Radium in the Treatment of Carcinomas of the Cervix Uteri and Vagina

Abstract

The scope of this paper has been intentionally limited to a consideration of the value of radium in treating the malignant epithelial new growths of the vagina and cervix uteri. Equally interesting technical problems and clinical phenomena are met when radium is used in treating other kinds of malignant tumors, for example, the sarcomas and carcinomas, and tumors in other organs, as the bladder, breast, tongue, etc. The technic, the indications for treatment and results obtained vary with the type of tumor and its location so greatly that each demands separate consideration. It is especially difficult to have to exclude the adenocarcinoma of the fundus uteri, as it is quite radiosensitive and as we have of it the most excellent material, both clinical and anatomic. The problems connected with its surgical as well as radium treatment, however, differ widely from those of the cervical\p=m-\uterineand vaginal \p=m-\cancers.Absolute valuation of a therapeutic agent is obtainable only after all methods of using it have been tried out on carefully selected and classified cases over a period of years. Our knowledge of the curative action of radium on cancers of the uterine cervix and vagina is as yet in its infancy ; nevertheless, its ultimate pos¬ sibilities, viewed in the light of present experience, seem very great. That it does greatly increase the per¬ centage of the curable cases of these cancers and cor¬ respondingly diminishes the percentage of the incur¬ able is already evident and demonstrable.So far as is known, untreated cancers of the cervix uteri and vagina do not heal spontaneously and do inevitably lead to painful death after a period of suf¬ fering varying from a few months to several years.The continuous and painstaking work and investiga¬ tions of many surgeons and pathologists through a period of more than two decades have firmly estab¬ lished the accepted surgical technics with their proved five year cures. During this time there has been accu¬ mulated an immense store of information regarding the occurrence, the etiologic importance of trauma, the histopathology, the avenues of extension, the rate of growth and the complications of these malignant, epithelial new growths.The Wertheim radical hysterectomy, in our opinion, yields a higher percentage of permanent cure in cancer of the uterine cervix than does any other operative procedure. It affords, however, much less help in the treatment of primary cancer of the vagina.Nothing is more misleading than a gross statistical statement of so many patients operated on, such a primary mortality and so many permanent cures. The operator who takes only the early and moderately advanced cases has a lower primary mortality and a higher permanent cure rate than does the one who treats many of the border-line operable type. Where a professional and public educational campaign against the disease has been carried out, as in Vienna, the pro-portion of easily operable cases is much larger than where such advanced methods have not been followed.Great need exists fo...

The Race For Megavoltage X-Rays Versus Telegamma

“…They then switched their 5-6 g radium supply exclusively over to radon production. From 1918 to 1922 they worked on a fixed, ceiling mounted, telecurie apparatus which used one to four curies of radon, and which became operational by 1923 (42,(44)(45)(46).…”

The Case for Hysterectomy

“…The commonest was delayed voiding, but if the retention catheter was reinserted without delay after attempts at voiding each few days the anxiety attendant on this problem was con¬ trolled. Six patients had recurrent enteroceles, 2 recurrent cystoceles, 22 slightlyshortened vaginas, 8 slight dyspareunia, and 7 partial or stress incontinence. The vast majority of these patients were highly pleased, felt much improved, and were helped by the psychological factor of a scar that is invisible.…”

“…In these, too, psychological explanations are most important for patients to be happy. 8. Menometrorrhagia (31 Cases).-Thirty-one patients had hysterectomy pri¬ marily because of menorrhagia or metrorrhagia.…”

American radium engenders telecurie therapy during World War I

“…30 Welch also enticed 16,30 Kelly had started using topical radium for brachytherapy in 1908, and by 1913 was interested in using large doses, mass radium, externally as the German gynecologists had pioneered. 17,31 The inability to purchase radium in these quantities ͑one to four grams͒ was what led Kelly to join with Douglas in creating the National Radium Institute ͑N.R.I.͒ from April 1913 to December 1916.…”

“…The radon was housed in a lead shielded cylinder which was suspended from the ceiling and was moved about by a pulley to position it over the tumor area. 17,31,32 Professor Douglas provided his four grams of radium to Memorial Hospital where it was employed by Henry H. Janeway, M.D. ͑1873-1921͒.…”