Focused Action Against the Tumor: Maintaining Quality of Life in Cervical Cancer
Regional chemotherapy is a highly effective method for treating malignant cancers, with significantly fewer side effects compared to standard chemotherapy or radiation therapy. It can also be used for cervical cancer.
Infection of the cervix by certain types of the human papillomavirus (HPV) can, if left untreated, lead to cervical cancer. The insidious thing about it is that in its early stages, cervical cancer and its precursors are asymptomatic.
Effective early detection, which is a free preventative service for women from the age of 20 and is combined with a Pap smear for women from the age of 35, has led to a decline in the incidence of cervical cancer in recent years. Nevertheless, there is no reason to let our guard down: With approximately 500,000 new cases worldwide each year, cervical cancer is still one of the most common cancers among women.
Common treatment options include radical surgery, systemic chemotherapy, and radiation therapy. However, these are often associated with significant complications, mostly due to local radiation damage. Because these therapies have a systemic effect, meaning they affect not only the tumor cells but the entire organism. The disadvantage: healthy body cells are also attacked, which can lead to typical side effects, including vaginal dryness, ureteral obstruction, or radiation damage to the vaginal, bladder, and/or colonic wall.
Targeted Therapy with Few Side Effects
At the Medias Clinic based in Burghausen, Germany, they specialize in a treatment option with significantly fewer side effects: regional chemotherapy. In this approach, the tumor is treated exclusively locally; the chemotherapeutic agents do not reach the entire body. Compared with systemic chemotherapy, this allows for considerably higher drug concentrations at the tumor and in surrounding tissue. The major advantage: the therapy is better tolerated and maintains quality of life, with only minor or no side effects.
The principle of regional chemotherapy can be applied to many types of cancer. In the case of cervical cancer, regional chemotherapy is often performed in the form of isolated pelvic perfusion. In this isolated circuit, a high-concentration dose of medication is administered directly to the tumor for a specific period. The cytostatic drugs are then filtered from the body via the perfusion catheters to prevent active substances from reaching other parts of the body.
“By treating only the region affected by the tumor, we are able to maximize the therapeutic effect and minimize side effects,” says Prof. Dr. Karl Reinhard Aigner, medical director and chief doctor at Medias Clinic. “We have been successfully using this procedure for years in various indications, including head and neck tumors, pancreatic cancer, and carcinomas of the ovaries, liver, and lungs.”
Case Examples & Details from Our Study
We herein present retrospective case reports of patients treated at long-term intervals with the same method of isolated hypoxic pelvic perfusion, performed at our private institution from 2005 to 2020.
Cervical Cancer Stage IVA with Presacral LNs Metastases
A 48-year-old patient with stage IVA G3 squamous cell cervical cancer involving the rectum and presacral nodes transitioned to hyperthermic pelvic perfusion (HPP) therapy after refusing standard chemoradiotherapy. Following initial chemotherapy and three HPP cycles, imaging revealed extensive tumor calcification and necrosis.
A radical hysterectomy performed in February 2006 confirmed a complete pathologic response. After one adjuvant HPP cycle, the patient remained disease-free for fifteen years with no reported systemic toxicities.
Cervical Cancer Stage IIIA Involving Parametrium and Vagina
A 46-year-old patient diagnosed with stage IIIA cervical cancer was initially considered inoperable after imaging showed a mass measuring 5.83 cm. Seeking a second opinion, she underwent two cycles of hyperthermic pelvic perfusion (HPP), which led to the immediate resolution of her pelvic pain and significant physical tumor regression.
After a third HPP cycle in June 2013, an FDG PET-CT confirmed a normal cervix with no metabolic activity. Follow-up imaging continued to show no evidence of disease, and the patient has successfully remained disease-free for seven years.
Cervical Cancer Stage III with Iliac LNs Metastases & Infiltration of Myometrium
A 63-year-old patient with stage III, grade G3 cervical cancer experienced disease progression to the iliac lymph nodes and severe vaginal bleeding after initially refusing standard treatment for naturopathic alternatives.
Upon presenting with a 4.29 cm metabolic lesion in early 2020, she underwent three cycles of hyperthermic pelvic perfusion (HPP). The therapy successfully stopped the bleeding and led to significant tumor regression, culminating in a September 2020 FDG PET-CT that showed no abnormal metabolic activity within the cervix and no systemic toxicities.
Study details: Aigner KR et al. Tumor response and the quality of life after isolated hypoxic pelvic perfusion for advanced G3 cervical cancer: A case series. International Journal of Surgery Case Reports (IJSCR 77 2020; 816-821), DOI: https://doi.org/10.1016/j.ijscr.2020.11.050.