Monitoring of rheologic variables during postoperative high-dose brachytherapy for uterine cancer

Clin Appl Thromb Hemost. 2004 Jul;10(3):239-48. doi: 10.1177/107602960401000306.

Abstract

Oxygenation of tumor tissue has recently been assed an important prerequisite for the effectiveness of radiotherapy in cervical cancer. Hyperviscosity is a common phenomenon in malignancy and a cause of reduced oxygen transport capacity that would favour tissue hypoxia. Hemorheological variables were serially tested preoperatively, during four cycles of fractionated adjuvant IR(192) HDR after loading radiation (HDR-AL) of the vaginal vault (weekly intervals), and 6 months postoperatively in patients with cervical (n=12) and endometrial cancer (n=26). Women who were scheduled for benign tumor surgery served as controls (n=29). Preoperatively, in cervical and endometrial cancer patients, mean plasma viscosity (PV: 1.31+/-0.1 mPa s; p<0.05; 1.35+/-0.13 mPa s; p<0.001) and fibrinogen levels (383+/-46 mg/dL; p<0.05; 379+/-117 mg/dL; p<0.05) were higher as compared to the controls (1.25+/-0.07 mPa s; 314+/-89 mg/dL). Red blood cell aggregation at low shear and stasis (RBC agg.: 15.7+/-5.6; p<0.05; 29.6+/-9.1; p<0.05) was higher in endometrial cancer patients as compared to the controls (13.7+/-3.4; 25.3+/-5.6). Postoperatively PV decreased in endometrial cancer patients and transiently increased in cervical cancer patients. After the third session of irradiation in both cancer groups, PV regained and at the 6-month checkup, levels were higher as compared to the values before surgery. Postoperatively fibrinogen levels increased and remained higher throughout HDR-AL and 6 months postoperatively. After surgery and during irradiation, anemia persisted in both cancer groups while hematocrit recovered after 6 months in endometrial cancer patients. Thrombosis was diagnosed in three patients postoperatively (7.9 %) but in none during HDR-AL. While a temporary reduction of hyperviscosity is found postoperatively and during HDR-AL in uterine cancer patients, 6 months after surgery RBC aggregation, PV, and hematocrit returned to the pretreatment range.

MeSH terms

  • Aged
  • Biomarkers
  • Blood Viscosity*
  • Brachytherapy*
  • Cell Hypoxia / radiation effects
  • Combined Modality Therapy
  • Endometrial Neoplasms / blood*
  • Endometrial Neoplasms / radiotherapy
  • Endometrial Neoplasms / surgery
  • Erythrocyte Aggregation
  • Female
  • Fibrinogen / analysis
  • Humans
  • Hysterectomy
  • Leukocyte Count
  • Middle Aged
  • Platelet Count
  • Radiotherapy, Adjuvant*
  • Uterine Cervical Neoplasms / blood
  • Uterine Cervical Neoplasms / radiotherapy
  • Uterine Cervical Neoplasms / surgery

Substances

  • Biomarkers
  • Fibrinogen