Healing of vulvo-vaginal radionecrosis following revascularization

Background: Invasive cancers of the vagina and vulva are treated with radiation-based therapy when proximity of the bladder and/or rectum precludes conservative surgical resection. Patient factors affect non-malignant tissue tolerance to radiation exposure. Case: A smoker with atherosclerotic disease developed tissue necrosis and the worsening of claudication after chemoradiation treatment of locally advanced squamous cell carcinoma of the vulva and vagina. Healing occurred after surgical revascularization. Conclusion: Conditions with impaired microvasculature, such as smoking and atherosclerotic disease, are associated with an increased incidence and severity of complications after radiation treatment. Patients undergoing pelvic radiation treatment should be counseled to modify their vascular risk factors. If this fails and patients develop significant radiation necrosis due to compromised arteriole flow, revascularization or stenting may offer important treatment options.