Primary Vaginal Cancer: Irradiation Management and End-Results

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Abstract
Primary cancer of the vagina can be cured by irradiation in a relatively high percentage of cases. This is substantiated in the present report of five-year end-results for 135 definitely primary cases treated at the Roswell Park Memorial Institute during the years 1919–49. Histologically, the diagnoses were as follows: squamous-cell carcinoma (131 cases), adenocarcinoma (1 case), and myosarcoma (3 cases). The average age of the patients at the time of admission, was 57.4 years. Four were under thirty years (1 thirteen years) and 19 over seventy years of age. Although any segment of the vagina may be involved, the most common site is the upper posterior wall (46 per cent of this series). Clinically, the cases have been classified as follows: Stage I (79 cases): The lesion is limited to the vagina or the immediate paravaginal tissue. It may secondarily involve the face of the cervix, but not the mucosquamous junction. Stage II (45 cases): The lesion (a) has extended beyond the immediate paravaginal tissues, (b) has invaded the urethra, bladder, rectum, or vulva, or (c) has metastasized to the regional lymph nodes or outside of the pelvis, etc. Stage III (11 cases): The lesion has had definitive treatment before admission of the patient to this Institute. Five patients who did not receive any definitive treatment after admission are not included in the statistics of this paper. They either did not return for treatment or were terminal when first seen. Treatment Contrary to the view of Paterson and Tod (1), who wrote that “x-ray treatment is never indicated for cancer of the vagina,” our experience leads us to believe that x-radiation should be combined with radium or radon in many patients in order that beneficial results may be achieved. Any consideration of technic must include the fact that the vagina borders closely on the bladder and rectum. With the most skillful irradiation, it is usually impossible to prevent acute reactions in either of these organs, but by the judicious selection of radiation quality and volume dose it may be possible to minimize more serious late complications. Among 164 cases followed at this Institute up to 1954, there have been 6 late rectal complications (ulcer), 1 late bladder reaction (ulcer), 4 rectovaginal fistulas, and 2 vesicovaginal fistulas. Radiation was responsible for all except the 2 vesicovaginal and 2 of the rectovaginal fistulas, which were attributable directly to the cancer itself. Often radium applied against the lesion by means of cavitary or surface applicators of Duraluminum, sponge rubber, plastics, etc., will suffice if used with the proper physical factors necessary to deliver a cancerocidal dose throughout the cancer site. The same precept holds for interstitial radium.

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