Review of Ten Years Experience with Transvaginal Roentgen Therapy

Abstract

It was my privilege to be an associate of the late Dr. E. A. Merritt when, in October 1936, his interest in the application of roentgen rays directly to the cervix was renewed. Merritt (1) had attempted this procedure in 1921 but was forced to abandon the project due to the dangers inherent in non-shock-proof apparatus. The material for the study to be reported here consists of cases referred by the Staff of the Warwick Clinic, by the Garfield Hospital, and private cases referred to Dr. Merritt or myself. This paper is an analysis of our experience with transvaginal roentgen therapy from October 1936 through December 1946. The transvaginal approach, either alone or in combination with other conventional methods, was employed in 346 cases of carcinoma of the cervix during that time; 202 cases were treated prior to 1943 and are thus available for analysis in terms of five- to ten-year survivals. Nine cases are untraced at present and are not included in the survival analysis. Definitive survival data are available for 192 cases. All cases are histologically proved. The cases are grouped clinically in accordance with the League of Nations classification as modified in 1937. Eighty-nine patients are living as of September 1947. The survival data by years are as follows: Inasmuch as no routine technic has been followed during the years covered by the study, the cases have been analyzed and placed in various categories depending upon the method or combination of methods by which the primary treatment was given. There are six different categories as follows: 1. Transvaginal therapy only. It is only fair to state that many patients in this group received small daily doses of external radiation (50–100 r) for seven to fourteen days prior to the intensive treatment, in an attempt to improve the local and general condition. This has since been abandoned. I feel that it contributed in no way to the control of the disease. 2. External roentgen therapy supplemented by transvaginal roentgen therapy. 3. External roentgen therapy supplemented by transvaginal roentgen therapy plus intrauterine and intracervical radium therapy. 4. External roentgen therapy supplemented by transvaginal roentgen therapy plus radium applied locally to the cervix. The radium in this group of cases probably contributed very little to control of the disease. It was given for the most part in small doses (1,200 mg. hr.) to control hemorrhage, prior to institution of the primary treatment. 5. Transvaginal roentgen therapy plus intracavitary radium. 6. Transvaginal roentgen therapy plus local radium. The radium in this instance was again used, as in 4, to control the bleeding. The survival rate by clinical stages, according to the method of treatment, is shown in Table I. Carcinoma of the Cervical Stump Fourteen of the 192 cases represent carcinoma developing in the cervical stump following supravaginal hysterectomy. Of these 14 patients, 10 (71 per cent) have lived from five to ten years.