Radiation therapy of carcinoma of the vagina

Twenty-two patients with invasive primary carcinoma of the vagina were treated with radiation therapy for cure between 1970 and 1980 at Massachusetts General Hospital. Eighteen demonstrated squamous cell carcinoma and six demonstrated adenocarcinoma. The 5-year actuarial survival was 0.38; no difference was noted between the different histologies. For stages I, II, III and IV disease, 5-year actuarial survivals were 0.71, 0.29, 0.48, and 0.52. A dose-response relationship could be demonstrated for both survival and local control. No serious complications were observed. On the basis of these results, increased reliance on implant techniques to increase the radiation dose to subvaginal tissues, is advocated in stage II disease.     

Integrated external and interstitial radiation therapy for primary carcinoma of the vagina

Twenty-seven patients with the diagnosis of primary carcinoma of the vagina were treated by definitive radiotherapy. Twenty-three patients received a combination of external and interstitial iridium-192 implant irradiation and four patients received only interstitial irradiation. Twenty-one patients had squamous cell carcinoma and six had adenocarcinoma. All patients were staged according to the FIGO classification. More than 70% of patients had relatively advanced local disease and conventional intracavitary irradiation was unsuitable. Local tumor control was observed in 85% (23 of 27 patients), and 56% of the patients remain alive and free of disease for a median follow-up period of 50 months to a maximum follow-up period of 84 months. Fifteen percent of the patients suffered from treatment-related complications.     

Radiation management of primary carcinoma of the vagina: clinical and histopathological variables associated with survival

Data are presented on 434 patients treated at the Gynecologic Radiotherapy Department of the University of Vienna for invasive primary carcinoma of the vagina between 1952 and 1984; data on 110 patients treated in the last few years are more detailed. In stage I, 5-year survival was 76.7%; in stage II, 44.5%; in stage III, 31%; and in stage IV, 18.2%. The overall uncorrected 5-year survival rate was 39.9%. The disease is primarily one of the elderly as 78% were found to be older than 60 years of age. Younger patients had a 5-year survival of 50%; patients between 61 and 75 years of age, 41.2%; and those 76 years of age or older, 34.3%. Patients with presenting symptoms had a cure rate of 36.9%, whereas 61.1% of asymptomatic cases survived. Best results (60%) were obtained when the lesion was in the upper third of the vagina; only 37% of patients with lesions of the middle third and lower third survived more than 5 years. Well-differentiated tumors were associated with a 5-year survival of 62.5%; and poorly differentiated tumors, with a rate of 34.9%. Our results indicate that stage of disease is the most significant prognostic factor, but age of the patient, location of lesion in the vagina, and differentiation of the tumor influence outcome too. The majority of patients were managed by a combination of external pelvic irradiation and local application of radium. In stage I and II patients treated with radium alone, good results were obtained, but no patient with stage III or IV disease survived 5 years when external irradiation was not performed.     

Radiotherapy of primary carcinoma of the vagina: management and results of different therapy schemes

Three hundred and sixty-two cases of primary vaginal carcinoma were treated at the Irradiation Department of the University Clinic for Obstetrics and Gynecology, Vienna, from 1950 to 1977. As the method of choice an individually dosed, fractioned, and protracted radium-telecobalt therapy was employed. Comparing the last period analyzed (1971-1977) with another period 20 years earlier (1951-1956), a marked increase of advanced stages and older patients can be observed. These changes are reflected in the 5-year remission rate: in the total population it was 39.8%, as compared to 32% for the period from 1971 to 1977. For a group of 99 patients, who were treated between 1971 and 1977, the therapeutic effect of different therapy schemes is reported. The benefit of teletherapy is remarkable for advanced states, whereas for stages I and II an intrauterine application may be of importance. The complication rate amounted to 8% recto- or vesicovaginal fistulas and 41% and 43% cystitis and proctitis. The central importance of gynecological screening, especially for older women, is emphasized.     

Patterns of recurrence of primary carcinoma of the vagina

Ninety-two cases of primary carcinoma of the vagina treated at the Massachusetts General Hospital were reviewed from 1961 to 1981. Forty patients were found to have recurrence. Their original clinical stage, location of lesion, histologic subtype, tumor differentiation, and treatment modality were examined to predict recurrence. Staging was the only variable predictive of recurrence. Location of lesion within the vagina was predictive of the site of recurrence. Upper (distal) vagina lesions more commonly recurred locally. In contrast, lower (proximal) lesions were associated with pelvic sidewall and distant recurrence. Adequate staging at the time of initial presentation will have implications on recurrence and prognosis.     

原发性阴道癌44例临床分析

目的 探讨原发性阴道癌临床预后及治疗方法。方法 １６例原发性阴道癌采用放疗加顺铂,５－ＦＵ及丝裂霉素三联全身化疗,单行放疗者２８例。结果 ５年及１０年存活率为５０．９％和３８．１％。Ⅱ期３年及５年存活率为７４．５％和６１．１％,Ⅲ期３年及５年存活率为５６．８％,和４５．１５,Ⅳ期３年及５年存活率为０,Ⅱ期与Ⅲ期３年及５年存活率比较Ｐ〈０．０５。     

Radiation therapy in breast carcinoma]

Strategies in treating breast cancer have been changed in the last years. In Stage I and early II radical operation techniques have been used not more. Today conservative methods are preferred in combination with axillary lymphonodectomy. This implies necessity of postoperative irradiation. Longterm results are not different between breast preserving methods and radical mastectomy. Cosmetic results can be excellent following high doses of radiation. Side effects are minimal and of non important clinical value. If there is a local recurrence or a second primary tumor, a secondary mastectomy can solve the problem in many cases.     

Radiation therapy for primary carcinoma of the female urethra: a survey over 25 years

Sixty-two patients with primary carcinoma of the female urethra were treated with a combined radiation therapy (high-dose intracavitary vaginal radium and external beam). Treatment was strictly individualized, but an administered tumor dose of 5500-7000 rad (55-70 Gy) was always attempted. Forty-two patients (67.7%) had tumors of the anterior urethra, and in 20 women (32.3%) the posterior urethra was involved. In 19 patients (30.6%) the clinical diagnosis of lymph node involvement was made. The overall 5-year-survival rate was 64.5%. Patients with anterior urethral carcinoma had a higher 5-year-survival rate (71.4%) than patients with posterior carcinoma (50.0%). The favorable results underline the substantial role of radiation therapy for this malignancy.     

子宫内膜癌的放射治疗

放射治疗(放疗)是子宫内膜癌的重要治疗方式。对于有高危因素的术后患者,辅助性放疗可明显改善肿瘤的局部控制率;对于不能手术的患者,根治性放疗是重要的替代治疗手段。放疗方式主要包括腔内照射和体外照射两种。     

Clinical and histopathologic factors related to prognosis in primary squamous cell carcinoma of the vagina

The goal of this retrospective study concerning primary carcinoma of the vagina (PCV) was to analyze clinical and histopathologic prognostic factors in one of the largest known material, which comprised 314 patients. PCV is a rare disease, and the majority of published studies are based on small materials; therefore, the established knowledge concerning prognostic factors is insufficient. Routine treatment is based on irradiation with risk for undertreatment or overtreatment, which leads to unnecessary complications in the absence of prognostic factors. The overall 5-year disease-specific survival rate in this study was 45% and in stage I 75%. In the univariate statistical analysis, several factors correlated significantly with disease-specific survival. However, in the multivariate analysis, there were only three factors that independently could predict poor survival-high age at diagnosis, large tumors (> or =4 cm), and advanced stage. Common background factors with no prognostic significance were prior hysterectomy, other gynecological malignancies, and pelvic irradiation. In conclusion, this study has elucidated three strong prognostic factors that might be considered in the choice of therapy and also for modification of the FIGO guidelines. Increased knowledge concerning complementary biologic markers to discriminate between low- and high malignant tumors is however of great importance.