Treatment of Carcinoma of the Endometrium

During the fifteen-year period, 1943 to 1957, a total of 330 patients with carcinoma of the endometrium were seen at the Ellis Fischel Cancer Hospital of Columbia, Missouri. Two hundred and forty-five cases were admitted without prior treatment. These are referred to as “primary” cases and constitute the material for analysis. The distribution by stage in accordance with the Annual Report on the Results of Treatment in Carcinoma of the Uterus is shown in Table I. Criteria for staging are as follows: Stage I: Growth confined to the uterus I1: Operation advisable I2: Bad operative risk Stage II: Spread of growth outside the uterus Vaginal spread was present on admission in more than a third (22 of 62) of the Stage II cases. This fact confirms previous reports demonstrating the propensity of this carcinoma to invade the vagina, when not treated. Three patients in whom the disease was clinically of Stage I refused the offered treatment; these have been excluded from the analysis, leaving a total of 242 primary cases for study. This includes 3 patients whose disease was classified as Stage I2 and 10 with Stage II lesions who were physically incapable of tolerating treatment. In all the patients, a positive tissue diagnosis was obtained either by endometrial biopsy or by dilatation and curettage. No case has been lost to follow-up. The age distribution is shown in Figure 1. The youngest patient was forty-three and the oldest ninety-two years of age; 66 per cent of the patients were sixty years old or older and 22 per cent were seventy or over. A large number of deaths could therefore be expected from intercurrent disease. With a single exception, all patients were white. Method of Treatment The method of treatment chosen varied with the clinical stage of the disease (Table II). In general, cases in Stage I1 received preoperative irradiation, followed within six weeks by abdominal hysterectomy and bilateral salpingo-oophorectomy. Preoperative therapy during the period 1943–1952 consisted of conventional roentgen irradiation through 10 × 15-cm. ports, with an average of 3,000 r (air dose) given in six to eight weeks to each of four pelvic fields, cross-firing the uterus and yielding a minimal uterine tumor dose of 4,000 rads. Technical factors employed were 250 kv, 20 ma, 2 mm. copper plus 1 mm. aluminum filtration, at 80 cm. distance, h.v.l. 3 mm. copper. This type of treatment was administered to 70 patients. During the 1943–1952 interval, 6 patients too obese for external irradiation to be effective were treated by means of a radium tandem and a colpostat prior to surgery. Hysterectomy was the sole treatment in 8 cases. A combination of external and transvaginal roentgen therapy plus intrauterine curie therapy (tandem) was used in 4 patients of this series and in 1 of the next period (1952–57). On Jan. 1, 1952, a fundamental change was introduced in the technic of preoperative irradiation.