Chemoembolization with HepaSpheres as a stage of comprehensive treatment for malignant pelvic tumors

Genital bleeding poses a serious threat to patients with progressive locally advanced malignant tumors. Surgical treatment is often impossible in these patients; therefore, to achieve reliable hemostasis, the patients should undergo embolization of vessels feeding the tumor. Good results have been achieved by selective catheterization of pelvic arteries using chemoembolization with HepaSphere microspheres (Biosphere Medical, France) delivering the therapeutic agent to the tumor. Hydrophilicity of microspheres loaded with cytostatics and their biological compatibility with tissues ensure long-term therapeutic effect by controlling tumor growth. Pronounced hemostatic and antitumor effects of this treatment method have been confirmed by a morphological study. This study analyzes 38 patients that underwent chemoembolization with HepaSpheres loaded with doxorubicin or irinotecan, which allowed surgery and further treatment.

1. Guan Y.S., He Q., Wang M.Q. Transcatheter arterial chemoembolization: history for more than 30 years. ISRN Gastroenterol 2012;2012:480650. PMID: 22966466. DOI: 10.5402/2012/480650.

2. Shashi B.P., Gamanagatti S., Sreenivas V. et al. Trans-arterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma: experience from a tertiary care centre in India. Indian J Radiol Imaging 2011;21(2):113–20. PMID: 21799594. DOI: 10.4103/0971-3026.82294.

3. Kato T., Nemoto R., Mori H. et al. Transcatheter arterial chemoembolization of renal cell carcinoma with microencapsulated mitomycin C. J Urol 1981;125(1):19–24. PMID: 7463576.

4. Seldinger S.I. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta Radiol 1953;39(5):368–76. PMID: 13057644.

5. Negussie A.H., Dreher M.R., Carmen G.J. et al. Synthesis and characterization of image-able polyvinyl alcohol microspheres for image-guided chemoembolization. J Mater Sci Mater Med 2015;26(6):198. PMID: 26105830. DOI: 10.1007/s10856-015-5530-3.

6. Massmann A., Rodt T., Marquardt S. et al. Transarterial chemoembolization (TACE) for colorectal liver metastases – current status and critical review. Langenbecks Arch Surg 2015;400(6):641–59. PMID: 26088872. DOI: 10.1007/s00423-015-1308-9.

7. Tsubamoto H., Wada R., Kanazawa R. et al. Neoadjuvant transarterial chemoembolization (TACE) using cisplatin with the combination of dose-dense intravenous administration of paclitaxel for the locally advanced cervical adenocarcinoma. J Clin Oncol 2009;27(suppl):e16518. DOI: 10.1200/jco.2009.27.15_suppl.e16518.

8. Martin R.C., Scoggins C.R., Schreeder M. et al. Randomized controlled trial of irinotecan drug-eluting beads with simultaneous FOLFOX and bevacizumab for patients with unresectable colorectal liver-limited metastasis. Cancer 2015;121(20):3649–58. DOI: 10.1002/cncr.29534.

9. Toyama T., Nitta N., Ohta S. et al. Clinical trial of cisplatin-conjugated gelatin microspheres for patients with hepatocellular carcinoma. Jpn J Radiol 2012;30(1):62–8. DOI: 10.1007/s11604-011-0010-2.

10. Tinelli A., Prudenzano R., Malvasi A. et al. Emergency endovascular nanopharmacologic treatment in advanced gynecological cancers. Int J Gynecol Cancer 2010;20(7):1250–5. PMID: 21224780. DOI: 10.1111/IGC.0b013e3181e4a68d.

11. Babaeva N.А., Antonova I.B., Aleshikova O.I. et al. The role of the selective uterine artery chemoembolization in combination therapy of locally advanced cervical cancer. Doctor.Ru 2018;2(146):20–5.

12. Pisco J.M., Martins J.M., Correia M.G. Internal iliac artery: embolization to control hemorrhage from pelvic neoplasms. Radiology 1989;172(2):337–9. PMID: 2748811. DOI: 10.1148/radiology.172.2.2748811.

13. Yamashita Y., Harada M., Yamamoto H. et al. Transcatheter arterial embolization of obstetric and gynaecological bleeding: efficacy and clinical outcome. Br J Radiol 1994;67(798):530–4. PMID: 8032805. DOI: 10.1259/0007-1285-67-798-530.

14. Mihmanli I., Cantasdemir M., Kantarci F. et al. Percutaneous embolization in the management of intractable vaginal bleeding. Arch Gynecol Obstet 2001;264(4):211–4. PMID: 11205712.

15. Yalvac S., Kayikcioglu F., Boran N. et al. Embolization of uterine artery in terminal stage cervical cancers. Cancer Invest 2002;20(5–6):754–8. PMID: 12197232.

16. Yin Y.J., Li H.Q., Sheng X.G. et al. The treatment of pelvic locoregional recurrence of cervical cancer after radical surgery with intensity-modulated radiation therapy compared with conventional radiotherapy: a retrospective study. Int J Gynecol Cancer 2015;25(6):1058–65. DOI: 10.1097/IGC.0000000000000360.

17. Tian Z.Z., Li S., Wang Y. et al. Investigation of uterine arterial chemoembolization and uterine arterial infusion chemotherapy for advanced cervical cancer before radical radiotherapy: a long-term follow-up study. Arch Gynecol Obstet 2014;290(1):155–62. PMID: 24573504. DOI: 10.1007/s00404-014-3166-z.

18. Malik S.N., Shams M. Role of uterine artery embolization in the management of cervical cancer: review article. J Cancer Sci Ther 2012;4:167–9. DOI: 10.4172/1948-5956.1000134.

19. Nagata Y., Araki N., Kimura H. et al. Neoadjuvant chemotherapy by transcatheter arterial infusion method for uterine cervical cancer. J Vasc Interv Radiol 2000;11(3):313–9.

20. Shao W., Zhng F., Cong N. et al. Transarterial chemoembolization combined with sorafenib for advanced hepatocellular carcinoma. J Oncol Lett 2014;8(5):2263–6. PMID: 25289106. DOI: 10.3892/ol.2014.2512.