Pelvic recurrences in cervical cancer: Multimodal treatment with sequential intra-arterial chemotherapy and surgery

Between June 1984 and June 1992, 48 consecutive patients with inoperable recurrent or persistent cervical carcinoma received sequential intra-arterial chemotherapy. Of 48 patients, 20 were pretreated with surgery and radiotherapy, 18 with radiotherapy and 10 with surgery alone. According to the Seldinger's technique, 5 French diameter polyethylene catheters were placed bilaterally in the internal iliac artery. Treatment consisted of a bilateral sequential infusion of polimelfalan 20 mg, doxorubicin 10 mg and cisplatin 20 mg in a 6 hour period via an external infusion pump. The median number of administered cycles was 5 (range 3-7) and the median time for treatment was 27 days. The major toxic effects, according to WHO criteria, were Haematologic 18.7% Grade 3-4, Renal 8.3% Grade 1-2, Gastrointestinal 79.2% Grade 1-2. 8.3% of patients had major local problems causing interruption of treatment: two cases of arterial subocclusion and two cases of femoral aneurysm. 64.6% of patients achieved a clinical response to intra-arterial chemotherapy: 4 (8.3%) had complete re response and 27 (56.2%) had partial response. All 31 responding patients underwent pelvic surgery. Of these, 10 (32.3%) underwent radical surgery and 21 (67.7%) palliative surgery. Two (50%) of 4 patients achieving clinical complete response had also pathological complete response; The median follow-up was 35 months (range 14-110). The survival rate was significantly (p