Volume 03 Issue 08-2023
59
International Journal of Advance Scientific Research
(ISSN
–
2750-1396)
VOLUME
03
ISSUE
08
Pages:
59-67
SJIF
I
MPACT
FACTOR
(2021:
5.478
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(2022:
5.636
)
(2023:
6.741
)
OCLC
–
1368736135
A
BSTRACT
Malignant neoplasms of the organs of the reproductive system have the largest share in the structure of
oncological morbidity in women - 37.3%, and genital tumors account for 17.3% of all malignant neoplasms.
According to the International Agency for Research on Cancer (IARC), about 500,000 new cases of
malignant neoplasms of the cervix, almost 320,000 cases of endometrial cancer and 240,000 cases of
ovarian cancer are registered annually in the world. In our research r=the studied patients were divided
into two groups. The main group consisted of 52 patients with IB2, IIB and IIIB stages of CEM who
underwent neoadjuvant chemotherapy followed by radical surgery and/or chemoradiotherapy.
Determination of the risk of adverse prognostic factors with careful dynamic monitoring of the tumor
process is one of the main conditions for the use of multicomponent treatment of patients with REM. The
technological basis of monitoring is the integration of MRI and ultrasound into diagnostic standards.
K
EYWORDS
Malignant neoplasms, endometrial cancer, neoadjuvant chemotherapy, methods for effectiveness
assessment.
I
NTRODUCTION
Journal
Website:
http://sciencebring.co
m/index.php/ijasr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Research Article
IMPROVEMENT OF TRADITIONAL METHODS FOR THE
TREATMENT OF ENDOMETRIAL CANCER USING
NEOADJUVANT CHEMOTHERAPY AND METHODS FOR
EFFECTIVENESS ASSESSMENT
Submission Date:
August 20, 2023,
Accepted Date:
August 25, 2023,
Published Date:
August 30, 2023
Crossref doi:
https://doi.org/10.37547/ijasr-03-08-09
Djurakhon Gafurovna Saidkhodjaeva
Associate Professor, Department Of Faculty Hospital Surgery, Andijan State Medical Institute, Andijan,
Uzbekistan
Volume 03 Issue 08-2023
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International Journal of Advance Scientific Research
(ISSN
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03
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Pages:
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SJIF
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6.741
)
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–
1368736135
Endometrial cancer (EM) is the most common
malignant tumor in women, most often of
reproductive age [4,5]. The prevalence of the
disease depends on age, SEM are detected,
according to various sources, in 25-50% of
women under the age of 50 years [3]. Most often,
fibroids are detected in women aged 30-35 years,
the average age of tumor detection is 32-33 years,
the peak incidence is 35-45 years. Recently, there
has been an increase in the frequency of detection
of fibroids in young women (up to 20-25 years
old), which is apparently associated both with the
hereditary nature of the disease (when the
mother, close relatives also had this disease), and
with the introduction of new , more advanced
diagnostic methods, as well as increasing their
availability [1, 4,].Even with endometrial cancer,
which differs from other localizations in a less
aggressive course, every fourth patient has
regional or distant metastases by the time the
tumor is detected.
In addition to an increase in the incidence and the
number of patients with common forms of
malignant neoplasms, there is a tendency for a
shift in the peak of incidence towards a younger
age. Decreased over the past 5 years (according to
world statistics by 3-4%) mortality from
malignant neoplasms can hardly be considered
encouraging.
M
ATERIALS AND RESEARCH METHODS
The study was of a prospective-retrospective
nature. The results of examination and treatment
of 98 patients were analyzed. The criterion for
inclusion in this study was a morphologically
verified squamous SEM of stages IB2, IIB and IIIB.
All patients underwent outpatient and inpatient
treatment at AFSMCO for the period from 2017 to
2020.
The studied patients were divided into two
groups. The main group consisted of 52 patients
with IB2, IIB and IIIB stages of CEM who
underwent neoadjuvant chemotherapy followed
by radical surgery and/or chemoradiotherapy.
The comparison group included 46 patients with
CEM stages IB2, IIB and IIIB, who received only
combined radiation therapy according to a radical
program. In all the studied patients, the
morphological
structure
of
the
tumor
corresponded to squamous cell carcinoma -
keratinizing (55.2%) and non-keratinizing
(44.8%).
All patients underwent a comprehensive
examination using general clinical, laboratory
and radiological diagnostic methods.The general
clinical study consisted of a detailed study of the
premorbid background of patients, their general
somatic and gynecological status. The general
conditio
n of the patients (“performance status”)
was assessed using the ECOG
–
WHO scale [275;
276].
All patients included in this study corresponded
to 0 - 1 degree of this scale. The use of standard
laboratory methods and radiodiagnosis (X-ray of
the chest organs, ultrasound of the abdominal
cavity, kidneys, sigmoidoscopy, cystoscopy)
made it possible to obtain the necessary
information about the presence of complications
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and concomitant diseases, as well as possible
distant SEM metastasis. The results of these
studies were used to determine the tactics of
patient management, the need for corrective
therapy before the start of special treatment, and
the choice of anesthesia.
When examining the cervix in the mirrors and
bimanual palpation examination, the shape, size,
nature of the growth of neoplasms, involvement
of the vaginal fornix, spread of parametria to the
tissues were determined. To compare the results
obtained, the volume of the cervical tumor was
calculated using the formula V = A x B x C x 0.52
(ellipsoid volume formula), where A, B, C are the
sizes of neoplasms, including parametric
infiltrates, in three orthogonal planes.
In addition to standard laboratory and
instrumental research methods, MRI and
ultrasound were used before the start of special
treatment and at all its stages. MRI was
performed on a Toshiba ExcelartVantage 1.5
Tesla machine using the Magnevist contrast agent
at a dose of 0.4 ml/kg of div weight. Due to the
different intensity of the signal from the neoplasm
and surrounding tissues, the visualization of the
tumor focus was noted, its shape, the nature of the
contours, and density were recorded.
Infiltration of paracervical tissues
was
established by the broken ring of the cervical
stroma, the spread of tumor tissue beyond the
cervix. The presence of enlarged lymph nodes and
their size were noted. The sizes of cervical
neoplasms, including infiltrates (if any), were
recorded in three orthogonal planes, and the
volume was calculated using the ellipsoid
formula. Ultrasound was performed on an ESAOT
Mylab 70 scanner. The following methods were
used: two-dimensional echography in B-mode, 3D
reconstruction in B-mode, EDC, color flow, 3D
angiography.
We
used
multifrequency,
broadband sensors with the ability to collect
volumetric information in automatic mode.For
transvaginal examination, a microconvex
volumetric ultrasound probe with a frequency of
3-9 MHz and a scanning depth of 28-159 mm was
used. Ultrasound images were archived in one
block in the hard disk memory of the ultrasonic
scanner workstation, USB media, and thermal
paper. Recording volumetric information in the
archiving system and further viewing of
statistical
and
dynamic
echograms
"VIDARInfoRad2.0" provided the possibility of a
retrospective comparative analysis of the data
obtained.
Examination
of
patients
began
with
transabdominal
ultrasound
against
the
background of a filled bladder. The procedure
was performed as standard in the supine position.
After emptying the bladder, a transvaginal
examination was performed. At the same time,
the relative position of the pelvic organs, the state
of the bladder, position, overall dimensions
(length, width, anteroposterior), shape, contours
and internal echostructure of the div and cervix
were assessed; anterior-posterior size (Fig.1),
contours and echostructure of the median uterine
structures (M-echo), also determined the
echostructure of regional lymph nodes.
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Figure 1. SEM of stage T2aN0M0. Vaginal variant (longitudinal scan).
The next step was ultrasound in three-dimensional B-mode. This method, thanks to the three-dimensional
reconstruction of the obtained image, makes it possible to obtain a section of the studied organ in any
desired plane [71], which plays an important role in determining the volume of the neoplasm [173] (Fig.
2).
Figure 2. 3D echogram (surface reconstruction mode). SEM stage T4 (bladder wall invasion)
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Next, the vascular structures of the cervical tumor were examined. In a qualitative assessment of
intratumoral blood flow, the degree of vascularization, the location of vessels, their shape, uniformity,
different calibers, discontinuity in the course, and distribution density were determined.
With the help of color doppler, an ultrasound image of the blood flow in the vessels was obtained by
displaying the movement of erythrocytes. In the EDC mode, angle-independent images of vascular
structures were obtained. The method, which is based on the analysis of the density of erythrocytes in a
given volume, makes it possible to visualize vessels running at any angle and in any direction (Fig. 3).
Figure 3 Doppler SEM of stage IB2 in CFM mode.
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Figure 4. Doppler SEM stage IIA in the EDC mode.
3D Doppler ultrasound, as well as 3D reconstruction of sections obtained in the EDC mode, was used to
obtain a spatial display of intratumoral blood flow (Fig.5).
Figure 5. Three-dimensional SEM angiogram stage III B (in EDC mode).
To assess the nature and speed of blood flow in
the tumor vessels, the method of pulsed flow
spectral Doppler was used. A control volume
marker was placed at the blood flow study point,
and all vessels were visualized, regardless of their
course relative to the ultrasound beam. The
resulting frequency shift was processed
automatically, obtaining curves of blood flow
velocities, which were used to calculate Doppler
parameters and indices.
When analyzing the blood flow velocity, the
following indicators were determined: the
maximum systolic blood flow velocity (MCV),
which reflects the highest velocity at the location
point, the maximum end-diastolic blood flow
velocity (DPV), which reflects the highest velocity
at the end of diastole, the peripheral resistance
index (resistance index - IR), which is the ratio of
the difference between MSS and CDS to MSS. For
the study of intratumoral blood flow, three color
loci of different types were determined, which
had the highest MCC and IR values, the lowest IR
values, and the highest venous blood flow
velocity.
Morphological studies were carried out in the
pathological departments of the AFSMC.
R
ESULTS AND DISCUSSIONS
The studied patients were divided into three
subgroups depending on the method of
neoadjuvant chemotherapy. The dynamics of
tumor size with its infiltrates was considered as
an indicator of the effectiveness of cytostatic.
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Determination of the effectiveness of the effects of
cytostatic was carried out 14 days after the end of
their administration. A clinical study, MRI and
ultrasound were used, the obtained data were
compared with each other and, subsequently,
with the results of a pathomorphological study of
the surgical material.
Tolerability, the number of side effects of
anticancer drugs were assessed, the diagnostic
value of various methods of examining patients
was studied in the formation of tactics for further
management.
When using cytostatic, one of the complex
problems is their systemic toxicity associated
with a non-selective effect on tumor and healthy
cells of the div. The emerging complications of
chemotherapy can significantly impair the quality
of life of patients, and early prevention and
correction of side effects are a prerequisite for
adequate treatment of patients.
In our study, 26 courses of systemic
chemotherapy were performed, as well as 26
courses of combined chemotherapy with
intravenous administration of paclitaxel and
carboplatin with the addition of local intra-
arterial infusion and embolization of tumor
vessels.
Chemotherapy was accompanied by standard
premedication
and
administration
of
antiemetogenic drugs. In all studied groups of
patients, satisfactory tolerability of drug therapy
was noted, the general condition of patients on
the ECOG scale during treatment did not decrease
by less than 1 point, the manifestation of side
effects of cytostatics on the CTCAE toxicity scale
did not exceed the second degree. Manifestations
of gastrointestinal toxicity were noted in 15
patients treated using only intravenous
cytostatics (57.9%) (n=26). Of these, grade I
nausea on the CTC toxicity scale was noted in 8
patients (30.7%), grade II nausea in 6 (23.1%).
Vomiting of I degree was noted in 7 patients
(26.9%), II degree - in 1 case (3.8%).
In the subgroups of patients who received intra-
arterial chemotherapy and embolization of tumor
arteries
(n=17),
manifestations
of
gastrointestinal toxicity were noted in 9 (64.7%).
Nausea I degree was observed in 9 patients
(52.9%), II degree - in 7 (41.1%). In 3 patients of
all subgroups, vomiting of the 1st degree (5.8%)
was noted. We did not observe nausea and
vomiting of III-IV degree among the studied
patients of both groups.
Anemia, neutropenia and thrombocytopenia
were noted in the studied patients in the analysis
of hematological toxicity.
The initial anemia was in 21 studied patients with
REM of both studied groups (21.4%). If necessary,
patients underwent special hemostimulating
treatment; by the time chemotherapy began, the
hemoglobin level was at least 100 g/l.
Neutropenia I degree (not lower than 2.0x109/l)
was established in 18 cases in patients in the
group of intravenous administration of
cytostatics and in 7 patients after intra-arterial
administration. The level of neutrophils was
restored without the use of hemostimulating
therapy in all cases. The blood test was monitored
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5 days after the administration of cytostatic; if
signs of neutropenia were detected, appropriate
drugs were prescribed, which made it possible to
carry out the planned treatment without violating
the terms and volumes.
Thrombocytopenia of the 1st degree was
established in 10 (10.2%) patients who received
only intravenous administration of cytostatics,
the level of platelets below 90x109/l was not
observed, specific therapy was not required.
Among patients subjected to intra-arterial
chemotherapy, thrombocytopenia was not
observed.
Nephrotoxicity was manifested in the form of a
slight increase in blood creatinine levels. In 18
(18.3%) patients who received only intravenous
chemotherapy, and in 6 patients (6.1%) from the
intra-arterial chemotherapy group, the creatinine
level increased to 120 mmol/l. These changes
stopped without special treatment.
Thus, the introduction of anticancer drugs up to
individually planned dosages was carried out in
all patients with REM. In general, the treatment
was well tolerated, there were slightly fewer
manifestations
of
gastrointestinal
and
hematological
toxicity
with
intra-arterial
administration of chemotherapy drugs, but no
statistically significant differences were found.
C
ONCLUSIONS
The highest incidence of endometrial cancer was
found in the age group of 30-39 years with the
largest number of patients in the reproductive
period. The use of neoadjuvant chemotherapy in
patients with CEM stages IB2
–
IIIB made it
possible to achieve complete tumor regression in
5.7% of cases, partial regression in 83.3%. Radical
operations were performed in 91.9% of cases and
determination of the risk of adverse prognostic
factors with careful dynamic monitoring of the
tumor process is one of the main conditions for
the use of multicomponent treatment of patients
with REM. The technological basis of monitoring
is the integration of MRI and ultrasound into
diagnostic standards.
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