Influence of brachytherapy and teletherapy on the treatment result in case of primary vaginal carcinomas

From 1971 to 1977 99 cases of primary carcinoma of the vagina were treated. Radiotherapy was adapted individually as far as possible due to the different localisations and extensions of this tumor and to the vicinity of bladder and rectum, two very radiation-sensitive organs. Basically a three-phased scheme of treatment was intended: 1. focal irradiation of the tumor by plaque-application, 2. combined intra-uterine and intra-vaginal radium insertion, 3. vaginal cylinder. Thus the vaginal tissue is charged with about 32 Gy in a depth of 0,5 cm, the tumor itself with about 100 Gy. Percutaneous telecobalt irradiation was applied additionally following the method prescribed for carcinoma of the cervix uteri. A vulvo-perineal irradiation field was applied supplementarily, if the tumor was localised in the lower third of the vagina. 5-year overall remissal rate amounted to 32% for the years 1971 to 1977. For separate stages, the following 5-year healing rates were observed: stage 1: 78%; stage 2: 48%; stage 3: 24% and stage 4: 19%. Recto-vaginal or vesico-vaginal fistulas occurred in 8% of the cases; less severe complications, such as cystitis or proctitis, were found in 41 and 43%, respectively. The effect of percutaneous telecobalt irradiation on the healing rate was marked in progressed cases, especially. Intrauterine brachytherapy was of more importance for remissal rate in early stages. (orig./WU)