Endolymphatic Radiotherapy in Cancer of the Cervix

Abstract

From 1962 to 1968, 93 patients with cancer of the cervix were given endolymphatic radiotherapy at the National Cancer Institute of Milan. Lipiodol Fluide 131I was injected at doses ranging from 2.3–2.5 mCi/cm3 (8–10 cm3 each foot) with a total activity of 46 to 50 mCi. The 93 patients were treated with endolymphatic radiotherapy and conventional radiotherapy or surgery (table 1). Lymph node metastases were detected in 29 of 93 patients. In 41 cases the histopathologic findings of lymph nodes removed during surgery were correlated with the lymphographic findings; a correct correlation was found in 90,2% of cases (table 4). No side-effects or complications of endolymphatic treatment were observed. The long-term results were evaluated in two groups of patients and compared with the series treated at our Institute with conventional therapy. A first group of 49 cases was treated with radium and endolymphatic radiotherapy. In the 19 who had metastatic retroperitoneal nodes on lymphography the 5-year survival was 26%; in the 30 without radiological evidence of nodal metastases the 5-year survival was 84% (text-fig. 1). Considering all cases for every stage, with and without metastases, the 5-year survival was 69% for stage I and 60% for stage II. In comparison with the series treated at our Institute with radiumtherapy only, the percent increase in 5-year survival is 9% for stage I and 13.2% for stage II (table 6). This difference is not statistically significant. A second group of 36 cases was treated with a combination of endolymphatic radiotherapy, surgery and radiumtherapy. Considering all cases for every stage, with and without metastases, the 5-year survival was 91% for stage I and 77% for stage II. In comparison with the series treated at our Institute with surgery and radiumtherapy the percent increase in 5-year survival is 16.5% for stage I and 7% for stage II (table 6). Again, statistical evaluation failed to detect a significant difference. No definite conclusions can be drawn from these results. However, there is the possibility that endolymphatic radiotherapy destroys early microscopic metastases located in the retroperitoneal nodes and so contributes substantially to the cure rate. To prove this hypothesis, a prospective randomized clinical trial is indicated.