[Comparison of uterine artery chemoembolization and internal iliac arterial infusion chemotherapy for the combining treatment for women with locally advanced cervical cancer].
OBJECTIVE
Uterine artery chemoembolization (UACE) and internal iliac arterial infusion chemotherapy (IAIC) are important methods to treat cervical cancer. However, whether the curative efficacy of the two methods has difference is not clear. This study was to evaluate the curative effects of UACE and IAIC on the combining treatment for women with locally advanced cervical cancer.


METHODS
One hundred and seventy-five patients with locally advanced cervical cancer treated between April 1997 and November 2007 were retrospectively analyzed. Patients were divided into two groups: the UACE group (n=92) and the IAIC group (n=83). The UACE group was treated by bilateral uterine artery chemoembolization. Sixty-five of them underwent radical hysterectomy two weeks after UACE, 37 of which received 192Ir high-dose-rate intracavitary radiotherapy 1-2 weeks before radical hysterectomy. The IAIC group was treated by bilateral internal iliac arterial infusion chemotherapy. Among them 70 patients underwent radical hysterectomy after IAIC, 34 of which received 192Ir high-dose-rate intracavitary radiotherapy 1-2 weeks before radical hysterectomy. All patients were treated by carboplatin-based combining chemotherapy. Radiotherapy was performed on 51 requisite patients with high risk of pathological conditions after radical surgery.


RESULTS
The tumor regression rate of the UACE group was 64.1%, which was significantly higher than 47.0% in the IAIC group (P=0.023). The effective rate for clinical stage IB cervical cancer in the UACE group was 77.8%, which was significantly higher than 41.2% in the IAIC group (P=0.037). However, for clinical stage II,III cervical cancer, the effective rates between the two groups had no significant differences (P=0.137 and P=0.524). Postoperative pathologic examinations showed that the negative percentages of cancer cell residue and pelvic lymph node metastasis in the UACE group were slightly higher than those in the IAIC group (17.2% and 80.6% vs. 12.9% and 79.4%, P=0.504 and P=0.861). The recurrent rate in the UACE group was slightly lower than that in the IAIC group (25% vs. 26.5%, P=0.820). The negative percentage of tumor embolus within lymphovascular space was lower in the UACE group than in the IAIC group (87.3% vs. 97.1%, P=0.072). The 1,3,5-year overall survival rates in the UACE group and the IAIC group were 95%, 81%, 77% and 91%, 79%, 71%, respectively (P=0.665).


CONCLUSIONS
UACE followed by preoperative radiotherapy can more effectively reduce the tumor volume of locally advanced cervical cancer compared with IAIC. But UACE does not increase the pathological complete response rate and not decrease the pelvic lymph node metastasis rate, the postoperative recurrence rate, and tumor embolus within lymphovascular space.The effect of UACE on the long-term survival of locally advanced cervical cancer needs to be further evaluated.
Yu
Lei
L
Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510080, PR China.
Tan
Guo-Sheng
GS
Xiang
Xian-Hong
XH
Guo
Wen-Bo
WB
Li
He-Ping
HP
Huang
Yong-Hui
YH
Yang
Jian-Yong
JY
D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007083:Iliac Artery; D007261:Infusions, Intra-Arterial; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012074:Remission Induction; D012189:Retrospective Studies; D047368:Tumor Burden; D055988:Uterine Artery; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
D007496:Iridium Radioisotopes; D016190:Carboplatin