[Epitheliomas of the cervis uteri: exclusive radio-curietherapy in 431 cases (32 of them residual cervices) treated between 1959 and 1969].

The author gives the results of treatment exclusively using physical agents (tele-cobalt therapy, radium therapy) in a series of 431 cases of epitheliomata of the cervix between 1959 and 1969. The analysis is of 399 patients and 32 carcinomata of the cervical stump (9 cases that were lost to follow-up and 12 who died of coincidental diseases have not been taken account of). The classification which has been adopted is that approved by U.I.C.C. in 1969. External irradiation, which was always carried out before radium treatment, varied in importance according to the stage of the disease: doses of from 2,000 to 5,000 rads were given to the whole pelvis in interrupted doses of 1,000 rads a week in from to to five weeks followed by classical radium treatment (the Paris method) by colpostat and an intra-uterine tube. As a result the number of mgh was lowered and the dose given was inversely proportionate to that of external irradiation. This type of treatment was on the whole well tolerated by most patients and nearly always complications were limited to minor digestive troubles which are not followed by the late after-effects usually found. The 5 years follow-up results give only one death in 19 cases with a stage T1 lesion. 72 cures were found in 93 patients with a stage T2a lesion (77%). 46 patients were cured out of 87 (53%) when the stage was T2b. 54 out of 131 (41%) were cured with stage T3a and 13 out of 46 (28%) with stage T3b. Furthermore these results improved as the years passed and for the period 1967 to 1969 reached 92% for stage T2a, 62% for stage T2b, 53% for stage T3a and 30% for stage T3b. The improvement in results seems to have been brought about by external irradiation, which plays, its part in sterilising macroscopic infiltrations in the pelvis or microscopic ones, in reducing inflammatory phenomena and in lessening the size of the cervix. This latter means that radium therapy can be administered in more favourable conditions. Radium therapy still remains an indispensable weapon for sterilising the primary lesion. The author compares the results that have been obtained in this way with those that have been reported in the literature and develops his arguments in favour of associating the tecnhiques of external irradiation and radium therapy, following a well-defined order. These techniques are particularly valuable in stages T2b and T3 in which lymph node involvement is concerned and for which sterilisation requires doses of the order of 5,000 to 6,000 rads. In conclusion, the possibilities of improving the results in the future by considering how to treat the lumbo-aortic area, the frequent site of metastases in the lymph nodes, and which deserves treatment at the same time as the area of the pelvis, are analysed.