Substantiation of adjuvant intraperitoneal chemotherapy in complex treatment of widespread endometriosis (III-IV stages)

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Preface. Hormonal therapy is the integral component of complex treatment of all forms of endometriosis. The saved up 20-years world experience shows, that the best results are achieved with GnRH-agonists using, and the basic mechanism of their action is amenorrhea achievement. The mentioned mono- or adjuvant therapy is always coexisting with development of by-effects: the developed picture of climacteric infringements, mental and vegetative frustration. It does impossible and inexpedient carrying out of hormonal therapy during more, than 6-8 months. Frequency of relapse of clinical signs reaches 48% after GnRH canceling within first two years of supervision. Works by Thipgen J.T. et al. (2004) have proved expediency of carrying out of intraperitoneal chemotherapy with doxorubicin and cisplatin in disseminated endometrial cancer management, and also have confirmed efficiency of application intraperitoneal chemotherapy (ICT) with these drugs with the purpose of suppression of growth and resorbtion activation of endometrial deposits.

Objective. To show expediency of carrying out of ICT with cytostatics in treatment of the widespread endometriosis.

Material and methods. Carrying out of hyperthermal intraoperational intraperitoneal (ICT) and normothermal postoperative chemotherapy with doxorubicin 60 mg/m2 and cisplatin 50 mg/m2 at 23 patients with endometriosis III-IV (ASRM staging). Control group - 10 women - adjuvant therapy with GnRH agonists for 3 months

Results. Adjuvant ICT was effective at treatment of the widespread endometriosis and has led to proof positive clinical effect at 93,4% of women within the first year of supervision. Single-staged adjuvant ICT at the widespread endometriosis is not accompanied by development after operation of any by-effects; and performance of second-look laparoscopy at 14 (60,9%) women has shown, that efficiency of ICT is higher, than adjuvant 3-4 month courses of GnRH agonists (Zola- dex, Buserelin) and leads to full resorbtion of endometriosis heterotopies and surrounding infiltration. The use of “soft” modes of CT (30 minutes perfusion of 42 C solutions) was not accompanied by development of adhesive process after operation in any case, and, hence, had no negative mechanical action on fertility patients. The specified variant of therapy did not result in ovulatory function disturbances.

About the authors

N. N. Ruhliada

Author for correspondence.
Email: info@eco-vector.com

professor, surgeon, gynecologist

References

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