Single-dose intra-arterial neoadjuvant chemotherapy while waiting for radical hysterectomy for stage IB-IIB cervical cancer

Abstract

Abstract. Extended wait time prior to initial surgery may increase patients' anxiety. Therefore, patients may opt to receive other available treatments to inhibit tumor growth until surgery. This retrospective study describes our experience with single-dose intra-arterial neoadjuvant chemotherapy (IANAC) to more effectively utilize the wait time prior to radical hysterectomy. A total of 12 patients with International Federation of Gynecology and Obstetrics stage IB1-IIB cervical cancer were treated with single-dose IANAC prior to radical hysterectomy. Cisplatin and paclitaxel were administered intra-arterially or intravenously, respectively. The surgical outcome, prognosis and factors affecting disease recurrence were compared between these 12 patients and 57 patients in a primary surgery alone (PS) control group. As regards surgical outcome, there were no significant differences between the two groups. During the postoperative follow-up period (median, 41 months), disease recurrence was observed in 5̸12 (41.6%) IANAC cases and in 22̸57 (38.5%) PS cases (median follow-up, 54 months). There was no significant difference in disease-free survival (DFS) or 3-year survival rates between IANAC and PS (91.6 vs. 71.9%, respectively).The multivariate analysis demonstrated that wait time duration (≥45 vs. <45 days) and the use of IANAC did not affect DFS. Only tumor histology (squamous vs. non-squamous) was found to be an independent prognostic factor for DFS (hazard ratio = 0.35, 95% confidence inerval: 0.145-0.8967, P=0.0292). In addition, distal recurrence was statistically more frequent in the IANAC group compared with that in the PS group (P=0.0405). Therefore, single-cycle IANAC should not be performed without careful consideration.

Surgical Outcomes and Prognostic Factors in Cervical Cancer: A 12 year, Single-center Experience

“…These variations resulted primarily in the number of samples, stage of the disease, the treatment modality, and the accessibility to follow-up. There is no evidence that shows that a longer waiting time affects the overall survival (OS) in the first 5 years [11,18,19]. One study has shown that a wait time to surgery longer than 8 weeks leads to worse OS after 5 years.…”

Total Mesometrial Resection With (Neo)Adjuvant Chemotherapy in Locally Advanced Cervical Cancer: A Tumor Response Score

“…The intervals of application vary (1,10,(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)60). In addition, the way the NACT was applied also varied between intravenous and intraarterial injection (53,(65)(66)(67)(68)(69).…”

Possibilities of endovascular surgery techniques in the combined treatment of patients with pelvic tumors

“…Уменьшение размеров опухоли в ближайшие 1-2 мес объясняется местным химиотерапевтическим воздействием, а также ишемическим некрозом новообразования, однако, по мнению ряда авторов, полного некроза опухоли не происходит, а имеет место лишь частичный некроз [14][15][16][17]. Руководствуясь этим, больным РШМ проведены неоднократные курсы внутриартериальной ХИ.…”