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Radiotherapy of cancer of the cervix uteri
356
AMERICAN
JOURNAL
OF
OBSTETRICS
AND
GYNECOLOGY
Carcinoma of the uterine corpus is usually of the glandular type. IDiagnosis cau generally be made by a curettage but cancer should be suspected in patients who commence to have a discharge or bleeding after the menopause. Carcinoma of the body is best treated by a course of deep x-ray therapy followed promptly by a panhysterectomy. J. THORNWELL WI’J~HERSPOON. Malpas,
P. :
Corporeal Recurrence 2: 1464, 1935.
After
Radium
Treatment
of
Carcinoma
Cervices, Lancet
There were 5 cases after radium therapy. abdominal and lumbar
in
359
The pain
cervicrtl
carcinomas
symptoms of and a return
enlarged and became globular. complications. It is emphasized treatment of cervical carcinoma and that the uterine applicator
that
had
the recurrences of the watery
Extension to the that hysterectomy for at least twelve be sufficiently long
corporeal
lower uterus
ureters and bowel are common has no place in the secondary months after ra,dium treatment for treatment. H.
Mackenzie, Kenneth: X-Radiation, New
recurrences
were irregular discharge. The
Advanced Cancer of the Cervix Zealand M. J. 35: 309, 1936.
CLOSE
Treated
HESSELTINE.
With
Acetone
and
Two cases of squamous cell epithelioma of the cervix in an advanced stage were treated by the application of pure acetone followed by x-ray irradiation. A marked improvement in the symptoms occurred immediately following this treatment and ultimately the ulcerating lesions which filled the vaginal vault completely disappeared. One year later both patients appeared free from the disease. One other case treated tion of the discharge.
similarly
by
the
author
resulted I?. L.
Mackenzie, Bruce M. J. 34: 171,
: Radiotherapy 1935.
of
Cancer
Radiologic treatment of cancer involves viation or cure. Alleviation is obtaine,d cells. This applies to advanced, widespread, plete eradication of all malignant cells and a.uthor deals with this group particularly. will
Fundamentally, an adequate cause no damage to normal
dose to all surrounding
of
the
in only ADAIR
Cervix
temporary AND
S. A.
Uteri,
New
alleviaPEARL.
Zealand
a distinction between two factors: alleupon incomplete eradication of cancer hopeless cases. Cure comprises comtheir conversion into benign tissue. The cancer tissues
cells are
and a regulated essentials.
dose
that
There is no fixed lethal cancer dose. Some radiosensitive cancers may be eradicated by a dose of 1,000 r., while radioresistant types may not be cured by 10,000 r. Between these extremes lie many gradations. The percentage of cures increases with increasing dosage. Damage to normal tissues must be avoided. Normal tissue tolerance varies with different tissues. In gynecologic work 3,000 to 4,000 r. tissue dose may be safely given in the course of a month. A homogeneous distribution of dosage through the entire tumor area is essential. X-ray may be used beneficially in conjunction with radium. Methods of x-ray treatment and their sequelae and complications are described. Local reactions, diarrhea, cystitis, vaginitis, and amenorrhea with sterility commonly follow, and all but the last require treatment.
357
ABSTRACTS
The author feels that where no reactions occurred an inadequate dose was administered. The larger doses, though drastic, give the best results. Early treatment is most important from the radiologic aspect because (1) the area involved is smaller, and (2) young tumor cells are more vulnerable than old ones. F. I,. Carranza, Boll.
Felipe de Sot.
F. : A Consideration de ostet.
y ginec.
of (Buenos
the Treatment Aires)
15:
ADAIR
AND
of Carcinoma 369,
S. A.
PEARL.
of the Vulva,
1936.
After reviewing his cases and results obtained by the several methods employed author arrives at the following conclusions: The treatment of choice in carcinoma of the vulva is electrosurgery not only of the local area, but also of the areas of regional metastasis, and extirpation of the lymph glands, four to six weeks following the vulvectomy. During the interval deep x-ray therapy is applied over these areas. The technique of treatment varies with the extent of involvement. Simple vulvectomy au&es in very early cases. In them, if the initial lesion is small, radium may be employed. In lesions of the second and third grade electrosurgery with eledrocoagulation of all regional lymph glands must be employed. It is best not to close the denuded areas with sutures but permit them to granulate. MARIO A. CASTALLO. the
Salacz, Paul von: Ztschr.
f. Geburtsh.
The Surgical u. GynIk.
Treatment of Cancer of the Female 110: 290, 1935.
Genitalia,
Operable cancer of the cervix is best treated by a combination of radiation and radical surgery which gives 18 per cent better results than either method alone. In the II. University Clinic of Budapest the radical vaginal operation (Schauta) is used rather than the abdominal operation of Wertheim because the final results are about the same, while the primary mortality, postoperative morbidity and complications are much greater with the abdominal operation. Inoperable cancer, as well as operable cancer complicated by old age, diabetes, hyperthyroidism, cardiorenal disease, etc., is treated only by radiation. Over a period of seventeen years, 217 cases of cervical cancer were operated by the Schauta method. Primary mortality was 3.6 per cent and morbidity 7.7 per cent. Uneventful recovery without a rise in temperature occurred in 55 per cent. There were Pregnancy complicated by cancer of the cervix 46.5 per cent of five-year cures. does not have the extremely bad prognosis generally believed. Cancer in pregnancy is treated by radical methods, either with or without cesarean section, depending upon the period of gestation and the extent of the cancer at the time that it is discovered. In his clinic the results were about the same as with cancer not complicated by pregnancy. Cancer of the uterine body is best treated by vaginal hysterectomy. The five-year cure rate in 81 cases was 73 per cent. Cancer of the vulva was treated by radiation, although the author describes the correct surgical procedure. No end-results are greater, but the prognosis is given as very bad. A few cases of cancer of the vagina were treated surgically with the results extremely unsatisfactory. Two cases of primary cancer of the tubes were seen. The patients lived less than one year after operation. Three cases of Krukenberg tumor are reported. Regardless of the age of the patients all ovarian tumors should be operated as soon as possible. Of 130 cases operated more than five years ago Inoperable cancers of the ovaries are treated 36.9 per cent are living and well. by radiation, but the results are universally bad. EUGENE 5. Au~R.
AMERICAN
JOURNAL
OF
OBSTETRICS
AND
GYNECOLOGY
Carcinoma of the uterine corpus is usually of the glandular type. IDiagnosis cau generally be made by a curettage but cancer should be suspected in patients who commence to have a discharge or bleeding after the menopause. Carcinoma of the body is best treated by a course of deep x-ray therapy followed promptly by a panhysterectomy. J. THORNWELL WI’J~HERSPOON. Malpas,
P. :
Corporeal Recurrence 2: 1464, 1935.
After
Radium
Treatment
of
Carcinoma
Cervices, Lancet
There were 5 cases after radium therapy. abdominal and lumbar
in
359
The pain
cervicrtl
carcinomas
symptoms of and a return
enlarged and became globular. complications. It is emphasized treatment of cervical carcinoma and that the uterine applicator
that
had
the recurrences of the watery
Extension to the that hysterectomy for at least twelve be sufficiently long
corporeal
lower uterus
ureters and bowel are common has no place in the secondary months after ra,dium treatment for treatment. H.
Mackenzie, Kenneth: X-Radiation, New
recurrences
were irregular discharge. The
Advanced Cancer of the Cervix Zealand M. J. 35: 309, 1936.
CLOSE
Treated
HESSELTINE.
With
Acetone
and
Two cases of squamous cell epithelioma of the cervix in an advanced stage were treated by the application of pure acetone followed by x-ray irradiation. A marked improvement in the symptoms occurred immediately following this treatment and ultimately the ulcerating lesions which filled the vaginal vault completely disappeared. One year later both patients appeared free from the disease. One other case treated tion of the discharge.
similarly
by
the
author
resulted I?. L.
Mackenzie, Bruce M. J. 34: 171,
: Radiotherapy 1935.
of
Cancer
Radiologic treatment of cancer involves viation or cure. Alleviation is obtaine,d cells. This applies to advanced, widespread, plete eradication of all malignant cells and a.uthor deals with this group particularly. will
Fundamentally, an adequate cause no damage to normal
dose to all surrounding
of
the
in only ADAIR
Cervix
temporary AND
S. A.
Uteri,
New
alleviaPEARL.
Zealand
a distinction between two factors: alleupon incomplete eradication of cancer hopeless cases. Cure comprises comtheir conversion into benign tissue. The cancer tissues
cells are
and a regulated essentials.
dose
that
There is no fixed lethal cancer dose. Some radiosensitive cancers may be eradicated by a dose of 1,000 r., while radioresistant types may not be cured by 10,000 r. Between these extremes lie many gradations. The percentage of cures increases with increasing dosage. Damage to normal tissues must be avoided. Normal tissue tolerance varies with different tissues. In gynecologic work 3,000 to 4,000 r. tissue dose may be safely given in the course of a month. A homogeneous distribution of dosage through the entire tumor area is essential. X-ray may be used beneficially in conjunction with radium. Methods of x-ray treatment and their sequelae and complications are described. Local reactions, diarrhea, cystitis, vaginitis, and amenorrhea with sterility commonly follow, and all but the last require treatment.
357
ABSTRACTS
The author feels that where no reactions occurred an inadequate dose was administered. The larger doses, though drastic, give the best results. Early treatment is most important from the radiologic aspect because (1) the area involved is smaller, and (2) young tumor cells are more vulnerable than old ones. F. I,. Carranza, Boll.
Felipe de Sot.
F. : A Consideration de ostet.
y ginec.
of (Buenos
the Treatment Aires)
15:
ADAIR
AND
of Carcinoma 369,
S. A.
PEARL.
of the Vulva,
1936.
After reviewing his cases and results obtained by the several methods employed author arrives at the following conclusions: The treatment of choice in carcinoma of the vulva is electrosurgery not only of the local area, but also of the areas of regional metastasis, and extirpation of the lymph glands, four to six weeks following the vulvectomy. During the interval deep x-ray therapy is applied over these areas. The technique of treatment varies with the extent of involvement. Simple vulvectomy au&es in very early cases. In them, if the initial lesion is small, radium may be employed. In lesions of the second and third grade electrosurgery with eledrocoagulation of all regional lymph glands must be employed. It is best not to close the denuded areas with sutures but permit them to granulate. MARIO A. CASTALLO. the
Salacz, Paul von: Ztschr.
f. Geburtsh.
The Surgical u. GynIk.
Treatment of Cancer of the Female 110: 290, 1935.
Genitalia,
Operable cancer of the cervix is best treated by a combination of radiation and radical surgery which gives 18 per cent better results than either method alone. In the II. University Clinic of Budapest the radical vaginal operation (Schauta) is used rather than the abdominal operation of Wertheim because the final results are about the same, while the primary mortality, postoperative morbidity and complications are much greater with the abdominal operation. Inoperable cancer, as well as operable cancer complicated by old age, diabetes, hyperthyroidism, cardiorenal disease, etc., is treated only by radiation. Over a period of seventeen years, 217 cases of cervical cancer were operated by the Schauta method. Primary mortality was 3.6 per cent and morbidity 7.7 per cent. Uneventful recovery without a rise in temperature occurred in 55 per cent. There were Pregnancy complicated by cancer of the cervix 46.5 per cent of five-year cures. does not have the extremely bad prognosis generally believed. Cancer in pregnancy is treated by radical methods, either with or without cesarean section, depending upon the period of gestation and the extent of the cancer at the time that it is discovered. In his clinic the results were about the same as with cancer not complicated by pregnancy. Cancer of the uterine body is best treated by vaginal hysterectomy. The five-year cure rate in 81 cases was 73 per cent. Cancer of the vulva was treated by radiation, although the author describes the correct surgical procedure. No end-results are greater, but the prognosis is given as very bad. A few cases of cancer of the vagina were treated surgically with the results extremely unsatisfactory. Two cases of primary cancer of the tubes were seen. The patients lived less than one year after operation. Three cases of Krukenberg tumor are reported. Regardless of the age of the patients all ovarian tumors should be operated as soon as possible. Of 130 cases operated more than five years ago Inoperable cancers of the ovaries are treated 36.9 per cent are living and well. by radiation, but the results are universally bad. EUGENE 5. Au~R.