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.