Six-Years Disease-Free Survival after Isolated Hypoxic Pelvic Perfusion with Chemofiltration for Advanced Cervical Carcinoma

Abstract

Cervical cancer is a highly preventable malignant disease and if detected early has a good prognosis and can be cured by surgery or radiotherapy alone. In western countries about 40,000 women die from advanced cervical cancer per year, in developing countries, however, where early diagnosis is the exception, the death rate from advanced cervical cancer is about six times as much. The treatment of choice is intracavitary brachytherapy, a localized radiotherapy which generates a much higher local dose of irradiation to affect advanced cervical cancer than external beam irradiation. It is so far the only means to induce substantial and long lasting remission induction and pelvic control rates up to 90% at three years [1,2] due to the extremely high local exposure to radiotherapy. Concomitant chemotherapy with cisplatin reduces the relative risk of death by approximately 50% [3-7]. With surgery alone, however, in stage I tumors, chances of adequate treatment do not exceed 12% [8]. Effective locoregional therapy, even in advanced stage IIIa disease not invading the pelvic side wall, in terms of radiochemotherapy may induce downsizing of the tumor burden to surgical resectability. The actual standard of care for downsizing is induction chemotherapy combined with external beam irradiation and intracavitary brachytherapy [2]. Despite highly effective intracavitary brachytherapy large volume tumors account for the majority of cervical cancer deaths [9].