The influence of repeated radiation on the salvage statistics of carcinoma of the cervix

Abstract

I N THE study of carcinoma of the cervix, there has been a constant endeavor to reach a clearer and more complete estimate of the results of treatment. The term “cure ” has been given up since one can nevel be sure when that point has been reached. We speak of “salvage ” as representing the number of years at the end of which the patient is alive and apparently free of the disease. The trend towa.rd a more complete understanding of the effect of cancer therapy was shown a year ago by Kimbrough who pointed out the fact that 20 per cent of the five-year survivals among a series of patients observed at the Hospital of the University of Pennsylvania subsequently died of cancer. Similar findings at Jefferson Medical College Hospital were presented by the author in discussion. In 1936 Lynch suggested another viewpoint that, has impressed us at Jefferson. This dealt with reradiation. He said “ Cases are reported as five-year cures, although they have received several courses of roentgen therapy, or have been reradiated during what is intended only for an observation period to determine the efficiency of the chosen therapy. ” It is of this reradiation and its influence upon salvage statistics that we wish to speak. We have for a long while followed the plan of Ward, Farrar and Sackett in personally observing cancer patients at appointed intervals after treatment and of reradiating those in whom recurrences were detected. Our statistics deal with comparatively few cases when compared with those of Heyman, Healy and Ward, numbering but 248 from 1921 to 1934. This figure includes all patients with cervical cancer seen in the gynecologic ward service at Jefferson Hospital, and, with few exceptions? treated by Dr. Anspach and myself. During this time our ideas relative t,o treatment have undergone considerable change for various reasons and in certain details. In the beginnin,, (r operative treatment still seemed desirable in some instances and a few patient,s were subjected to piInhysterectomy, but since 1924 we have depended entirely upon radiation. At the outset, and during the period covered by this report, our available radium was in capsules screened with silver and brass (0.3 mm. ol’ silver, 1.0 mm. of brass), and with Ifone metal needles (0.3 mm. 1. We knew very little about filtration. Neither was the deep x-ray t.l\el*apy the efficient means of radiation that it is at present. For the past, fca J-;ears lvc have been using high voltage x-ray therapy prior to t,he aplllication of radium, now screened with platinum (50 mgm. capsnlcs with 1.5