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Chemotherapy
Emergency Endovascular Nanopharmacologic Treatment in Advanced Gynecological Cancers
  1. Andrea Tinelli, MD*,
  2. Raffaele Prudenzano, MD†,
  3. Antonio Malvasi, MD‡,
  4. Mario Santantonio, MD§ and
  5. Vito Lorusso, MD∥
  1. *Department of Gynecology and Obstetrics, Division of Experimental Endoscopic Surgery, Imaging, Minimally Invasive Therapy, and Technology;
  2. †Department of Radiology, Vito Fazzi Hospital, Lecce;
  3. ‡Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari;
  4. §Departments of Radiotherapy, and
  5. ∥Oncology, Vito Fazzi Hospital, Lecce, Italy.
  1. Address correspondence and reprint requests to Andrea Tinelli, MD, Department of Gynecology and Obstetrics, Division of Experimental Endoscopic Surgery, Imaging, Minimally Invasive Therapy and Technology, Vito Fazzi Hospital, Lecce, Italy, 73100 Lecce, Italy. E-mail: andreatinelli{at}gmail.com.

Abstract

Introduction: Advanced cases of uterine carcinomas with parametrial and fornix infiltration often cause massive genital bleeding, with severe anemia, fast deterioration, and a high risk of death for patients; women with advanced uterine cancer (UC) and genital massive bleeding were treated using an endovascular therapy in local anesthesia.

Methods: Ten women with advanced UC and genital massive bleeding were hospitalized for a high risk of immediate death; after blood transfusions and resuscitation therapy, the patients were submitted to an experimental nanopharmacologic endovascular therapy in local anesthesia.

Results: On average, the total operative time for the procedure was 38.6 minutes, the intrasurgical blood loss was of 37 mL, the postoperative analgesic request for 48 hours was just for 3 patients (all dismissed in the second day after pelvic artery embolization), the hemoglobin level at dismissal was of 6.5 g/L, and the duration of hospital stay was 1.4 days. All patients well tolerated the procedure, with no linked complications; clinical check was at the 10th and 30th days after dismissal, with no further recurrent genital bleeding in the follow-up course stopped at the visit in the 60th day.

Conclusions: Genital bleeding in advanced UC is a serious complication because it causes deterioration of the patient's general status and has a worse prognosis. The pelvic uterine embolization according to our endovascular nanopharmacologic methods is bloodless, less traumatic, and faster than a surgical procedure. Even if it requires experience in intervention radiology, it enables the continuation of external radiotherapy without delay and can replace laparotomic or laparoscopic treatment.

  • Gynecological oncology
  • Advanced uterine cancer
  • Pelvic embolization
  • Nanospheres
  • Microcoils
  • Endometrial cancer
  • Uterine sarcoma

http://dx.doi.org/10.1111/IGC.0b013e3181e4a68d

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    Footnotes

    • The authors certify that there is no actual or potential conflict of interest in relation to this article and that there are no financial interests or connections, direct or indirect, or other situations that might raise the question of bias in the work reported or in the conclusions, implications, or opinions stated-including pertinent commercial or other sources of funding for the individual author(s) or for the associated department(s) or organization(s), personal relationships, or direct academic competition.