Intra-arterial chemotherapy in locally advanced cervical cancer: a review of the scientific literature
Cherchenko K., Lukashenko A. , Patsko V. , Kostikov V., Ostapenko Y.
Summary. The aim of this review was to evaluate the safety and efficacy of intra-arterial chemotherapy in locally advanced cervical cancer, as monotherapy and as a neoadjuvant treatment. Materials and methods. The publications from National Center for Biotechnology Information (NCBI), PubMed, the European Society for Medical Oncology (ESMO), the National Comprehensive Cancer Network (NCCN), ASCOPubs, and the data from ClinicalTrials.gov registry were used, the search criteria included the keywords «intra-arterial chemotherapy», «regional chemotherapy», «locally advanced cervical cancer». Results. Cervical cancer is the fourth most common cancer among women in the world. Surgical treatment is recommended by international guidelines only up to and including stage IB2, while chemoradiotherapy±brachytherapy is defined as the main treatment method for stages IB3–IVA. The new trials were conducted to find new therapeutic approaches to improve long-term survival outcomes and quality of life, and one of the approaches investigated was intra-arterial administration of chemotherapy drugs. The potential advantages of this technique are increased local concentration of the drug and lower systemic toxicity. Cytotoxic drugs are administered into the paired uterine artery using two vascular accesses. Available publications describe platinum-containing regimens of intra-arterial chemotherapy in the neoadjuvant or stand-alone setting, the response rates, survival outcomes, and potential for conversion. Intra-arterial chemotherapy has been found to increase response rates, including the percentage of complete responses. Conversion is often mentioned in publications. There was an improvement in survival and lower risk of recurrence for patients who responded to neoadjuvant intra-arterial chemotherapy and underwent surgery, compared to those who received only radiation therapy. Intra-arterial chemotherapy is potentially effective for metastases in pelvic lymph nodes and potentially ineffective for metastases in para-aortic lymph nodes. One of the studies describes the possibility of achieving criteria for fertility-sparing surgery for patients with stage IB1 cervical cancer. The toxicity profile of the treatment was acceptable. Conclusions. Platinum-based intra-arterial chemotherapy has a good safety profile and was well-tolerated. The technique is promising for use in neoadjuvant setting for potential conversion, in situations with difficult access to radiation therapy, and for upcoming investigation in clinical trials.
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