Radiation therapy of carcinoma of the vagina.

Abstract

IN 1935 TAUSSIG made the defeatist statement: “We acknowledge our total inability to do anything effective for primary cancer of the vagina,” and as late as 1947 McIlrath in a review of the literature on carcinoma of the vagina summarized: “Primary carcinoma of the vagina is acknowledged to be a rare and usually fatal disease.… All authors agree that primary vaginal carcinoma is difficult to treat.” This seems indeed to reflect a quite prevalent opinion. Yet results of the Institut du Radium as presented by Courtial in 1938 demonstrate that the prognosis in cases treated by adequate radiation therapy compares favorably with that of cancer of the cervix with comparable extension of the disease. Our own observations are in agreement with this conclusion. It is the purpose of the following discussion to evaluate the results of treatment in relation to the biological and clinical peculiarities of vaginal carcinoma and to the technics used. It is essential to differentiate clearly between primary carcinoma of the vagina and carcinoma of the cervix extending into the vagina. We classify a lesion as a carcinoma of the vagina when on clinical examination the cervix is found intact or when a slight cervical involvement disappears rapidly after radiological treatment while the main part of the tumor is still present in the vagina. In cases in which the cervix cannot be adequately examined prior to treatment, the final diagnosis must be postponed. Carcinoma of the vagina is rare. The proportion of vaginal carcinoma to carcinoma of the cervix is about 1:50, or 2 per cent (Courtial, Way). Since 1933, 485 carcinomas of the cervix have been seen in our institution. During the same time we have observed 10 carcinomas of the vagina. Statistical evaluation of results is therefore not possible. It is particularly difficult to reach conclusions regarding curability from reports in the literature because in many instances it is impossible to judge clearly the extension of the disease in the treated cases. For evaluation and comparison of results, it is necessary to agree to a certain staging. A clinically useful classification was proposed by Courtial, analogous to the staging of carcinoma of the cervix. He differentiates three stages: Stage I: Nodular tumor or flat ulceration, in surface area involving not more than one-half of either anterior or posterior vaginal wall, with only slight infiltration. Stage II: Tumors with a surface area extending over more than half of the anterior or posterior vaginal wall, infiltrating paravaginal soft tissues unilaterally or bilaterally, and/or with moderate infiltration into the vesicovaginal or rectovaginal septum, but without fixation to pelvic bone and without demonstrable infiltration into the rectal (proctoscopy) or bladder mucosa (cystoscopy).