[Interventional treatment of hemorrhages in advanced cervical carcinoma]

Retrospective evaluation of percutaneous interventional treatment of locally advanced cervical carcinoma.

Since 1991, 13 patients with advanced tumor disease have been referred to our department for diagnosis and therapy of an acute blood loss. In all patients (age 40-88 years, mean 61 years) hemorrhage was detected by decrease in red blood cell count. In all cases patients suffered from locally advanced or recurrent disease after surgery and/or additional radio- or chemotherapy. Embolization was performed by transfemoral access using minicoils in most cases, liquid agents less often and a covered vascular stent in one patient.

The site of the hemorrhage or the blood pooling of the tumor could be seen in all cases angiographically. Twenty-seven treatment cycles (2.1 per patient) were performed at intervals of 3 days to 6 months. The maximum time of follow-up and additional treatments if necessary was 1 year. In 9 of 13 patients (69%) the bleeding could be stopped immediately with a single treatment or initial treatment via both iliac arteries. One patient (7,7%) died during therapy because of an uncontrollable bleeding and consecutive decrease in red blood cells count. The remaining three patients (23%) showed slight persistent or recurrent bleeding, which could be managed interventionally until the following episode. There were two complications (15%) during therapy, representing a coil misplacement and a coil wash-out, which both could be managed interventionally.

Hemorrhage following locally advanced or recurrent cervical carcinoma can be stopped interventionally in about 70% of cases. Even in partial success it is possible to manage the acute life-threatening situation. Follow-up examinations of up to 1 year justify this therapeutic concept.