Abstract:

Introduction: currently, chemoradiation therapy is widely used as the main method of specific treatment for locally advanced head and neck cancer. Previously it was believed that radiation damage of carotid arteries occurs only several years after treatment.

Material and methods: article presents two case reports of internal carotid artery stenosis which arose directly during the course of chemoradiation of head and neck malignant tumors. In the first case, patient K., 54 years old, had laryngeal cancer (stage III: T3N1M0), in the second case, patient M., 40 years old, had tongue cancer (stage I: T1N0M0).

Conlusion: article presents angiographically confirmed carotid artery stenosis arisen directly during chemoradiation and in early stages after its completion. The discussion presents data on the incidence of stenosing lesions of carotid arteries, cerebrovascular events among patients undergoing radiation therapy. It is necessary to draw attention of specialists to the problem of early stenosis of carotid arteries during radiation and chemoradiation therapy of head and neck tumors.

Abstract:

Cervical cancer (CC) is one of the most common oncological disease in the world. There are lots of methods to treat it. Often we use radiation therapy (RT), chemotherapy (CT), surgical treatment. However, when on one hand we have successes, on the other hand we have a number of unsolved problems. To solve them, we study the method of chemoembolization of uterine arteries (CUA). This treatment option is being studied as one of promising methods in the complex or combined radiation treatment of primary and recurrent cervical cancer. This allows, with minimal trauma and relapse rate, to stop bleeding and reduce the size of the tumor. In this article a number of literature sources about using embolization or chemoembolization and results of treatment with CUA has been analyzed.

References

1.     Kaprin AD, Starinskij W, Petrova GV. The state of cancer care for the population of Russia in 2018. - M.: MNIOI im. P.A. Gertsena - filial FGBU «NMITS radiologii» Minzdrava Rossii, 2019; 236 [In Russ].

2.     Lindsey AT, Ahmedin J, Rebecca L. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2018; (68): 394-424.

3.     Ashrafyan LA, Antonova IB, Aleshikova Ol et al. Surgical stage as one of the main components in the complex treatment of cervical cancer stage IIb-IIIb. Russian journal o f oncology. 2007; (3): 21-25 [In Russ].

4.     Benedetti-Panici P, Greggy S, Colombo A et al. Neoadjuvant chemotherapy and radical surgery versus exclusive radiotherapy in locallyadvanced squamous cell cervical cancer: results from the Italian multicenter randomizedstudy. J Clin Oncol. 2002; (20): 179-188.

5.     Benedetti-Panici PL, Zullo MA, Muzii Let. al. The role of neoadjuvant chemotherapy followed by radical surgery in the treatment of locally advanced cervical cancer. EurJ Gynecol Oncol. 2003; 24 (6): 467-470.

6.     Duenas-Gonzalez A, Lopez-Graniel C, Gonzalez-Enciso A et al. A phase II study of multimodality treatment for locally advanced cervical cancer: neoadjuvant carbo-platin and paclitaxel followed by radical hysterectomy and adjuvant cisplatin chemoradiation. Ann Oncol. 2003; 14 (8): 1278-1284.

7.     Sananes C, Giaroli A, Soderini A et al. Neoadjuvant chemotherapy followed by radical hysterectomy and post­operative adjuvant chemotherapy in the treatment of carcinoma of the cervix uteri: long-term follow-up of a pilot study. Eur J Gynaecol Oncol. 1998; 19 (40): 368-373.

8.     Pavlov AS, Kostromina KN. Cervical cancer (radiation therapy). Meditsina. 1983; 160 [In Russ].

9.     Suvorova JuV. The role of angiography and arterial embolization in malignant tumors of the uterus and bladder complicated by bleeding. Avtoref. dis. kand. med. nauk. 1998; 24 [In Russ].

10.   Oliver J Jr, Lance J. Selective embolization to control massive hemorrhage following pelvic surgery. Am J Obstet Gyn. 1979; (135): 431-432.

11.   Ravina JH, Merland JJ, Herbreteau D. et al. Preoperative embolization of uterine fibroma. Pres Med. 1994; (23): 1540.

12.   Chen C, Wang W, Zhou H et al. Pharmacokinetic comparison between systemic and local chemotherapy by carboplatin in dogs. Department of Obstetrics and Gynecology, Nanfang Hospital, Guangdong Province, PR China. Reprod Sci. 2009; Nov.

13.   Kosenko IA, Matylevich OP, Dudarev VS et al. The effectiveness of complex treatment of locally advanced cervical cancer using uterine artery chemoembolization. Oncological journal named P.A. Gertsena. 2012; (10): 15-19 [In Russ].

14.   Sabekiya IM, Stolyarova IV, Vinokurov VM. Role of endovascular interventions in combined treatment of patients with locally advanced cervical cancer. Oncology issues. 2004; (5): 590-594 [In Russ].

15.   Kobayashi K, Furukawa A, Takahashi M, Murata K. Neoadjuvant intra-arterial chemotherapy for locally advanced uterine cervical cancer: clinical efficacy and fac­tors influencing response. Cardiovasc Intervent Radiol. 2003; 26 (3): 234-241.

16.   Komov DV, Roshhin EM, Kuchinskij GA et al. Results of the first phase of clinical studies of the doxorubicin-estrone complex in patients with malignant neoplasms of the liver during chemoembolization with lipiodol. Bulletin of the ONTs AMS of Russia. 1997; (4): 34-37 [In Russ].

17.   Huang K, Zhou Q, Wang R et al. Doxorubicin-eluting beads versus conventional transarterial chemoembolization for the treatment of hepatocellular carcinoma. J Gastroenterol Hepatol. 2014; 29 (5): 920-925.

18.   Lichinitser MR, Gutorov SL. A new approach to chemotherapeutic treatment of cancer. Jornal Oncology.ru (internetsource). 2011; 13 [In Russ].

https://rosoncoweb.ru/librarv/chemotherapy/001.pdf

19.   Dmitriev VN, Golivets TP, Sukhoterin IV et al. Chemotherapy of tumors of the female reproductive system: definitions and methodological aspects. Scientific statements of BSU, Medicine Pharmacy. 2011; 22(177): 234-244 [In Russ].

20.   Thigpen J, Blessing H, Homesley et al. Phase III trial of doxorubicin +/- cisplatin in advanced or recurrent endometrial carcinoma: a Gynaecologic Oncology group study. Proceedings of ASCO. 1993; 12: 261.

21.   Arybzhanov DT, Bajnazarova AA, Kulakeev OK. Embolization of uterine arteries in the treatment of patients with cervical cancer. Medical Bulletin of Bashkortostan. 2009; (2): 39-41 [In Russ].

22.   Suvorova JuV, Tarazov PG, Zharinov GM. Arterial embolization in chronic bleeding in patients with uterine cancer. Oncology issues. 1996; 42 (4): 59-61 [In Russ].

23.   Suvorova JuV, Tarazov PG. Arterial embolization in uterine and bladder tumors complicated by bleeding. Palliative medicine and rehabilitation. 199; (2): 79-80 [In Russ].

24.   Tarazov PG, Suvorova JuV, Neklasova NY Arterial embolization in malignant tumors of the uterus complicated by bleeding. Obstetrics and gynecology. 1996; (3): 39 [In Russ].

25.   Kedrova AG, Lebedev DP, Shablovskij OR et al. Modern chemoembolization of the pelvic vessels as a stage in the treatment of malignant tumors of the body and cervix. Clinical practice. 2016; (2) [In Russ].

26.   Shakhov EB, Kanishheva NV, Ermolaeva AM et al. The first experience of using selective chemoembolization of the uterine arteries in patients with cervical cancer. Oncology. Medical Almanac Journal. 2016; (2): 124-126 [In Russ].

27.   Nalgieva FK, Shanazarov NA. The problem of treatment of complicated cervical cancer at the present stage. Basic research. 2011; 1 (11): 221 -226 [In Russ].

28.   Bajnazarova AA, Yakubova MB, Kulakeev OK et al. Embolization of uterine arteries in the treatment of patients with cervical cancer. Oncology. Medical Bulletin of Bashkortostan. 2009. (2): 39-41 [In Russ].

29.   Bajnazarova AA, Yakubova MB, Kulakeev OK et al. Embolization of uterine arteries in the treatment of patients with cervical cancer. Oncology. Tyumen Medical Journal. 2010; (3-4): 37-39 [In Russ].

30.   Kosenko IA, ZHavrid EA, Matylevich OP et al. Immediate results of surgical intervention after neoadjuvant polychemotherapy with selective chemoembolization. Tumors of the female reproductive system. 2009; (3-4): 121-124 [In Russ].

31.   Bokhman YV. Oncology guide. 2002; 544 [In Russ].

32.   Stolyarova IV, Vinokurov VL. Modern possibilities of chemoradiation therapy in the treatment of advanced uterine cancer. VII Ross, onkol. kongress 25-27 noyabrya 2003: Congress materials. 2003; 198 [In Russ].

33.   Tian ZZ, 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): 155-162.

34.   Yu L, Tan GS, Xiang XH et al. Comparison of uterine artery chemoembolization and internal iliac arterial infusion chemotherapy for the combining treatment for women with locally advanced cervical cancer. Ai Zheng. 2009; 28 (4): 402-407.

35.   Song J, Chen W, Zhu X et al. Short-term efficacy, safety, and cost-effectiveness of transarterial chemoembolization with drug-eluting beads versus synchronous radiochemotherapy for cervical cancer. Int J Gynaecol Obstet. 2019; 147 (1): 29-35.

36.   Babaeva NA, Antonova IB, Aleshikova Ol et al. The role of selective chemoembolization of the uterine arteries in the complex treatment of locally advanced cervical cancer. Doctor.Ru. 2018. 146 (2): 20-25 [In Russ].

Abstract:

Purpose. Was to determine the possibilities of transrectal ultrasound research (TUR) in grayscale-mode with the use of ultrasound angiography in diagnostics of rectitis and in monitoring its treatment in patients with prostate cancet (PC) after radiation therapy.

Materials and methods. The research consists of 62 patients with verified localized prostatic cancer (T13N01M0), which have already obtained conformed radiation therapy (RT) as a radical strategy. To estimate expressive radiation reaction patients were underwent transrectal ultrasound research before, during and after (in 3, 6, 12 months) radiation therapy. During the experiment, using grayscale-mode, the thickness of rectum front wall, its structure and echogenicity, and prostata capsula propria (lat.) tracking were estimated in dynamics. Vascularization of rectum front wall and pararectal cellulose was also analyzed in dynamics. Results of transrectal ultrasound were compared with clinical symptoms during the whole period of supervision, and were registered on the basis of patient’s personal note during and after treatment.

Results. Based on patients complaints we have noticed development of radiation rectitis (radiation therapy after-effect) which can be registered as higher thickness of rectum front wall, changes in its structure, decreasement of echogenicity and increased vascularization. The major part of patients with these changes noticed that such symptoms were therapeutically eliminated during supervision. Such echo-graphic changes won’t appear in case of prostate cancer progression and it can be used as a differential diagnostics between radiation therapy after-effect and prostate cancer growth.

Conclusion. Transrectal ultrasound allows to visualize early radiation rectitis implications in patients with prostatic cancer during radiation theraphy, and can promote the necessary treatment correction and advanced symptomatic therapy. 

References

1.    Орлова Л.П., Зарезаев О.А. Ультразвуковой метод исследования в оценке эффективности лечения больных геморроем. SonoAceInternational (Рус. верс.). 2006; 14: 3–34.

2.    Гранов А.М., Матякин Г.Г., Зубарев А.В. и др. Возможности современных методов лучевой диагностики и лечения рака предстательной железы. Кремл. мед. клин. вест. 2004; 16: 9–12.

3.    Давыдов М.И., Аксель Е.М. Статистика злокачественных новообразований в России и в странах СНГ в 2007 г. Вестник РОНЦ им. Н.Н. Блохина РАМН. 2009; 20 (3 – прил. 1): 8–138.

4.    Канделаки С.М., Гаджиев Г.И., Богомазов Ю.К. и др. Возможности эндоректальной эхографии с контрастным усилением в диагностике свищевой формы парапроктитов. SonoAceInternational (Рус. верс.). 2004; 12: 20–26.

5.    Pescatori M., Regadas F.S.P., Regadas S.M.M. Imaging atlas of the pelvic floor and anorectal diseases. Springer – Verlag Italy. 2008; 4–16, 27–34, 51–61, 73–81, 91–105.

6.    Трапезникова М.Ф., Голдобенко Г.В. Рак предстательной железы. Под ред. Н.Е. Кушлинского, Ю.Н. Соловьева, М.Ф. Трапезниковой. М.: Изд-во РАМН. 2002; 322–328.

7.    Yablon C.M. et al. Complications of prostate cancer treatment. Spectrum of imaging findings. Radiographics. 2004; 24: 181–194.

8.    Hulsmans F.-J.H. et al. Colorectal adenomas. Inflammatory changes that simulate malignancy after laser coagulation evaluation with transrectal US. Rad. 1993; 187: 367–371.

9.    Гранов А.М., Винокуров В.Л. Лучевая терапия в онкогинекологии и онкоурологии. С.-Пб.: ООО «Издательство ФОЛИАНТ». 2002; 178–208.

10.  Hricak H. et al. State of the art. Imaging prostate cancer. А multidisciplinary perspective. Rad. 2007; 243 (1): 28–53.

11.  Moore E.M., Magrino T.J., Johnstone P.A.S. Rectal bleeding after radiation therapy for prostate cancer – endoscopic evaluation. Rad. 2000; 217: 215–218. 

Abstract:

Since December 2010 till September 2012, 24 patients with III stage laryngeal carcinoma (T3_4NxxM0) underwent chemoradiation therapy Intra-arterial chemotherapy via both superior thyroid and laryngeal arteries with intermitting in 30-45 minutes infusions of cisplatin and 5-fluorouracil was done. Average doses of cisplatin consist 75mg/m2, and 5-fluorouracil dose was1000mg/m2. In 48 hours multifractional radiotherapy started (1,1Gy x 2 per day, 5 days per week) with planned total dose 74-78Gy Then total dose was 26-30Gy and 50Gy pauses for 2 or 3 days in radiotherapy established for repeated same intra-arterial chemotherapy In 21 patients (87,5%) total regress of the tumor was marked. In 3 patients (12,5%) sclerosis of residual volume developed without tumor cells in control biopsies. In the only patient (4,2%) after 6 months reoccurrence was marked and dissection laryngectomy managed. Stability of positive results we observe during 12 months following such chemoradiation therapy.

References

1.     Гаджиева А.К., Маджидов М.Г, Джамалутдинов Ю.А. Факторы риска рака гортани у населения разных климатогеографических зон южного региона Российской Федерации. Материалы XVII съезда оториноларингологов России, 26-28 апреля Санкт-Петербург. 2011;3:327-8.

2.     Шаньгина О.В., Сдвижков А.М., Кожанов Л.Г, Финкельштерн М.Р. Факторы риска развития рака гортани в странах восточной и Центральной Европы. Вопр.онкологии. 2007; 53(3):321-8.

3.     Пачес А.И. Опухоли головы и шеи. М.: Медицина. 2000; 467с.

4.     Brunin F., Rodriguez J., Jaulerry C. Laryngeal cancer and conservative treatment. Place of combined radiotherapy chemotherapy and modified fractionation radiotherapy. Bul Cancer. 1997; 84(2):191-8.

5.     Furness S., Glenny A.M., Worthington H.V., Pavitt S., Oiver R. et al. Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy. Cochrane Database Syst Rev.2010; Sept 8(9): CD006386. 20.

6.     Katori H., Tsukuda M., Taguchi T. Analysis of efficacy and toxicity of chemotherapy with cisplatin, 5-fluorouracil, methotrexate and leucovorin (PFML) and radiotherapy in the treatment of locally advanced squamous cell carcinoma of the head and neck. Cancer Chemother. Pharmacol. 2007;59(6): 789-94.

7.     Porceddu S.V. Is induction chemotherapy the new standard in organ preservation treatment for locally advanced head and neck cancer in 2010? Asia Pac. J. Clin. Oncol. 2010;6(2):75-6.

8.     Гаспарян С.А., Островерхов Г.Е., Трапезников Н.Н. Регионарная длительная внутриартериальная химиотерапия злокачественных опухолей. М.: Медицина. 1970; 207с.

9.     Пачес А.И. Регионарная внутриартериальная химиотерапия в лечении опухолей головы и шеи: Сб. науч. тр. М.: Медицина, 1971; 159с.

10.   Lee W.T., Alkureishi, Remco de Bree, Gary L. Ross RADPLAT: An alternative to Surgery? The Oncologist. 2006; 11(5): 469-80.

11.   Rapidis A.D., Trichas M., Stavrinidis E., Roupakia A. et al. Induction chemotherapy followed by concurrent chemoradiation in advanced squamous cell carcinoma of the head and neck: final results from a phase II study with docetaxel, cisplatine and 5-fluorouracil with a four-year follow-up. Oral. Oncol. 2006;42(7): 675-84.

12.   Van den Broek G.B., Balm A..J, van den Brekel M.W., Hauptmann M. et al. Relationship between clinical factors and the incidence of toxicity after intra-arterial chemoradiation for head and neck cancer. Radiother. Oncol. 2006; 81(2): 143-50.

13.   Corry J., Peters L.J., Rischin D. Optimising the therapeutic ratio in head and neck cancer. Lancet Oncol. 2010; 11(3): 287-91.

14.   Samant S., Robbins K.T., Kumar P. et al. Bone or cartilage invasion by advanced head and neck cancer: intra-arterial supradose cisplatin chemotherapy and concomitant radiotherapy for organ preservation. Arch. Otolarynogol. Head Neck Surg. 2001; 127: 1451-1456.

15.   Арыбжанов Д.Т., Сабуров А.Р. Непосредственные результаты неоадъювантной регионарной химиотерапии больных раком желудка. Диагностическая и интервенционная радиология. 2009; 3(3): 41-44.

16.   Balm A.J., Rasch C.R., Schornagel J.H. et al. High-dose superselective intra-arterial cisplatin and concomitant radiation (RADPLAT) for advanced head and neck cancer. Head Neck. 2004; 26:485-93.

17.   Nashimura T., Sanada J., Furukawa M. Cervical radiculopathy due to inra-arterial unfusion of cisplatin. J. Laryngol. Otol. 2005; 119(8): 649-50.

18.   Madasu R., Ruckenstein M.J., Leake F., Steere E., Robbins K.T. Ototoxic effect of supradose cisplatin with sodium thiosulfate neutralization in patients with head and neck cancer. Arch. Otolaryngol. Head and Neck Surg. 1997; 123(9): 978- 

Abstract:

Aim: was to proceed comparative analysis of immediate and long-term results of chemoradiation treatment of unresectable local-spread oropharyngeal cancer with use of standart chemoradiatior therapy with intravenous chemoinjection and individual volume-controlled superselective intraarterial chemotherapy.

Materials and methods: 43 patients with unresectable oropharyngeal cancer were included in trial comparing intra-arterial (IA) and intravenous (IV) chemoradiation. IV chemoradiation (n=19 patients) comprised 3-4 times of 100 mg/m2 cisplatin infusion on days 1, 22, 43 combined 2Gy x 5 days fractions with total radiation dose 72Gy The IA chemoradiation group (n=24) comprised 3 or 4 x 90 mg/m2 cisplatin administered in the tumor-feeding artery by personified volume- controlled targeted perfusion. The induction IA chemotherapy was given one day before radiation. Then IA chemotherapy conducted regularly 22, 43, 64 days followed radiation.

Results: we made 86 IA procedures and had no IA-related death or procedure related complications. Five patients of IA group were excluded from long term analysis because of non-comleted protocol. The median follow-up was 21±2.3 months in IA group and 36 months in all patients in IV therapy group. In 19 patients received IA chemoradiotherapy protocol - 100% complete response (CR) and in IV chemoradiotherapy - only in 10 (53%) of 19 patients (ф = 6,820, р<0.05). CR was noted in 8 patients with N1 lymph-nodes and in 9 of 10 patients with N2 lymph nodes in IA therapy group. Initial lymph nodes regress more than 80-90% was observed and follow up improvement was confirmed by PET-CT. One-year overall survival (OS) rates were 95% and 79%, respectively in IA and IV groups (not significant OR = 4,8; ф = 1,51; р = 0,05), but two year OS rates were 90% and 58%, respectively (р<0,05). These data are encourage but further follow-up results need to be investigated. 

References

1.     Paches A.I. Opukholi golovy i shei [Head and neck cancer]. Moscow. 2013: 478 [In Russ].

2.     Korytova L.I., Sokurenko V.P., Maslennikova A.V. Sovremennye tendentsii v terapii mestnorasprostranennogo raka rotoglotki i polosti rta [Current trends in the treatment of locally advanced cancers of the oropharynx and oral cavity].Saint Petersburg. 2011; 112. [In Russ].

3.     Perevodchikova N.I., Gorbunova V.A. Rukovodstvo po khimioterapii opukholevykh zabolevaniy [Guidelines for chemotherapy of tumor diseases] .Moscow. 2015; 154-158 [In Russ].

4.     Alieva S.B., Tkachev S.I., Romanov I.S. et all. Varianty i rezultaty khimioluchevoy terapii bolnykh s mestnorasprostranennym ploskokletochnym rakom glotki [Modifications and results of chemoradiotherapy in patients with locally advanced squamous cell carcinoma of the pharynx]. Meditsinskaya radiologiya i radiatsionnaya bezopasnost. 2012; 57 (3): 32-38 [In Russ].

5.     Pignon J. P, Bourhis J., Designe L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analises of updated individual date. Lancet. 2000. 355(9208):949-55.

6.     Browman G.P, Hodson D.I., Mackenzie R.J. et al. Choosing a concomitant chemotherapy and radiotherapy regimen for squamous cell head and neck cancer: A systematic review of the published literature with subgroup analysis. Head Neck. 2001; 23(7):579-89.

7.     Granov A.M., Davydov M.I. Interventsionnaya radiologiya v onkologii [Interventional radiology in oncology]. Saint Petersburg. 2013; 560 [In Russ].

8.     Kovacs A.F. Intraarterial induction high-dose chemotherapy with cisplatin for oral and oropharyngeal cancer: Long-term result.Br. J. Cancer. 2004. 90(7): 1323-1328.

9.     Robbins K. T., Kumar P., Harris J. et al. Supradose intra-arterial cisplatin and concurrent radiation therapy for the treatment of stage IV head and neck squamous cell carcinoma is feasible and efficacious in a multi-institutional setting: Results of radiation therapy. Oncology Group trial 9615. J. Clin. 0ncol.2005;23(7):1447-54.

10.   Olshanskiy M.S., Znatkova N.A., Stikina S.A., Redkin A.N., Sukhochev E.N., Zdobnikov V.B., Konstantinova Yu.S. et all. Superselective himioinfuziya and intraarterial chemoembolization of tumor blood vessels with chemoradiation therapy for inoperable cancer of the oropharynx. Trudy XX Rossiyskogo onkologicheskogo kongressa «Zlokachestvennye opukholi» [Proc. XX Ros. Cancer congress «Malignant tumors»]. Moscow. 2016;4: 190-191 [In Russ].

11.   Rhode S., Paul M. C., Martens E. et al. Simulation of haemodynamic flow in head and neck cancer chemotherapy. Biomed. Enq. Online. 2011; 10.1186/1475-925X-10-104.

12.   Kumar P., Robbins K.T. Treatment of advanced head and neck cancer with intra-arterial cisplatin and concurrent radiation therapy: the “RADPLAT” protocol. Curr. Oncol. Rep. 2001;3(1):59-65.

13.   Robbins K.T., Kumar P., Regine W.F. et al. Efficacy of targeted supradose cisplatin and concomitant radiation therapy for advanced head and neck cancer: The Memphis experience. Int. J. Radiat. Oncol. Biol. Phys. 1997; 38(2):263-71.

14.   Robbins K.T., Kumar P., Wong FS, et al. Targeted chemoradiation for advanced head and neck cancer: analysis of 213 patients. Head Neck. 2000; 22(7):687-93.

15.   Yoshizaki T., Wakisaka N., Murono S. et al. Intraarterial chemotherapy less intensive than RADPLAT with concurrent radiotherapy for resectable advanced head and neck squamouse cell carcinoma: a prospective study. Ann. Otol. Rhinol. Laryngol. 2007;116(10):754-61.