Radiation management of primary carcinoma of the vagina.

This 15-year retrospective study includes 71 patients with diagnosis of primary carcinoma of the vagina treated at the University of Maryland Hospital, Radiation Therapy section from 1957 to 1970. The lesions were staged according to the system advocated by International Federation of Gynecology and Obstetrics (FIGO) with a minor modification (Perez et al.11). With the exception of Stage O, histologic diagnosis was 94% (60/64) invasive squamous cell carcinoma and 6.0% (4/64) adenocarcinoma. Of 71 cases who are eligible for a minimum five-year follow-up, the absolute five-year cure rate for various clinical stages is as follows: Stage O 100% (7/7), Stage 1 83.2% (5/6), Stage 11A 65% (13/20), Stage 11B 63.5% (7/11), Stage 111 40% (8/20), Stage IV 0% (0/7). The overall absolute five-year cure-rate for all stages combined was 56.3% (40/71). A comparable result and even better in some stages (II and III) as compared to several previous reports are thought to be due to the proper intergrated irradiation combining interstitial and intracavitary radium with external super-voltage beam. Furthermore, an aggressive radium implant to the vagina, paracolpium, and specifically to parametrium and pelvic wall in Stage II and III appears to be one of the keys to our good results. The technique of treatment, stage by stage, are being fully discussed along with a few complications and failures.