Fistula Prevention in Recurrent Cervical Cancer

Clinical Context and Guidelines

The National Comprehensive Cancer Network (NCCN) acknowledges that fistulae from pelvic recurrences in heavily irradiated sites represent an "unsolved clinical issue" that is "clinically challenging" to palliate, with these sites generally not responsive to chemotherapy 1, 2, 3
The European Society for Medical Oncology (ESMO) also recognizes the challenge of palliating complications in heavily irradiated recurrent disease, although current guidelines do not specifically address prophylactic metronidazole for fistula prevention 1, 2, 3, 5

Fistulae represent devastating complications that severely impact quality of life through urinary/fecal incontinence, malodor, and social isolation 1, 3
Monitoring for fistula symptoms, such as vaginal passage of urine or stool, recurrent urinary tract infections, and fecal incontinence, is crucial in patients with locally recurrent cervical cancer after radiation therapy 4