Severe metrorrhagia in patients with advanced gynecologic cancer: endovascular treatment benefits in acute and chronic setting.
Embolization
Endovascular treatment
Gynecologic cancers
Metrorrhagia
Journal
La Radiologia medica
ISSN: 1826-6983
Titre abrégé: Radiol Med
Pays: Italy
ID NLM: 0177625
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
24
06
2019
accepted:
02
07
2020
pubmed:
15
7
2020
medline:
2
3
2021
entrez:
15
7
2020
Statut:
ppublish
Résumé
Interventional radiology plays an established role in the management of many conditions of the female reproductive tract. Since in benign gynecological and obstetric pathologies, as myomas and postpartum hemorrhages, uterine arteries embolization has been already evaluated, this manuscript aims to report on a single-center experience concerning the endovascular management of metrorrhagia caused by gynecological malignancies. Single-center retrospective analysis of thirty patients affected by gynecologic cancer treated with endovascular embolization between January 2016 and December 2018 for acute or chronic metrorrhagia. All patients were in advanced oncological stage (III or IV) with loco-regional spread of the tumor or invasion of pelvic structures, with a poor performance status. They were not suitable for surgery. On initial CT angiography, contrast media extravasation was confirmed in two patients (6.6%), while on DSA examination, tumor stain was displayed in 28 patients (93.4%). In two patients (6.6%) a pseudoaneurysm was reported. Endovascular treatment of metrorrhagia in oncologic patients could be a valid therapeutic alternative, especially when in elderly patients with poor clinical conditions not suitable for surgery. A bilateral and superselective embolization using non-resorbable embolic agents should be performed, except for those cases in which there is infiltration of major vessels causing pseudoaneurysms or fistulas that require embolization.
Identifiants
pubmed: 32661778
doi: 10.1007/s11547-020-01251-6
pii: 10.1007/s11547-020-01251-6
doi:
Substances chimiques
Contrast Media
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
277-282Références
Wu CC, Lee MH (2006) Transcatheter arterial embolotherapy: a therapeutic alternative in obstetrics and gynecologic emergencies. Semin Interv Radiol 23(3):240–248. https://doi.org/10.1055/s-2006-948761
doi: 10.1055/s-2006-948761
Dariushnia SR et al (2014) Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol 25:1737–1747
doi: 10.1016/j.jvir.2014.08.029
Pelage JP et al (2014) Role of arterial embolization in the management of postpartum hemorrhage. J Gynecol Obstet Biol Reprod (Paris) 43(10):1063–1082. https://doi.org/10.1016/j.jgyn.2014.10.002
doi: 10.1016/j.jgyn.2014.10.002
FIGO Committee on Gynecologic Oncology (2014) FIGO staging for carcinoma of the vulva, cervix, and corpus uteri. FIGO Comm Gynecol Oncol Int J Gynecol Obstet 125(2):97–98. https://doi.org/10.1016/j.ijgo.02.003
doi: 10.1016/j.ijgo.02.003
Filippiadis DK, Binkert C, Pellerin O et al (2017) Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Interv Radiol 40(8):1141–1146. https://doi.org/10.1007/s00270-017-1703-4
doi: 10.1007/s00270-017-1703-4
Borhart J (2013) Emergency department management of vaginal bleeding in the nonpregnant patient. Emerg Med Pract 15(8):1–20
pubmed: 24044770
Ramesh HS, Jain S, Audisio RA (2005) Implications of aging in surgical oncology. Cancer J 11:488–494
doi: 10.1097/00130404-200511000-00008
Banovac F, Lin R, Shah D et al (2007) Angiographic and interventional options in obstetric and gynecologic emergencies. Obstet Gynecol Clin N Am 34(3):599–616
doi: 10.1016/j.ogc.2007.06.004
Giurazza F, Corvino F, Silvestre M et al (2020) Role of interventional radiology in obstetric and gynecological diseases. J Radiol Rev 7:26–38. https://doi.org/10.23736/S2283-8376.20.00253-3
doi: 10.23736/S2283-8376.20.00253-3
Corvino F, Giurazza F, Cangiano G et al (2019) Endovascular treatment of peripheral vascular blowout syndrome in end-stage malignancies. Ann Vasc Surg. https://doi.org/10.1016/j.avsg.2018.10.051
doi: 10.1016/j.avsg.2018.10.051
pubmed: 30731226
Lewis E, Zornoza J, Jing BS et al (1982) Radiologic contributions to the diagnosis and management of gynecologic neoplasms. Semin Roentgenol 17(4):251–268
doi: 10.1016/0037-198X(82)90019-0
Lachance JA, Everett EN, Greer B et al (2006) The effect of age on clinical/ pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecol Oncol 101:470–475
doi: 10.1016/j.ygyno.2005.11.009
Pisco JM, Martins JM, Correira MG (1989) Internal iliac artery: embolization to control hemmorhage from pelvic neoplasm. Radiology 172:337–339
doi: 10.1148/radiology.172.2.2748811
Athanasoulis CA, Waltman AC, Barnes AB et al (1976) Angiographic control of pelvic bleeding from treated carcinoma of the cervix. Gynecol Oncol 4(2):144–150
doi: 10.1016/0090-8258(76)90056-1
Miller FJ Jr, Mortel R, Mann WJ et al (1976) Selective arterial embolization for control of hemorrhage in pelvic malignancy: femoral and brachial catheter approaches. AJR Am J Roentgenol 126(5):1028–1032
doi: 10.2214/ajr.126.5.1028
Lang EK (1981) Transcatheter embolization of pelvic vessels for control of intractable hemorrhage. Radiology 140(2):331–339
doi: 10.1148/radiology.140.2.7196055
Yalvac S, Kayikcioglu F, Boran N et al (2002) Embolization of uterine artery in terminal stage cervical cancers. Cancer Investig 20:754–758
doi: 10.1081/CNV-120003543
Katz MD, Sugay SB, Walker DK et al (2012) Beyond hemostasis: spectrum of gynecologic and obstetric indications for transcather embolization. Radiographics 32(6):1713–1731. https://doi.org/10.1148/rg.326125524
doi: 10.1148/rg.326125524
pubmed: 23065166