Hypogastric Arteriography Prior to Continuous Infusion of Malignant Tumors of the Uterine Cervix and Vagina

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RECENTLY, Sullivan, Miller, and Sikes1 reported the treatment of advanced squamous-cell carcinoma of the mouth and the nasopharynx by continuous intraarterial infusion with amethopterin. In several of their patients regression of the tumor was so striking that an attempt to adapt their technics and methods to the treatment of squamous-cell carcinoma of the uterine cervix and the vagina was undertaken here at the Cleveland Clinic. The project has been in progress since December, 1959, and this preliminary report is concerned with the visualization of the vascular anatomy of the uterus and of the upper vagina in nine patients.

For maximum benefit from infusion of malignant tumors in any location, the following four requirements must be met: (1) the one or two arteries selected for infusion must deliver most of their blood to the region of the tumor; (2) most of the blood supply of the tumor itself must come from these arteries; (3) the vessels must be accessible and of adequate size to be catheterized easily; (4) the sacrifice of the arteries must be possible, if necessary, without serious damage to normal tissues. For infusion of carcinoma of the uterus, cervix, and upper vagina, these four requirements are fulfilled by employing the hypogastric arteries. Sullivan and Miller2 have used these arteries for the infusion of tumors of the bladder in two male patients. It is logical that the hypogastric arteries be used in female patients for treatment of carcinoma of the cervix and of the vagina.

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