Цель. Определить диагностические характеристики ультразвукового исследования (УЗИ) при оценке ответа на неоадъювантную химиотерапию у больных местно-распространенным раком шейки матки (РШМ). Материалы и методы. Проанализированы данные обследования 142 больных местно-распространенным РШМ стадий IB2–IIIB, которым на первом этапе комплексного лечения проводили неоадъювантную химиотерапию. Оценку эффективности лечения осуществляли с применением физикальных методов исследования, а также комплексного УЗИ. Результаты. После проведения неоадъювантной химиотерапии у больных местно-распространенным РШМ объем первичного очага, определенный по данным клинического обследования и УЗИ (В-режим), уменьшался более чем на 50%. При допплерографии выявлено достоверное снижение скоростных показателей кровотока в маточных артериях и строме шейки матки. Радикальное хирургическое вмешательство после химиотерапии удалось выполнить в 133 (93,7%) случаях. Выводы. Динамический ультразвуковой мониторинг является достаточно информативным при оценке эффективности неоадъювантной химиотерапии у больных местно-распространенным РШМ. Основными ультразвуковыми критериями ответа на лечение являются динамика объема опухоли, а также функциональные показатели кровотока в ткани новообразования.
Aim. To determine the diagnostic characteristics of ultrasound when evaluating the response to neoadjuvant chemotherapy in patients with locally advanced cervical cancer. This assessment is very important and necessary to define further treatment policy. Materials and methods. The survey data of 142 patients with locally advanced cervical cancer of stages IB2–IIIB, who underwent neoadjuvant chemotherapy at the first stage of complex treatment, was analyzed. Evaluation of the effectiveness of treatment was carried out using clinical methods of research, as well as a comprehensive ultrasound. Complex ultrasound study was conducted before treatment initiation and after each chemotherapy cycle. Results. After neoadjuvant chemotherapy in patients with locally advanced cervical cancer, the volume of the primary focus, as determined by clinical examination and ultrasound (B-mode), decreased by more than 50%. Doppler ultrasound revealed a significant decrease in the velocity parameters of blood flow in the uterine arteries and the cervical stroma. Radical surgery after chemotherapy was performed in 133 (93.7%) cases. Conclusions. Dynamic ultrasound monitoring is quite informative when assessing the effectiveness of neoadjuvant chemotherapy in patients with locally advanced cervical cancer. The main ultrasound response criteria for treatment is the dynamics of the tumor volume, as well as functional parameters of blood flow in the tumor tissue.
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[Kurmyshkina O.V., Belova L.L., Kovchur P.I., Volkova T.O. Remodelirovanie angiogeneza i limfangiogeneza pri razvitii raka sheiki matki. Biomeditsinskaia khimiia. 2015; 5: 579–97 (in Russian).]
28. Alcazar JL, Arribas S, Martinez-Monge R, Jurado M. Three-Dimensional Power Doppler Ultrasound for Predicting Response and Local Recurrence After Concomitant Chemoradiation Therapy for Locally Advanced Carcinoma of the Cervix. Int J Gynecol Cancer 2016; 26 (3): 534–8.
29. Eisenhauer EA, Therasse P, Bogaerts J et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45 (2): 228–47.
________________________________________________
1. Bokhman Ia.V. Rukovodstvo po onkoginekologii. Saint Petersburg, 2002 (in Russian).
2. Eifel PJ. Chemoradiotherapy in the treatment of cervical cancer. Semin Radiat Oncol 2006; 16 (3): 177–85.
3. Wiebe E, Denny L, Thomas G. Cancer of the cervix uteri. Int J Gynaecol Obstet 2012; 119 (Suppl. 2): S100–9.
4. Khokhlova S.V., Kolomiets L.A., Kravets O.A. et al. Prakticheskie rekomendatsii po lekarstvennomu lecheniiu raka sheiki matki. Prakticheskie rekomendatsii po lecheniiu zlokachestvennykh opukholei Rossiiskogo obshchestva klinicheskoi onkologii. Moscow: RUSSCO, 2016 (in Russian).
5. Aleshikova O.I. Luchevye i molekuliarno-biologicheskie kriterii otsenki effektivnosti neoad"iuvantnoi khimioterapii mestnorasprostranennogo raka sheiki matki (IIB–IIIB stadii). Ros. onkol. zhurn. 2007; 3: 21–5. (in Russian).
6. Ashrafian L.A., Antonova I.B., Aleshikova O.I. Sovremennye luchevye metody diagnostiki (sonografiia i magnitno-rezonansnaia tomografiia) v otsenke effektivnosti neoad"iuvantnoi khimioterapii mestno-rasprostranennogo raka sheiki matki (IIb–IIIb stadii). Sib. onkol. zhurn. 2008; 5: 17–22 (in Russian).
7. St-Amant P, Foster W, Froment MA et al. Use of 3D transabdominal ultrasound imaging for treatment planning in cervical cancer brachytherapy: Comparison to magnetic resonance and computed tomography. Brachytherapy. 2017.10.1016/j.brachy.2017.03.006
8. Xu Y, Zhu L. Ru T et al. Three-dimensional power Doppler ultrasound in the early assessment of response to concurrent chemo-radiotherapy for advanced cervical cancer. Acta Radiol 2017.10.1177/ 0284185116684677: 284185116684677.
9. Bolla D, In-Albon S, Papadia A et al. Doppler Ultrasound Flow Evaluation of the Uterine Arteries Significantly Correlates with Tumor Size in Cervical Cancer Patients. Ann Surg Oncol 2015; 22 (Suppl. 3): S959–63.
10. Huang YF, Cheng YM, Wu YP et al. Three-dimensional power Doppler ultrasound in cervical carcinoma: monitoring treatment response to radiotherapy. Ultrasound Obstet Gynecol 2013; 42 (1): 84–92.
11. Alcazar JL, Jurado M, Lopez-Garcia G. Tumor vascularization in cervical cancer by 3-dimensional power Doppler angiography: correlation with tumor characteristics. Int J Gynecol Cancer 2010; 20 (3): 393–7.
12. Enzelsberger H, Skodler WD, Vavra N, Reinold E. Ultrasonic Doppler flow studies of the uterine arteries in women with cervix cancer. Gynecol Obstet Invest 1991; 32 (2): 112–4.
13. Tanaka K, Umesaki N. Impact of three-dimensional (3D) ultrasonography and power Doppler angiography in the management of cervical cancer. Eur J Gynaecol Oncol 2010; 31 (1): 10–7.
14. Adamian L.V., Demidov V.N., Gus A.I. Luchevaia diagnostika i terapiia v akusherstve i ginekologii: natsional'noe rukovodstvo. Moscow: GEOTAR-Media, 2012 (in Russian).
15. Blok B. Tsvetnoi atlas ul'trazvukovykh issledovanii. Moscow: MEDpress-inform, 2013 (in Russian).
16. Dubile P., Benson K. Atlas po ul'trazvukovoi diagnostike v akusherstve i ginekologii. Moscow: MEDpress-inform, 2011 (in Russian).
17. Khachkuruzov S.G. UZI v ginekologii. Simptomatika, diagnosticheskie trudnosti i oshibki. Saint Petersburg: ELBI-SPb, 2012 (in Russian).
18. Gazhonova V.E., Mamaev V.V., Andriianicheva E.N. Sravnitel'naia otsenka diagnosticheskoi tsennosti UZI i MRT v vizualizatsii invazivnykh form raka sheiki matki. Meditsinskaia vizualizatsiia. 2006; 2: 56 (in Russian).
19. Fischerova D. Ultrasound scanning of the pelvis and abdomen for staging of gynecological tumors: a review. Ultrasound Obstet Gynecol 2011; 38 (3): 246–66.
20. Bourgioti C, Chatoupis K, Moulopoulos LA. Current imaging strategies for the evaluation of uterine cervical cancer. World J Radiol 2016; 8 (4): 342–54.
21. Ashrafian L.A., Aleshikova O.I., Babaeva N.A. et al. Otsenka rezul'tatov neoad"iuvantnoi khimioterapii mestno-rasprostranennogo raka sheiki matki IIB–IIIB stadii pri kompleksnoi ul'trazvukovoi diagnostike. Opukholi zhenskoi reproduktivnoi sistemy. 2015; 2: 76–81 (in Russian).
22. Gazhonova V.E. Ul'trazvukovaia diagnostika v ginekologii. Moscow: MEDpress-inform, 2005 (in Russian).
23. Alcazar JL, Arribas S, Minguez JA, Jurado M. The role of ultrasound in the assessment of uterine cervical cancer. J Obstet Gynaecol India 2014; 64 (5): 311–6.
24. Belitsos P, Papoutsis D, Rodolakis A et al. Three-dimensional power Doppler ultrasound for the study of cervical cancer and precancerous lesions. Ultrasound Obstet Gynecol 2012; 40 (5): 576–81.
25. Folkman J. Seminars in Medicine of the Beth Israel Hospital, Boston. Clinical applications of research on angiogenesis. N Engl J Med 1995; 333 (26): 1757–63.
26. Scappaticci FA. Mechanisms and future directions for angiogenesis-based cancer therapies. J Clin Oncol 2002; 20 (18): 3906–27.
27. Kurmyshkina O.V., Belova L.L., Kovchur P.I., Volkova T.O. Remodelirovanie angiogeneza i limfangiogeneza pri razvitii raka sheiki matki. Biomeditsinskaia khimiia. 2015; 5: 579–97 (in Russian).
28. Alcazar JL, Arribas S, Martinez-Monge R, Jurado M. Three-Dimensional Power Doppler Ultrasound for Predicting Response and Local Recurrence After Concomitant Chemoradiation Therapy for Locally Advanced Carcinoma of the Cervix. Int J Gynecol Cancer 2016; 26 (3): 534–8.
29. Eisenhauer EA, Therasse P, Bogaerts J et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45 (2): 228–47.
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России, Москва, Россия
*d_ovodenko@oparina4.ru
________________________________________________
Dmitry L. Ovodenko*, Grigory N. Khabas, Anna S. Makarova, Mariya S. Pirogova, Alexandr A. Seregin, Yulia S. Golitsyna, Lev A. Ashrafyan
V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
*d_ovodenko@oparina4.ru