Zur Klinik und Radiotherapie des primären Vaginalkarzinoms (362 Fälle)

Abstract

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.

Radiotherapy of vaginal carcinoma

“…Auf ein Vaginalkarzinom entfallen etwa 3 Vulva-, 12 Korpusund 60 Zervixkarzinome [9]. Der Häufigkeitsgipfel liegt um das 65.…”

“…Bei Diagnose befinden sich ca. 50% der Patientinnen in fortgeschrittenem Stadium, 20-25% haben Lymphknotenmetastasen [11].…”

“…In fortgeschrittenen Stadien oder in der Rezidivsituation sind rektovaginale und vesikovaginale Fisteln durch Tumoreinbruch oder als Therapiefolge gefürchtet. Eine Fistelbildung wird bei 5-15% der behandelten Patientinnen beschrieben [11].…”

“…Jahres auftreten. Das umschriebene Frührezidiv kann in bis zu 70% der Fälle durch eine Salvage-Therapie [11] geheilt werden, ausgedehnte Rezidive sind dagegen kaum zu beherrschen. Die Fernmetastasierung ist selten und meist mit einem lokalen oder lymphogenen Rezidiv gekoppelt [2,21].…”

High-dose-rate brachytherapy with external beam radiotherapy in the treatment of carcinoma of cervix: dosimetric and radiobiologic analysis

“…The important prognostic factors of carcinoma of cervix includes tumour stage according to the International Federation of Gynecology and Obstetrics (FIGO) classification, initial tumour volume, tumour extent within the vagina, histological grading and lymphatic involvement 4, 5 . To improve the local control in the treatment of advanced stage of carcinoma of cervix, many therapeutic modalities have been used 4, 6 . Among them, irradiation is regarded to be the standard treatment for all tumour stages, 4 , 7– 9 which includes external beam radiation therapy (EBRT) and brachytherapy (BT), or a combination of the two.…”