ADJUVANT USE OF RADIOACTIVE COLLOIDS IN THE TREATMENT OF CARCINOMA OF THE OVARY.

Abstract

The definitive treatment for malignant lesions of the ovary is removal of the tumor by hysterectomy and bilateral salpingo-oophorectomy. The peritoneal surfaces are a major route of metastasis in ovarian carcinoma (6), and at operation release of malignant cells into the peritoneum by spill from a cystic tumor, the presence of malignant cells in peritoneal washings, and superficial excrescences of tumor on the surface of the ovary are signs that peritoneal spread has already taken place or is highly likely. Such situations have been considered indications for postoperative radiation therapy. Irradiation of the entire peritoneal cavity by conventional external means at cancerocidal dose levels is not possible in most patients, however, because of the large volume of tissue to be treated. The definitive treatment for malignant lesions of the ovary is removal of the tumor by hysterectomy and bilateral salpingo-oophorectomy. The peritoneal surfaces are a major route of metastasis in ovarian carcinoma (6), and at operation release of malignant cells into the peritoneum by spill from a cystic tumor, the presence of malignant cells in peritoneal washings, and superficial excrescences of tumor on the surface of the ovary are signs that peritoneal spread has already taken place or is highly likely. Such situations have been considered indications for postoperative radiation therapy. Irradiation of the entire peritoneal cavity by conventional external means at cancerocidal dose levels is not possible in most patients, however, because of the large volume of tissue to be treated. The definitive treatment for malignant lesions of the ovary is removal of the tumor by hysterectomy and bilateral salpingo-oophorectomy. The peritoneal surfaces are a major route of metastasis in ovarian carcinoma (6), and at operation release of malignant cells into the peritoneum by spill from a cystic tumor, the presence of malignant cells in peritoneal washings, and superficial excrescences of tumor on the surface of the ovary are signs that peritoneal spread has already taken place or is highly likely. Such situations have been considered indications for postoperative radiation therapy. Irradiation of the entire peritoneal cavity by conventional external means at cancerocidal dose levels is not possible in most patients, however, because of the large volume of tissue to be treated. Selection of Patients At the Mayo Clinic, 118 patients with cancer of the ovary have been treated postoperatively with radioactive gold since 1952. In 68 of these patients five years or more have elapsed since initial treatment, and they form the basis of this report. Patients were considered suitable for this therapy if they were in one of the following groups: Group 1 : The tumor had spread to the peritoneal surface of the ovary but all known carcinoma had been confined to the ovaries and had been removed (11 patients). Group 2 : The peritoneal space was contaminated by spillage of cystic contents before or during surgery, but no known spread had occurred beyond the ovaries (22 patients).