Irradiation Treatment in Carcinoma of the Uterus

Abstract

BETWEEN the years of 1921 and 1934, together with Dr. Soiland (1921–1925) and Dr. Soiland and Dr. Meland (1926–1934), we have treated 1,143 eases of carcinoma of the uterus by irradiation methods. Of this group, 718 were primary carcinomas of the cervix, 183 were carcinomas of the cervix treated post-operatively, 105 were primary carcinomas of the fundus, 68 were carcinomas of the fundus treated postoperatively, and 69 were carcinomas occurring in the cervical stump, following a previous subtotal hysterectomy. Cases of carcinoma of the uterus are not seen in the early stage of the disease. In our practice, early carcinomas of the cervix, which would fall into Group I of the Schmitz classification, were rare. In the treatment of carcinoma of the uterus, the big problem has always been the metastatic pelvic glands. The Schmitz classification, as follows, was used: 1. Group I. The clearly localized carcinoma; beginning nodule. 2. Group II. The doubtfully localized carcinoma; beginning ulceration. 3. Group III. The invading carcinoma, para-metrial involvement. 4. Group IV. The terminal carcinoma: (a) fixation; (b) involvement of adjacent organs; (c) distant metastasis. The clinical grouping of the 718 cases of carcinoma of the cervix showed 5 per cent which would fall into Group I of the Schmitz classification, 24 per cent were in the Group II or doubtful early cases, and 71 per cent in Groups III and IV, with definite pelvic gland involvement. Of the post-operative group of carcinomas of the cervix (183 cases), 81 per cent had evidence of definite recurrence when they first reported for irradiation treatment. It is interesting to note here that of the 183 post-operative cervical cases, 153 were seen between the years 1921 and 1930. In this era, and in this locality, much more surgery was being done for carcinoma of the cervix than during the past five years or at the present time. Carcinoma of the Cervical Stump The 69 cases of carcinoma of the cervical stump were approximately 6 per cent of the total of 1,143 cases of cancer of the uterus that were seen. Following previous supravaginal hysterectomy, the shortest time of appearance of carcinoma was two months and the longest time, twenty-three years. Fourteen cases developed carcinoma under one year after operation and 29 in less than two years after operation; these cases were probably pre-existing at the time of operation. The average time of recognition after operation was four and a half years. Fifty-two per cent of the cases had pelvic gland metastasis when first examined. In this group it is difficult to understand why there should be a larger number of cases in which the disease was localized or doubtfully localized to the cervix, than in the group of primary carcinomas of the cervix.