dose of 24 Gy. One year and 9 months after treatment, the patient gave birth to a healthy child at 39 weeks pregnancy. A C-section was needed due functional dystocia during labor. CONCLUSION: This case report recounts a successful pregnancy carried to term after surgery and brachytherapy for squamous cell vaginal cancer.