Real-world data on predictors of survival in patients with gynecological tumors following pelvic arterial embolization

Background: Uterine bleeding is a potentially life-threatening complication of gynecologic malignancies. Pelvic transarterial embolization (TAE) is used for hemorrhage control, but data on outcomes and prognostic factors remain limited. This retrospective study evaluated women treated with TAE in whom cervical cancer, endometrial cancer, and radiotherapy-induced pelvic sequelae were identified within the cohort. Methods: Women who underwent TAE at the Brazilian National Cancer Institute (INCA) between 2019 and 2020 were included. Demographic and tumor characteristics, clinical response to TAE, and survival data were analyzed. Hemorrhage control was classified as a complete response (CR), temporary response (TempR), or no response (NR). Overall survival (OS) was estimated using the Kaplan-Meier method and compared according to response status (CR/TempR vs. NR), International Federation of Gynecology and Obstetrics (FIGO) stage (I–III vs. IV), and the presence of genitourinary fistulas. Results: Among 26 patients, 16 (61.5%) achieved CR, 7 (26.9%) TempR, and 3 (11.5%) NR. Patients with CR were younger, had better functional status, fewer genitourinary fistulas, and lower FIGO stages (I–III). Transfusion requirements decreased after TAE across all groups, and hemoglobin levels increased over time. Median follow-up was 23.9 months, with 19 deaths. Median OS was 5.7 months, with 12- and 24-month OS of 37.3% and 22.4%, respectively. CR was associated with improved survival (p < 0.001), while FIGO stage IV and fistulas were associated with worse outcomes. Conclusions: Pelvic TAE is a safe and minimally invasive option for hemorrhage control in gynecologic malignancies, with more favorable hemostatic outcomes largely influenced by baseline patient and disease characteristics, including younger age, lower Eastern Cooperative Oncology Group (ECOG) scores, and earlier FIGO stages.

Embolization; Hemorrhage; Cervical cancer; Endometrial cancer; Radiotherapy sequelae

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