Investigation of uterine arterial chemoembolization and uterine arterial infusion chemotherapy for advanced cervical cancer before radical radiotherapy: a long-term follow-up study.

PURPOSE: To investigate the contribution of uterine arterial chemoembolization (UACE) and uterine arterial infusion chemotherapy (UAIC) to advanced cervical cancer before radical radiotherapy. METHODS: A total of 735 patients with primary advanced cervical cancer were retrospectively studied; of these patients, 299 were classified as FIGO stage II, 359 as stage III and 77 as stage IVa. 126 underwent UACE, 103 underwent UAIC before radiotherapy, and 506 received radical radiotherapy alone (RT). Disease-specific survival (DSS), pelvic control (PC), distant metastasis-free survival (MFS), and risk factors of late toxicity were analyzed. RESULTS: The 1-, 2-, 5-, and 8-year DSS of all patients was 94.4, 82.1, 50.2, and 30.7 %, respectively. The DSS of the UACE group was 96.0, 83.4, 39.6, 18.3 %; UAIC group was 95.6, 84.3, 59.6, 42.7 % and RT group was 93.7, 80.8, 51.5, 31.5 % (χ (2) = 10.236, P = 0.006). The 1- and 2-year DSS of the UAIC and UACE groups was higher than those of the RT group (χ (2) = 2.510, P = 0.285; χ (2) = 2.822, P = 0.244). The 5- and 8-year DSS of the UACE group was obviously decreased (χ (2) = 14.962, P = 0.001; χ (2) = 14.043, P = 0.001). PC and MFS were highest in the UAIC group and lowest in the UACE group. The incidence of late radiation toxicity of the small intestine and rectosigmoid was similar. The bladder injury was highest in the UACE group (UACE:UAIC:RT = 11.1:4.8:4.2 %, χ (2) = 9.579, P = 0.008). UACE is a risk factor for late radiation toxicity of the urinary bladder. CONCLUSIONS: The use of UAIC before radical radiotherapy could improve the treatment outcome and prognosis of patients with advanced cervical cancer, while the UACE would significantly decrease long-time survival. UACE is an important risk factor for late radiation toxicity.

[Clinical value of the comprehensive treatment in intermediate and advanced cervical cancer with uterine arterial interventional chemoembolization and radiotherapy].

OBJECTIVE: To investigate the long-term curative effect of the radiotherapy combined uterine arterial interventional chemoembolization for cervical cancer. METHODS: Records of 632 patients with cervical cancer stage II - IVa proved by pathology in Lanzhou Command General Hospital from January 1st, 1999 to August 31st, 2009 were retrospective analysed. One hundred and twenty-six cases of them were treated with radical radiotherapy combined uterine arterial interventional chemoembolization (arterial chemoembolization + radiotherapy group), 506 cases of them were treated with radical radiotherapy only (radiotherapy group); the evaluation of the late radiation injury was done, according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) advanced radiation injury criteria. Prognosis and complications were compared between two groups, relative risk factors of radiotherapy complications were identified by method of logistic regression. RESULTS: (1) Survival: the total survival rates of 1-year, 2-year, 5-year and 8-year were 94.4%, 82.3%, 48.8%, 29.1%, respectively. The survival rates of arterial chemoembolization + radiotherapy group were 96.0%, 82.1%, 37.2%, 25.7%, while the survival rates of radiotherapy group were 94.1%, 80.8%, 51.1%, 31.5%, in which there were significant differences between two groups (χ(2) = 0.009, P = 0.993; χ(2) = 0.158, P = 0.691; χ(2) = 11.197, P = 0.001;χ(2) = 9.649, P = 0.002). During the follow-up period, the rate of recurrence and metastasis in arterial chemoembolization + radiotherapy group were 77.0% (97/126), while 73.3% (371/506) in radiotherapy group (χ(2) = 0.705, P = 0.401). (2) Radiotherapy complications and relative risk factors: the total incidence of tardive bladder injury higher than RTOG/EORTC stage II was 5.5% (35/632), while it was 11.1% (14/126) in arterial chemoembolization + radiotherapy group, 4.2% (21/506) in the radiotherapy group (χ(2) = 9.344, P = 0.002). The results of logistic regression showed that the uterine arterial interventional chemoembolization was relative risk factors of the tardive bladder injury (χ(2) = 6.440, OR = 2.869, P = 0.011). CONCLUSIONS: Compared with the simple radiotherapy, there are a similar short-term survival rate and significant poor 5-year, 8-year survival rate in the patients treated with the uterine arterial interventional chemoembolization combined with radiotherapy, which also may be strong dangerous factor for the occurrence of tardive bladder injury. The results shown that the uterine arterial interventional chemoembolization do not recommend to be routine adjuvant therapy for the radical radiotherapy of cervical cancer.