ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
Ru
En

The Role of Selective Uterine Artery Chemoembolization in Combination Therapy for Locally Advanced Cervical Cancer

For citation: Babaeva N. А., Antonova I. B., Aleshikova O. I., Ivashina S. V., Ashrafyan L. A., Ovodenko D. L. The Role of the Selective Uterine Artery Chemoembolization in Combination Therapy of locally Advanced Cervical Cancer. Doctor.Ru. 2018; 2(146): 20–25.
20 February 10:30

Study Objective: To assess the efficacy and expediency of selective uterine artery chemoembolization (UACE) in combination therapy for locally advanced cervical cancer (LACC).

Study Design: This was a summarizing evaluation study.

Materials and Methods: Selective UACE using carboplatin (AUC 4) was performed for 49 patients stage IB–IIIB LACC: 16 (32.7%) with FIGO stage IB-2A (Т1b-2аN0М0), 18 (36.7%) with stage IIB (Т2bN0М0), and 15 (30.6%) with stage IIIA-B (Т1bN1V0, Т2aN1М0, Т2bN1М0, Т3bN0М0, Т3bN1М0). Average patient age was 45.8 years. Average uterine volume prior to treatment was 88.3 cm3. The majority of the patients had exophytic tumors (44%); 24% suffered from the mixed form, and 32% had the endophytic form.
A comprehensive examination included magnetic resonance imaging of the true pelvis with IV contrast, 3D ultrasound imaging of the true pelvis, measurement of the tumor marker SCC, cystoscopy and flexible sigmoidoscopy/colonoscopy. All patients underwent dynamic assessment of intratumoral blood flow and uterine and ovarian arterial blood flow hemodynamics prior to treatment and on days 7, 14 and 21 after UACE.

Study Results: Significant reduction in tumor size was found after UACE; the range was from 16 cm3 to 63 cm3, with an average of 36.6 cm3. The greatest shrinkage, 76.3%, was observed in patients with exophytic tumors. Notable reduction in the number of intratumoral blood vessels and in blood flow velocity was recorded, as well as an increased resistance index.
On day 21 after UACE, 10 (20.4%) patients who had not had parametrial tissue infiltration, and whose tumor had shrunk by 50% or more, underwent surgery—extended hysterectomy with/without appendages. Thirty-nine patients continued to have neoadjuvant polychemotherapy, receiving two courses of taxane-platinum therapy at intervals of 21 days. Another 25 (51.0%) of the patients had radical surgery after completion of two courses of polychemotherapy; these were patients who had achieved significant reduction of tumor size and parametrial infiltrate resorption after the combination neoadjuvant therapy. Fourteen (28.6%) patients with residual parametrial infiltration or cervical tumor shrinkage of less than 50% underwent combined radiation therapy.
Post-surgery histological examination found tumor histological response in all 35 study participants. Grade 1 tumor histological response was recorded in 42.8% of the patients, grade 2 in 31.4%, and grades 3 or 4 in 25.8%.

Conclusion: It is advisable for LACC patients to receive combination therapy including selective UACE. This method is especially promising for patients who have exophytic tumors with bleeding.

N. A. Babaeva — Russian Scientific Center for Radiology, Moscow. E-mail: natbabaeva@yandex.ru
I. B. Antonova — Russian Scientific Center for Radiology, Moscow. E-mail: iran24@yandex.ru
O. I. Aleshikova — Russian Scientific Center for Radiology, Moscow. E-mail: olga.aleshikova@gmail.com
S. V. Ivashina — Russian Scientific Center for Radiology, Moscow. E-mail: s.ivashina@bk.ru
L. A. Ashrafyan — Academician V. I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatalology, Moscow. E-mail: l_ashrafyan@oparina4.ru
D. L. Ovodenko — Academician V. I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatalology, Moscow. E-mail: d_ovodenko@oparina4.ru

Доктор.ру
20 February 10:30
LITERATURE
  1. Ashrafyan L. A., Antonova I. B., Babaeva N. A., Aleshikova O. I., Vashakmadze S. L. Evalution of neoadjuvant chemotherapy results in locally advanced cervical cancer IIB–IIIB stages with current ultrasound diagnosis. Int. J. Gynecol. Cancer. 2015; 25(suppl.2): 169.
  2. Shimada M., Nagao S., Fujiwara K. Neoadjuvant chemotherapy with docetaxel and carboplatin followed by radical hysterectomy for stage IB2, IIA2, and IIB patients with non­squamous cell carcinoma of the uterine cervix. Int. J. Clin. Oncol. 2016; 21(6): 1128–35.
  3. Benedetti­Panici P. L., Zullo M. A., Muzii L., Manci N., Bellati F., Plotti F. et. al. The role of neoadjuvant chemotherapy followed by radical surgery in the treatment of locally advanced cervical cancer. Eur. J. Gynecol Oncol. 2003; 24(6): 467–70.
  4. Chen Z., Shi Y., Wang S. Meta­analysis showing that early response to neoadjuvant chemotherapy predicts better survival among cervical cancer patients. Oncotarget. 2017; 8(35): 59609–17.
  5. Teramae M., Fukuda T., Wada T., Kawanishi M., Imai K., Yamauchi M. et al. Sirtuin1 expression predicts the efficacy of neoadjuvant chemotherapy for locally advanced uterine cervical cancer. Mol. Clin. Oncol. 2015; 3(1): 73–8.
  6. Ашрафян Л. А., Алешикова О. И., Бабаева Н. А., Антонова И. Б., Ивашина С. В., Вашакмадзе С. Л. и др. Оценка результатов неоадъювантной химиотерапии местнораспространенного рака шейки матки IIB–IIIB стадий при комплексной ультразвуковой диагностике. Опухоли женской репродуктивной системы. 2015; 11(2): 76–81. [Ashrafyan L. A., Aleshikova O. I., Babaeva N. A., Antonova I. B., Ivashina S. V., Vashakmadze S. L. i dr. Otsenka rezul'tatov neoad"yuvantnoi khimioterapii mestnorasprostranennogo raka sheiki matki IIB–IIIB stadii pri kompleksnoi ul'trazvukovoi diagnostike. Opukholi zhenskoi reproduktivnoi sistemy. 2015; 11(2): 76–81. (in Russian)]
  7. Черенков В. Г., Петров А. Б., Строженков М. М., Чистякова Т. В., Тверезовский С. А., Иванченко О. Г. Результаты внедрения новых технологий и реконструктивных операций в диагностике и лечении опухолей женских репродуктивных органов. Рос. онкол. журн. 2016; 21(1–2): 38–43. [Cherenkov V. G., Petrov A. B., Strozhenkov M. M., Chistyakova T. V., Tverezovskii S. A., Ivanchenko O. G. Rezul'taty vnedreniya novykh tekhnologii i rekonstruktivnykh operatsii v diagnostike i lechenii opukholei zhenskikh reproduktivnykh organov. Ros. onkol. zhurn. 2016; 21(1–2): 38–43. (in Russian)]
  8. Fei H., Ke P., Wang N., Shen H., Huang J., Tan J. et al. An evaluation comparing Californium252 neutron brachytherapy with neoadjuvant intra­arterial embolism chemotherapy assisted surgery effect for treating advanced cervical carcinoma patients. Eur. J. Gynaecol. Oncol. 2015; 36(4): 442–6.
  9. Важенин А. Н., Шаназаров Н. А., Налгиева Ф. Х. Эффективность применения эндоваскулярной химиоэмболизации в комбинированном лечении рака шейки матки, осложненного кровотечением. Мед. наука и образование Урала. 2011; 2: 17–20. [Vazhenin A. N., Shanazarov N. A., Nalgieva F. Kh. Effektivnost' primeneniya endovaskulyarnoi khimioembolizatsii v kombinirovannom lechenii raka sheiki matki, oslozhnennogo krovotecheniem. Med. nauka i obrazovanie Urala. 2011; 2: 17–20. (in Russian)]
  10. Malik N. S., Shams M. Role of uterine artery embolization in the management of cervical cancer: review article. J. Cancer Sci. Ther. 2012; 4.6: 167–9.
  11. Seldinger S. I. Catheter replacement of needle in percutaneous arteriography: new technique. Acta Radiol. (Stockholm). 1953; 39(5): 368–76.
  12. Москвичев В. Г., Хамошина М. Б., Москвичева А. В. Эмболизация артериальных сосудов в лечении онкологических больных. II Международный симпозиум по мультимодальному лечению рака: сб. тезисов. Владивосток; 1994: 44. [Moskvichev V. G., Khamoshina M. B., Moskvicheva A. V. Embolizatsiya arterial'nykh sosudov v lechenii onkologicheskikh bol'nykh. II Mezhdunarodnyi simpozium po mul'timodal'nomu lecheniyu raka: sb. tezisov. Vladivostok; 1994: 44. (in Russian)]
  13. Хамошина М. Б. Эмболизация внутренних подвздошных артерий при раке шейки матки, осложненном кровотечением. Актуальные вопросы современной лучевой диагностики и лучевой терапии: сб. тезисов докладов I Всесоюзной научной конференции студентов медицинских институтов. Обнинск; 1990: 71–72. [Khamoshina M. B. Embolizatsiya vnutrennikh podvzdoshnykh arterii pri rake sheiki matki, oslozhnennom krovotecheniem. Aktual'nye voprosy sovremennoi luchevoi diagnostiki i luchevoi terapii: sb. tezisov dokladov I Vsesoyuznoi nauchnoi konferentsii studentov meditsinskikh institutov. Obninsk; 1990: 71–72. (in Russian)]
  14. Zeghal Souki D., Touhami O., Rajhi H., Ben Hmid R., Zouari F., Mnif N. et al. Selective arterial embolization in case of bleeding in advanced cervical cancer. Tunis Med. 2013; 91(8–9): 558–9.
  15. Порханова Н. В., Мурашко Р. А., Цаплина Н. Н. Химиоэмболизация — этап комплексного лечения распространенных форм рака шейки матки. Злокачественные опухоли. 2016; 4(20): 141–2. [Porkhanova N. V., Murashko R. A., Tsaplina N. N. Khimioembolizatsiya — etap kompleksnogo lecheniya rasprostranennykh form raka sheiki matki. Zlokachestvennye opukholi. 2016; 4(20): 141–2. (in Russian)]
  16. Черенков В. Г., Петров А. Б., Строженков М. М. Новые технологии и реконструктивные операции в диагностике и лечении опухолей женских репродуктивных органов. Вестн. Новгородского государственного университета им. Ярослава Мудрого. 2016; 1(92): 50–3. [Cherenkov V. G., Petrov A. B., Strozhenkov M. M. Novye tekhnologii i rekonstruktivnye operatsii v diagnostike i lechenii opukholei zhenskikh reproduktivnykh organov. Vestn. Novgorodskogo gosudarstvennogo universiteta im. Yaroslava Mudrogo. 2016; 1(92): 50–3. (in Russian)]
  17. Sugiyama T., Nishida T., Muraoka Y., Tokuda T., Kuromatsu H., Fujiyoshi K. et al. Radical surgery after neoadjuvant intra­arterial chemotherapy in stage IIIb sguamous cell carcinoma of the cervix. Int. Surg. 1999; 84(1): 67–73.
  18. Tian Z. Z., Li S., Wang Y., Yue Y. J., Zhu X. H., Zhao R. et al. Investigation of uterine arterial chemoembolization and uterine arterial infusion chemotherapy for advanced cervical cancer before radical radiotherapy: a long­term follow­up study. Gynecol. Obstet. 2014; 290(1): 155–62.
  19. Tinelli A., Prudenzano R., Torsello M., Gustapane S., Dell'Edera D., Malvasi A. Salvage utilization of selective and super selective embolization in emergency by use of a­magnetic coil and nano­particles in gynecology. Eur. Rev. Med. Pharmacol. Sci. 2011; 15(9): 1101–6.
  20. Косенко И. А., Матылевич О. П., Дударев В. С., Литвинова Т. М., Орехов В. Ф., Фомина И. Н. и др. Эффективность комплексного лечения местнораспространенного рака шейки матки с использованием химиоэмболизации маточных артерий. Онкология. Журн. им. П. А. Герцена. 2012; 1: 16–20. [Kosenko I. A., Matylevich O. P., Dudarev V. S., Litvinova T. M., Orekhov V. F., Fomina I. N. i dr. Effektivnost' kompleksnogo lecheniya mestnorasprostranennogo raka sheiki matki s ispol'zovaniem khimioembolizatsii matochnykh arterii. Onkologiya. Zhurn. im. P. A. Gertsena. 2012; 1: 16–20. (in Russian)]
  21. Туганбеков Т. У., Боровский С. П., Шаназаров Н. А., Малаев Н. Б., Ашимов Н. Т. Особенности ангиоархитектоники матки и ее влияние на результаты рентгенохирургических вмешательств. Тюменский мед. журн. 2014; 16(4): 57–62. [Tuganbekov T. U., Borovskii S. P., Shanazarov N. A., Malaev N. B., Ashimov N. T. Osobennosti angioarkhitektoniki matki i ee vliyanie na rezul'taty rentgenokhirurgicheskikh vmeshatel'stv. Tyumenskii med. zhurn. 2014; 16(4): 57–62. (in Russian)]
  22. Бабаева Н. А., Ашрафян Л. А., Антонова И. Б., Алешикова О. И., Оводенко Д. Л., Ивашина С. В. и др. Роль химиоэмболизации маточных артерий в лечении местнораспространенного рака шейки матки: аналитический обзор. Акушерство и гинекология: новости, мнения, обучение. 2017; 1(15): 16–21. [Babaeva N. A., Ashrafyan L. A., Antonova I. B., Aleshikova O. I., Ovodenko D. L., Ivashina S. V. i dr. Rol' khimioembolizatsii matochnykh arterii v lechenii mestnorasprostranennogo raka sheiki matki: analiticheskii obzor. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie. 2017; 1(15): 16–21. (in Russian)]

News

30 June 00:00
A New Issue of Doctor.Ru Neurology Psychiatry, Vol. 20, No. 5 (2021), Published

Find original articles and reviews covering various aspects of neurology, psychiatry and the interview with Professor Marina Arkadievna Kinkulkina

28 June 00:00
A New Issue of Doctor.Ru Internal Medicine, Vol. 20, No. 4 (2021), Published

Find original articles and reviews covering various aspects of cardiology, gastroenterology, internal medicine and the interview with Professor Elena Zelikovna Golukhova

 

3 May 17:06
A New Issue of Doctor.Ru Pediatrics, Vol. 20, No. 3 (2021), Published

Find original articles and reviews covering various aspects of pediatrics and the interview with Professor Evgeny Grigorievich Furman

3 May 17:06
A New Issue of Doctor.Ru Endocrinology, Vol. 20, No. 2 (2021), Published

Find original articles and reviews covering various aspects of endocrinology and the interview with Professor Valentin Viktorovich Fadeev

16 April 11:57
Igor Evgenievich Khatkov joined the American Surgical Association

Igor Evgenievich Khatkov, Head of A. S. Loginov Moscow Clinical Scientific and Practical Centre, Chief Oncologist in and for Moscow is now an honoured member of the American Surgical Association.

All news