Prognostic importance of histologic vascular density in cervical cancer treated with hypertensive intraarterial chemotherapy

Background. Over the past 20 years, various methods have been suggested to determine the histopathologic stage and grade of cervical cancer for predicting biologic behavior during chemotherapy. However, none of these complicated techniques have proved consistently accurate enough to predict chemotherapeutic effects on locally advanced cervical cancer. Methods. Primary treatment with hypertensive intraarterial chemotherapy and, 4 weeks later, with radical hysterectomy were performed on 20 patients with locally advanced cancer of the uterine cervix (International Federation of Gynecology and Obstetrics [FIGO] Stages IIa‐IVa). The vascular densities of biopsy specimens from pretreatment cancers stained by the Elastica‐Goldner technique were measured semiquantitatively. Cytologic and histologic changes in the early stages after the intraarterial chemotherapy were simultaneously recorded. Patients were divided into two groups after analysis of the final histologic effects on operation materials in accordance with the criteria of the Japan Society for Cancer Therapy: (1) an effective group (≧ Grade 2; n = 7) or (2) a noneffective group (< Grade 2; n = 13). Results. The vascular densities of the effective and noneffective groups were 6.91 plus or minus 4.51/mm2 and 1.94 plus or minus 1.21/mm2, respectively. The vascular densities of biopsy specimens were significantly higher in the effective group (P < 0.05). The early cytologic and histologic changes 1 week after chemotherapy were significantly greater in the effective group (P < 0.05). Conclusions. These results indicate that the efficacy of intraarterial chemotherapy for cervical cancers depends on their individual vascular densities, which can be detected beforehand through the study of biopsy specimens. Furthermore, cytologic and histologic changes in the early stages would seem to reflect the overall histologic effect of the treatment as a whole.