Impact of Bilateral Uterine Artery Chemoembolization in Gestational Trophoblastic Diseases: A Retrospective Analysis of 25 Patients—A Single-Center Experience

High-risk gestational trophoblastic neoplasia (GTN) is usually treated with multi-agent chemotherapy such as the EMACO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) regimen. However, in some cases, severe chemotherapy-related toxicity can limit treatment continuation. In addition, we have to search for alternative minimal invasive treatment for cases presenting with persistent vaginal bleeding. This article aims to evaluate the feasibility, safety, and clinical outcomes of bilateral uterine artery chemoembolization using methotrexate and Adriamycin in patients with high-risk GTN who developed severe toxicity to systemic chemotherapy with or without significant vaginal bleeding. This retrospective observational study was conducted at a tertiary-care center, King George Medical University (KGMU), Lucknow. Twenty-five patients with high-risk GTN who presented with persistent vaginal bleeding with or without systemic chemotherapy-related toxicity and rising or plateauing of beta-human chorionic gonadotropin (β-hCG) levels were included. All patients underwent bilateral uterine artery chemoembolization with intra-arterial methotrexate and Adriamycin followed by polyvinyl alcohol particle embolization. Patients were followed up with serial β-hCG measurements and imaging (transvaginal ultrasonography). The procedure was technically successful in all 25 patients (100%). Immediate control of vaginal bleeding was achieved in 22 patients (88%), while 3 patients (12%) showed gradual improvement within 1 week with complete cessation of vaginal bleeding. A persistent decline in β-hCG levels was observed in all patients. Twenty patients (80%) achieved normalization β-hCG levels within 12 weeks, while 5 patients (20%) required additional consolidation chemotherapy. No major procedure-related complications were observed. Bilateral uterine artery chemoembolization with intra-arterial chemotherapy is a safe and effective treatment option in patients with high-risk GTN who cannot tolerate systemic chemotherapy and have significant vaginal bleeding. The technique provides rapid hemorrhage control and reduction of tumor burden with intent to preserve the uterus for future childbearing in young patients. The technique allows us to have good local concentration of chemo drugs thereby reducing the systemic side effects.