Afterloading short-term irradiation of inoperable uterine cancer

Abstract

Irradiation using the afterloading therapy equipment enabling monitored short-term high-dose radiation, not only reduces exposure of the medical staff to radiation, but also places less strain on the patients. 94 patients with endometrial carcinoma were treated by irradiation alone between 1980-1985 and could be followed up for at least 12 months up to 5 years. Evaluation was performed with regard to a recurrence-free survival rate and radiation side effects. The 5-year survival rates with radiation alone are compared with a previously recorded control group. Before the afterloading technique had become available, the 5-year survival for endometrial carcinoma treated by intracavitary radium-226 was 50%. Using the afterloading iridium-192 technique, the 3-year recurrence-free rate was 81% and the 5-year survival rate 70%. There was no difference between younger (50-69 years of age) and older (70-85 years of age) patients, nor was there any difference between highly and less differentiated tumours. Incidence of severe damage caused by radiation in the overall group: 2 cases of ileus, 1 case of rectovaginal fistula, 3 cases of rectal ulcers and 1 case of severe vaginal necrosis. Severe complications did not occur with the optimal intrauterine fraction dose of 850 cGy (4 times) and 700 cGy intravaginal (once), nor could any complications be observed when the total rectal dose did not exceed 500 cGy. In only 5% of the patients the treatment was combined with percutaneous telecobalt irradiation (stage II). Intrauterine and intravaginal applications were performed without anaesthesia or sedation, and outpatient treatment was possible in almost all cases.