The use of radiation techniques to analyze the effectiveness of systemic and regional neoadjuvant chemotherapy in the treatment of locally advanced cervical cancer

Objective: to evaluate the effectiveness of systemic and regional neoadjuvant chemotherapy (SRNC) in the complex treatment of locally advanced cervical cancer (LACC) in accordance with radiation research methods. Materials and methods. The results of treatment of 221 patients with LACC stages IB2 - IIIB, who were treated by the use of SRNC at the RSCRR and at the NMRC OGP named after Academician V.I. Kulakov from 2003 to 2019 were evaluated. The patients were divided into three groups. All patients underwent a comprehensive examination before and after treatment using ultrasound sonography, three-dimensional echography and energy Doppler mapping, three- dimensional ultrasound angiography, and magnetic resonance imaging. Results. In the 1st group, 114 patients underwent two courses of intravenous SRNC; according to the RECIST classification, a complete regression was achieved in 7 patients (6.1%), a partial regression in 97 patients (85.1%), and no changes in 10 patients (8.8%). In the second group of patients, 71 patients underwent a single course of SRNC using a combination of intravenous and intra-arterial chemotherapy in combination with chemoembolization of the uterine arteries.According to the RECIST criteria, complete regression was achieved in 4 patients of this group (5.6%), partial regression in 59 (83.1%), no change in 8 (11.3%). In group 3, consisted of 36 patients, combined administration of cytostatics (intravenous, intra-arterial and chemoembolization of uterine arteries) was performed 21 days after the first systemic course of chemotherapy. Complete regression was observed in 3 patients (4.2%), partial regression in 32 (88.9%), and no changes in 1 (2.7%). Radical surgical treatment was performed in 196 (88.7%) patients. Study of dynamic ultrasound and MRI data in the course of SRNC showed a significant reduction in the tumor volume and a significant decrease in the number of color loci in cases of complete or partial therapeutic response of the tumor to cytostatic treatment. According to histological examination of postoperative material, the therapeutic pathomorphosis in the tumor was detected in the majority of cases.Conclusion. A cervical tumor volume of less than 50 cm³, decreased maximal systolic blood flow velocity in the uterine arteries and increased resistance index in the uterine artery branches and in the blood vessels of the tumor are reliable criteria determining the effectiveness of SRNC in LACC, which allows radical surgical treatment in most cases. The frequency of achieving complete and partial regression after SRNC was similar with intravenous infusion of cytostatics and with intraarterial chemotherapy combined with chemoembolization. The inclusion of uterine artery chemoembolization in the comprehensive treatment plan for LACC patients with clinical signs of tumor bleeding is reasonable.