ARTERIAL-OCCLUSION COMPLICATING TREATMENT OF GYNECOLOGIC CANCER - A CASE SERIES

The objective in this paper is to describe the severity and outcome of arterial occlusion complicating treatment of women with gynecologic c ancer, A series of six patients who underwent amputation were identifi ed. Acute arterial occlusions were seen in three patients, One patient suffered extensive thrombosis of the hand and wrist resulting in ampu tation 3 weeks after cytoreductive surgery and chemotherapy for Fallop ian tube cancer, She had a history of pulmonary embolism and deep-vein thrombosis, This patient was thought to have thrombophilia, One elder ly patient with known arteriosclerosis developed sepsis following radi cal deep excision and groin dissection for vulvar cancer and lost two digits presumably due to microemboli. One patients developed thrombosi s of the femoral artery on the second day following cytoreductive surg ery for ovarian cancer, She responded to anticoagulation therapy; howe ver, necrosis remained in portions of the heel and toes, Three patient s underwent amputation of a lower extremity when they developed chroni c arterial insufficiency after pelvic radiotherapy, The patients were irradiated at the ages of 28, 30, and 35 years for cenix cancer in two patients and a low-grade retroperitoneal sarcoma in one patient, Two received neutron beam therapy and one received conventional photon bea m therapy, All three had extensive late radiation morbidity to the bla dder and rectum and had multiple prior surgeries, The amputations occu rred at the ages of 48, 48, and 55 due to accelerated arteriosclerosis . Two patients died as a result of this complication, Acute and chroni c arterial occlusions are rare yet dramatic complications of therapy f or gynecologic cancer, This series illustrates the predisposing factor s, presentation, and management of these unusual events. (C) 1996 Acad emic Press, Inc.