Endovascular interventions in advanced cancer of the uterus

The primary endpoint of this study was to estimate the efficacy of endovascular interventions -EVI- (occlusion and chemoinfusion of the internal iliac arteries- IIA) in the control of bleeding of patients with advanced cervical and endometrial cancer. Tumor response and survival were also estimated.

EVI were carried out in 95 patients with advanced uterine carcinoma (study group). In 82 (86%) of them EVI preceded primary radiotherapy. Autoclots, Ivalon, and Gelfoam were used for arterial occlusion. In 43 patients intraarterial chemotherapy was followed by occlusion of the internal iliac arteries (IIA). For chemoinfusion, cisplatin (120 mg/m(2)), and later the combination of cisplatin, doxorubicin and cyclophosphamide (CAP) were administered into the femoral artery using the Seldinger method. These patients were compared with a similar group of 143 patients treated with radiotherapy alone (control group).

Bleeding was controlled by embolization in all 95 patients with EVI and in 122 (85.3%) patients of the control group (p <0.01). Repeat angiographic studies in patients undergoing chemoembolization showed complete remission (CR) in 7%, partial remission (PR) in 63% and disease stabilization (SD) in 30% of the patients. The corresponding figures for the control group were 5%, 54% and 23%, while progressive disease (PD) was observed in 18% of the patients of this group. The 3-year overall survival was 47% versus 36% in the study and control groups, respectively (p <0.01).

EVI is a method effective in stopping bleeding in patients with advanced uterine carcinoma. Chemoembolization of the IIA increases the efficacy of subsequent radiotherapy in patients with advanced uterine carcinoma.