What is your approach to a patient with locally advanced cervical cancer who presents with a fistula (rectal or bladder)?
Do you recommend upfront diversion? Are there unique planning considerations such as the inability to use bladder filling? How do you boost? What are long-term functional outcomes?
Answer from: Radiation Oncologist at Academic Institution
For bladder fistula, we usually get a bilateral nephrostomy done for diversion and then treat patients with definitive intent with chemo RT with brachy using an interstitial device. We reassess the patient with PET/CT in 3 months and if complete responses, then they get urinary diversion with ideal ...
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