Uterine recurrence

Uterine leiomyomas are the most frequent benign disease of the female reproductive apparatus. At least 20-25% of women of fertile age and 50% of women studied in postmortem have uterine leiomyomas (Stewart 2001 Palomba et al. 2005a). In between 20 and 50% of cases, the uterine leiomyomas cause a clinically relevant symptomatology (such as menorrhagia, infertility, recurrent abortion, pelvic pain, and so on) and treatment is required (Stewart 2001 Palomba et al. 2006a). Thus, this disease is one of the main causes of health expense in the field of gynecology (Stewart 2001 Palomba et al. 2006a). In fact,... 

De Palo G, Cerrotta A, Gardani G, et al. Concurrent Radiotherapy and Taxol as Radiosensitizer in Locally Advanced or Recurrent Carcinoma of the Uterine Cervix (abstract 1404). Pro Am Soc Clin Oncol 1998 17 364a. 

Lissoni A, Cormio G, Colombo N, Gabriele A, Landoni F, Zanetta G, Mangioni C. High-dose epirubicin in patients with advanced or recurrent uterine sarcoma. Int J Gynaecol Cancer 1997 7 241. ... 

Rhomberg WU. Vindesine for recurrent and metastatic cancer of the uterine cervix a phase II study. Caucer Treat Rep 1986 70(12) 1455-7. 

Koivisto-Korander, R., Leminen, A. and Heikinheimo, O. (2007) Mifepristone as treatment of recurrent progesterone receptor-positive uterine leiomyosarcoma. Obstetrics and Gynecology, 109, 512-514. 

Megestrol acetate is a progestin that inhibits secretion of pituitary gonadotropins, thereby preventing follicular maturation and ovulation (contraceptive effect) inhibits spontaneous uterine contraction and transforms proliferative endometrium into secretory endometrium. It is indicated as a palliative treatment of advanced inoperable, recurrent, or metastatic carcinoma of breast or endometrium. 

After embolization of a uterine fibroid clinical follow-up might be sufficient. However, to prevent an early recurrence, early MR controls might be necessary. Pain control following embolization... 

Fig. 10.3.8. Patient with recurrent symptoms following uterine artery embolization. MRA demonstrating large right ovarian artery...

In conclusion, uterine artery embolization is both a safe and effective procedure to offer patients with symptomatic uterine fibroids. UFE has been described as a valuable alternative to hysterectomy and recurrent multiple myomectomy. Clinical success rates for control of heavy menstrual bleeding, pelvic pain and bulk-related symptoms have been reported to be 80%-95% of patients treated with a low rate of recurrence. The risk of major complications, including pulmonary embolism, uterine... 

Marret H, Alonso AM, Cottier JP, Tranquart F, Herbreteau D, Body G (2003) Leiomyoma recurrence after uterine artery embolization. J Vase Interv Radiol 14 1395-1399... 

Ten years after Ravina et al. first introduced the concept of embolization as a definitive therapy for symptomatic fibroids, uterine fibroid embolization (UFE) is accepted as a safe alternative to surgical treatment of fibroid tumors. Technique and materials have been greatly refined. Much progress has been made in our understanding of fibroid vasculature, management of postoperative pain and complications, and causes of treatment failure. According to the literature, the failure rates vary between 6% and 14% [1,2] however, there is still some confusion as to how to define success, failure or recurrence. In this chapter, we discuss the causes of failure after UFE and the different options available to minimize them. 

Early recurrence of symptoms can occur when uterine artery embolization is performed on patients with adenomyosis (please see Chap. 10.4). Uterine artery embolization for adenomyosis is reported to be effective to control the bleeding initially [22,23] however, this clinical success is short-term. There is a high rate of clinical recurrence after embolization of the uterine artery for adenomyosis. In a recent study by Pelage et al, 44% of the patients required an additional treatment, including hysterectomies in 28% of the cases [24]. 

Recently, two minimally invasive therapies have been introduced to treat uterine fibroids. High frequency focused ultrasound and transvaginal paracervical clamping of the uterine arteries have been reported in the management of symptomatic uterine fibroids [10]. From our own experience with the use of uterine fibroid embolization, we know that unless complete devascularization of all identified fibroids is obtained after these therapies, the results in terms of recurrence will not be better than after myomectomy and maybe higher than after embolization. 

Once hemorrhage is stopped or necrosis of the tumor is obtained, occlusion of uterine arteries and vessels is no longer necessary. A long-lasting arterial occlusion may alter the uterine artery functionality. The stakes include the preservation of the uterine artery to maintain the functionality of the uterus (fertility, sexuality) but also possibilities of re-embolization in case of recurrence. 

Raziel A, Arieli S, Bukovsky I, Caspi E, Golan A (1994) Investigation of the uterine cavity in recurrent aborters. Fertil Steril 62 1080-1082... 

Green JA, Kirwan JM, Tierney JF, Symonds P, Fresco L, Collingwood M, Williams CJ (2001) Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix a systematic review and meta-analysis. Lancet 358 781-786... 

Choi JI, Kim SH, Seong CK, Sim JS, Lee HJ, Do KH (2000) Recurrent uterine cervical carcinoma spectrum of imaging findings. Korean J Radiol 1 198-207... 

Rietbroek RC, Schilthuis MS, Bakker PJ, van Dijk JD, Post-ma AJ, Gonzalez Gonzalez D, Bakker AJ, van der Velden J, Helmerhorst TJ, Veenhof CH (1997) Phase II trial of weekly locoregional hyperthermia and cisplatin in patients with a previously irradiated recurrent carcinoma of the uterine cervix. Cancer 79 935-943... 

Wadler S, Schwartz EL, Haynes H, Rameau R, Quish A, Mandeli J, Gallagher R, Hallam S, Fields A, Goldberg G et al (1997) AW-trans retinoic acid and interferon-a-2a in patients with metastatic or recurrent carcinoma of the uterine cervix. Cancer 79 1574-1580... 

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