case_images: PMC11805538_01
case_images: MR T2 sagittal view. T2 sagittal MR at diagnosis showing cervical tumor.
case_images: cureus-0017-00000077151-i01.jpg
case_images: PMC11805538_01_cureus-0017-00000077151-i01.jpg
case_images: FIG1
case_images: An MRI of the abdomen confirmed an ill-defined enhancing soft tissue anterior to the right psoas muscle with an associated peripherally enhancing tubular fluid-filled structure that extended to the right lower abdomen in the setting of the bicornuate uterus with a heterogeneously enhancing left uterine horn (Figures 1, 2). A repeat pelvic MRI performed four months after the initial MRI confirmed the presence of a known cervical tumor that invaded the bladder neck, upper vagina, and upper urethra (Figures 1, 2).
case_images: MR T2 coronal view . Coronal MRI at diagnosis showing cervical tumor (blue arrows) invading bladder neck, upper vagina, and upper urethra and bicornuate uterus.
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case_images: PMC11805538_01_cureus-0017-00000077151-i02.jpg
case_images: FIG2
case_images: An MRI of the abdomen confirmed an ill-defined enhancing soft tissue anterior to the right psoas muscle with an associated peripherally enhancing tubular fluid-filled structure that extended to the right lower abdomen in the setting of the bicornuate uterus with a heterogeneously enhancing left uterine horn (Figures 1, 2). A repeat pelvic MRI performed four months after the initial MRI confirmed the presence of a known cervical tumor that invaded the bladder neck, upper vagina, and upper urethra (Figures 1, 2).
case_images: Patient treatment plan in axial view . Patient treatment plan axial prescribed to 48.6 Gy over 27 fractions. Dose color wash values are 50 Gy (pink), 45 Gy (orange), 40 Gy (yellow), 35 Gy (green), 30 Gy (light blue), 25 Gy (blue), 20 Gy (purple), 15 Gy (red), 10 Gy (white), and 5 Gy (lavender).
case_images: cureus-0017-00000077151-i03.jpg
case_images: PMC11805538_01_cureus-0017-00000077151-i03.jpg
case_images: FIG3
case_images: The CTV vagina, which was expanded with a 1.0 cm margin (Figures 3, 4, 5).
case_images: Patient treatment plan in coronal view. Patient treatment plan coronal prescribed to 48.6 Gy over 27 fractions. Dose color wash values are 50 Gy (pink), 45 Gy (orange), 40 Gy (yellow), 35 Gy (green), 30 Gy (light blue), 25 Gy (blue), 20 Gy (purple), 15 Gy (red), 10 Gy (white), and 5 Gy (lavender).
case_images: cureus-0017-00000077151-i04.jpg
case_images: PMC11805538_01_cureus-0017-00000077151-i04.jpg
case_images: FIG4
case_images: The CTV vagina, which was expanded with a 1.0 cm margin (Figures 3, 4, 5).
case_images: Patient treatment plan in sagittal view. Patient treatment plan sagittal prescribed to 48.6 Gy over 27 fractions. Dose color wash values are 50 Gy (pink), 45 Gy (orange), 40 Gy (yellow), 35 Gy (green), 30 Gy (light blue), 25 Gy (blue), 20 Gy (purple), 15 Gy (red), 10 Gy (white), and 5 Gy (lavender).
case_images: cureus-0017-00000077151-i05.jpg
case_images: PMC11805538_01_cureus-0017-00000077151-i05.jpg
case_images: FIG5
case_images: The CTV vagina, which was expanded with a 1.0 cm margin (Figures 3, 4, 5).
case_images: Coronal CT showing mini-ovoids
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case_images: PMC11805538_01_cureus-0017-00000077151-i06.jpg
case_images: FIG6
case_images: Because they were not symmetrical and were not able to accommodate regular cylinders, mini-ovoids were placed on both sides to stabilize the Y-tandems and to spread the vaginal canal (Figures 6, 7).
case_images: Coronal CT showing Y-tandem
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case_images: PMC11805538_01_cureus-0017-00000077151-i07.jpg
case_images: FIG7
case_images: Because they were not symmetrical and were not able to accommodate regular cylinders, mini-ovoids were placed on both sides to stabilize the Y-tandems and to spread the vaginal canal (Figures 6, 7).
case_images: Sagittal CT showing HR-CTV (red) and CTV vagina (purple) . The bladder and the rectum were contoured in yellow and brown, respectively.
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case_images: PMC11805538_01_cureus-0017-00000077151-i08.jpg
case_images: FIG8
case_images: CTV vagina was separately contoured to delineate the extra-cervical tumor extension (Figure 8).
case_images: Dose-volume histogram showing the rectum (brown), bladder (yellow), CTV vagina (purple), and HR-CTV (red) (from left to right)
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case_images: PMC11805538_01_cureus-0017-00000077151-i09.jpg
case_images: FIG9
case_images: D90% [Gy] was 5.08 Gy (total EQD2 = 79.21 Gy). D2cc of the bladder and rectum were 4.43 Gy and 2.39 Gy (Figure 9).