Interventional treatment of hemorrhages in advanced cervical carcinoma

Purpose: Retrospective evaluation of percutaneous interventional treatment of locally advanced cervical carcinoma. Materials and methods: Since 1991, 13 patients with advanced tumor disease have been referred to our department for diagnosis and therapy of an acute blood loss. In all patients (age 40-88 years, mean 61 years) hemorrhage was detected by decrease in red blood cell count. In all cases patients suffer ed from locally advanced or recurrent disease after surgery and/or addition al radio- or chemotherapy. Embolization was performed by transfemoral acces s using minicoils in most cases, liquid agents less often and a covered vas cular stent in one patient. Results: The site of the hemorrhage or the blood pooling of the tumor could be seen in all cases angiographically. Twenty-seven treatment cycles (2.1 per patient) were performed at intervals of 3 days to 6 months. The maximum time of follow-up and additional treatments if necessary was 1 year. In 9 of 13 patients (69%) the bleeding could be stopped immediately with a singl e treatment or initial treatment via both iliac arteries. One patient (7,7% ) died during therapy because of an uncontrollable bleeding and consecutive decrease in red blood cells count. The remaining three patients (23%) show ed slight persistent or recurrent bleeding,which could be managed intervent ionally until the following episode. There were two complications (15%) dur ing therapy, representing a coil misplacement and a coil wash-out, which bo th could be managed interventionally. Conclusion: Hemorrhage following locally advanced or recurrent cervical car cinoma can be stopped interventionally in about 70% of cases. Even in parti al success it is possible to manage the acute life-threatening situation. F ollow-up examinations of up to 1 year justify this therapeutic concept.