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References in the literature to the frequent occurrence of cervix carcinoma accompanied by nicotine abuse led us to investigate the effects of cigarette smoking on the results of treatment in primary irradiation of cervix carcinoma. As not only nicotine abuse but also diabetes mellitus can lead to angiopathy, we also investigated the influence of diabetes mellitus on the results of treatment. Of 410 nonsmokers with carcinoma of the cervix in Stages I and II, 260 (63.4%) reached the 5-year limit, but only 62 of 115 smokers survived (53.9%). In Stages III and IV there were significantly less favorable rates of cure in patients with nicotine abuse. Of 626 nonsmokers with cervix carcinoma in Stages III and IV, 212 survived (33.9%); but of 153 smokers, only 31 (20.1%) could be cured (P less than 0.01). The frequency of side effects of primary irradiation was distinctly higher in smokers than in nonsmokers. Reversible complications occurred in 17.5% of the smokers and 15.5% of the nonsmokers. Severe irreversible changes occurred in 28% of the smokers versus 15.2% of the comparative group of nonsmokers (P less than 0.01). The injuries caused by smoking not only reduce the biologic effectiveness of ionizing radiation but also increase the rate of side effects due to the deficient capacity for regeneration of the tissue surrounding the tumor. With diabetes as a complication, however, no significant changes in frequency of side effects were noted. Five-year survival in diabetic patients was affected in Stage I and II, but not in the advanced stages.

In a prospective therapeutic study, 571 cases of endometrial cancer in pathological stage I were treated initially with total hysterectomy and received 6 weeks after surgery double high-dose-rate iridium 192 irradiation of the vagina (afterloading technique). The single dose was 700 cGY (at 2 cm distance from the applicator axis). Postoperative treatment planning was based on the prognosticators of depth of myometrial invasion and tumor grading with subtypes. External irradiation was prescribed only for patients with poor prognostic factors (Cobalt-60,5600 cGY on the pelvis wall, 30 fractions). At the time of this report, the patients had been followed up for 6 to 96 months after their original therapy. Survival was calculated by the life table method. 327 cases with slight tumor infiltration, independent of the tumor morphology, received postoperative vaginal irradiation only. Survival rate was 90.6%. 27 cases with tumor infiltration of the middle third of the myometrium and grade 1 tumors, received also only vaginal irradiation. Survival rate was 100%. 101 cases with tumor infiltration of the middle third of the myometrium and grade 2 and 3 tumors, received vaginal irradiation plus external irradiation. Survival rate was 89.9%. 116 cases with tumor infiltration of the external third of the mymetrium and any tumor grade, received vaginal irradiation plus also external irradiation. In these patients with poor prognosis, the survival rate was 85%. Differences between groups are not significant. Considering the treatment group with good prognosis and the group with poorer prognosis and the additional external irradiation, the survival figures were quite similar (90.6% and 87.9% respectively). In spite of the unfavorable situation of patients with poor prognosticators, treatment results after the additional external irradiation were rather similar to those cases with good prognosticators and without external irradiation. The value of external irradiation in cases of endometrial cancer in stage I with unfavorable prognosticators seems to be quite clear. This therapy improvement was all the better, because side effects of external irradiation were low (0.2% rectovaginal fistulas) and in case of irradiation of the vagina only, no severe side effects occurred. Relapse rate for the treatment group with good prognosis and vaginal irradiation only was 0.6% (2 from 354) and for the group with poor prognosis and additional external irradiation 2.8% (6 from 217) respectively.

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362 cases of primary vaginal carcinoma were treated at the Irradiation Department of the University Clinic for Obstetrics and Gynaecology, Vienna, from 1950 to 1977. As method of choice an individually dosed, fractioned and protracted radium-telecobalt therapy was employed. An overall 5-years' survival rate of 39.8% could be achieved, a value which is above the average reported in world literature. Comparing the last period analysed in the present study (1971 to 1977) with another period 20 years earlier (1951-1956), the following differences can be observed: the fraction of stages III and IV rose markedly from 57.2% to 68.7%; associated with this change was an increase of the percentage of older patients (greater than 60a) from 53.6% to 70.7%. These two developments had an impact on the survival rate: in the total population, it was 39.8% as compared to 32% for the period from 1971 to 1977. The 5-year-survival rate in stage I (n = 60) was 75%, in stage II (n = 95) 45.3%, in stage III (n = 145) 30.3% and in stage IV (n = 62) 19.3%. The incidence of rectovaginal or vesico-vaginal fistulas amounted to 8%. The importance of gynaecological screening for old age patients is emphasized being the only possibility for reducing the high percentage of progressed stages.