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Journal of Cancer & Metastasis Research

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Pelvic Artery Embolization In Patients With Cervical Cancer Complicated By Hemorrhage: Single-Institution Experience In Belarus

Author(s): Olga P Matylevich, Oleg G Sukonko, Kathlen M Schmeler, Thomas C Randell, Ludmila V Mirilenko

Cervical cancer (CC) is the second most common cancer among women worldwide, with around 600,000 new diagnoses and 300,000 deaths per year (GLOBOCAN 2018). CC is a leading cause of cancer morbidity in women globally. In 2018, in the Republic of Belarus the morbidity and mortality rate from CC were 11.2 and 4.2 per 100,000 of female population, respectively. In addition, 33.9% of cases of CC in Belarus are diagnosed at advanced stages (III-IV) of disease, and the majority of women presenting have at least locally advanced (stage IB2 or greater) disease.

One of the serious complications of locally advanced CC is hemorrhage from tumor. In 11% of patients vaginal bleeding can be massive and life threatening. This requires emergency hemostatic interventions, and therefore interrupts or delays antineoplastic therapy. This leads to a poorer prognosis. Bleeding is the immediate cause of death in 6% of women with CC. Management of hemorrhage often poses a challenge.

The recent advances in angiography have made it possible to control pelvic hemorrhage through radiologically guided occlusion of the branches of the internal iliac arteries. In gynecologic oncology practice up to the present time, pelvic artery embolization (PAE) has generally been deemed to be a palliative procedure and not as a component of antitumor therapy. In our experience, PAE can also be used to stop bleeding before proceeding or continuing anticancer therapy.