[en] In the department of radiotherapy of the 1st University-Clinic of Gynaecology and Obstetrics in Vienna the electroresection and electrocoagulation is practiced with good success in the treatment of carcinoma of the vulva. Of 386 treated cases with vulvar carcinoma, 234 (60,6%) were alive after five years. After surgical treatment the inguinal lymphonodes were irradiated (6000 rad). In comparison with the international statistic of the Annual Report of the results of treatment in gynaecological cancer (1979) the results obtained in Vienna are much better than the international average. (orig.)

[en] On the occasion of the 30th anniversary of the department of radiotherapy of th 1st University-Clinic of Gynaecology and Obstetrics in Vienna, the results obtained in the treatment of gynaecologic malignancy are presented. During this period, more than 10 000 malignant tumors of the female genital tract were treated, including 3605 cases of cancer of the cervix, 1412 endometrial carcinomas and 397 cases of cancer of the vagina. The principal method of irradiation was local application of radium. Dosage was established empirically after measurements on a model. In addition conventional percutaneous roentgen therapy was used until 1972, when telecobalt irradiation equipment was put into use. Five-year survival rates for cervical, endometrial and vaginal cancer are presented for the years from 1950 through 1972. These results are attributed primarily to intracavitary radium application. Of 2687 cases with cervical cancer 1222 (45.5%) were alive after five years, in stage III cervical cancer 535 out of 1321 (40.5%). The latest international tables published in the Annual Report give a five-year survival rate of 31.7% for stage-III cancer of the cervix. Of 994 cases of endometrial cancer 473 were alive after five years (49.8%), while the Annual Report gives a five-year survival rate of 39.0% for primary irradiation in endometrial cancer. For cancer of the vagina, our five-year survival rate was 42.8% (127 patients out of a total of 297), while the Annual Report gives 37.3%. This demonstrates, that the results obtained at the department of radiotherapy of the 1st University Clinic of Gynaecology and Obstetrics in Vienna are better than the international average. Apart from the different methods of treatment the importance of primary radiation therapy in gynaecologic oncology is pointed out, and the side effects and complications are discussed. (orig.)

[en] The benefit of adjuvant radiotherapy of operated cervical and endometrial cancer is not clear. In a prospective trial of 571 endometrial cancers stage 1, cases with poor prognosticators are treated additionally with external pelvic irradiation (Co 60, 56 Gy) and show nearly the same outcome as cases with good prognosticators and without such an adjuvant therapy. A benefit of adjuvant irradiation of cervical carcinoma stage 1/b could only be shown in cases with similar histopathologic characteristics (tumor volume, grading, vessel invasion, lymphnode involvement). In a retrospective study 171 cases of cervical carcinoma were analyzed. With adjuvant external irradiation the relapse free interval was longer and 5-year survival better than without such an adjuvant therapy. (Author)

[en] Although in our department only partially or completely inoperable cases went through a radiation therapy, 757 (= 47,7% out of 1586 cases) achieved to survive for more than five years. At a discussion concerning the intestinal complications which occur due to irradiation, it has been proved, that 18,6% show reversible reactions. The permanent reactions like recto-vaginal-fistula etc. were only seen in 2,4%. It is interesting to note, that the patients subjected to intestinal complications were seen by advanced cases (stage III: 65,1%) and 69% of them were over 60 years of age. Irradiation consequences are by younger patients and by cases with a possible local operability rather rare. At the end, physiopathology and the treatment of the intestinal post-irradiation effects are discussed. (MG/orig.) 891 MG/orig.- 892 BRE

[en] Three hundred and sixty-two cases of primary vaginal carcinoma were treated at the Irradiation Department of the University Clinic for Obstetrics and Gynecology, Vienna, from 1950 to 1977. As the method of choice an individually dosed, fractioned, and protracted radium-telecobalt therapy was employed. Comparing the last period analyzed (1971-1977) with another period 20 years earlier (1951-1956), a marked increase of advanced stages and older patients can be observed. These changes are reflected in the 5-year remission rate: in the total population it was 39.8%, as compared to 32% for the period from 1971 to 1977. For a group of 99 patients, who were treated between 1971 and 1977, the therapeutic effect of different therapy schemes is reported. The benefit of teletherapy is remarkable for advanced states, whereas for stages I and II an intrauterine application may be of importance. The complication rate amounted to 8% recto- or vesicovaginal fistulas and 41% and 43% cystitis and proctitis. The central importance of gynecological screening, especially for older women, is emphasized

[en] The results of treatment in the department of 607 patients with invasive squamous cell carcinoma of the vulva between 1952 and 1980 is described and analyzed. The absolute 5-year cure rate in these patients was 60.3%. Particular attention was given to lymph node status (TNM system) in the analysis of the last 141 patients treated. The absolute 5-year survival rate was 67% for the N0-N1 patients and 43% for the N2-N3 patients. Patients were treated uniformly by means of electrosurgical operation and postactinic irradiation of the inguinal lymph nodes. Operative lymphadenectomy was performed only in 5% of cases when the diameter of inguinal lymph nodes was greater than 2 cm. This simple surgical technique, in combination with irradiation of inguinal lymph nodes, gives excellent results and avoids the complications associated with inguinofemoral lymphadenectomy. Owing to its combination of electrosurgical operation of the vulva and irradiation of the inguinal regions as a standard procedure, the treatment involves extremely low strain on the patient and is almost free of complications. This seems to be particularly important as the results of our treatment are not less satisfactory than those of more aggressive procedures

[en] A report is given on 683 cases of ovarian cancer, who underwent postoperative radiation therapy at the Radiation Department of the 1st University-Clinic of Obstetrics and Gynecology in Vienna. A uniform staging and histological classifications is complicated by the fact, that in recent years the rate of cases operated elsewhere and subsequently admitted to our clinic went up to 76%. Of all 683 cases, 193 (28,3%) reached a five-year survival time. Because of these still unsatisfying results of postoperative radiation treatment in ovarian cancer the importance and necessity of randomised studies with different therapeutic programs is emphasized. (orig.)

[en] Plasminogen, fibrinogen and fibrin degradation products (FDP) were determinated in 15 patients with an inoperable cervix cancer before and after the irradiation. Before the radium treatment, the local level of plasminogen and FDP was higher than normal, fibrinogen was a little below normal. After the treatment FDP disappeared and plasminogen was reduced to a physiological concentration level. Only in two patients, the plasminogen level remained high and FDP did not disappear; in the same patients no therapeutic effect occurred. The radium treatment reduces not only the hyperfibrinolytic activity of cancer, but also the FDP with its immunsuppressive action. The haemostatic effect of the irradiation is not only a consequence of liberating thromboplasitc factors from destroyed tumor tissue, but also a consequence of the reduced hyperfibrinolytic activity of cancer tissue. (orig.)

[en] Sixty-two patients with primary carcinoma of the female urethra were treated with a combined radiation therapy (high-dose intracavitary vaginal radium and external beam). Treatment was strictly individualized, but an administered tumor dose of 5500-7000 rad (55-70 Gy) was always attempted. Forty-two patients (67.7%) had tumors of the anterior urethra, and in 20 women (32.3%) the posterior urethra was involved. In 19 patients (30.6%) the clinical diagnosis of lymph node involvement was made. The overall 5-year-survival rate was 64.5%. Patients with anterior urethral carcinoma had a higher 5-year-survival rate (71.4%) than patients with posterior carcinoma (50.0%). The favorable results underline the substantial role of radiation therapy for this malignancy

[en] Today the endometrial carcinoma is the most frequent malignant tumor found in female genital tract. Endometrial carcinoma ought to be operated in all cases, if possible. Traditionally some form of adjuvant radiotherapy has been given. Despite the large number of patients treated by combined therapy over the last 30 years, surprisingly there is a lack of hard data on which to establish a theory for an improved outcome. It is generally accepted that the risk of local relapses in the vagina is lowered when postoperative vaginal irradiation is applied. The question of the value of additional external irradiation in stage I endometrial cancer still is unsetteled. Only two prospective studies led to the conclusion that only patients with poorly differentiated tumors and with deep infiltration of the myometrium might benefit from additional external radiotherapy. Therefore a simple score for these risk factors is proposed enabling assignment into patient groups of similar risk on the base of a point system due to individual prognostic factors. With a score of one to two points prognosis is very good and adjuvant irradiation seems not to be necessary. With three to four points local vaginal irradiation is recommended, with five and more points additionally external beam irradiation to the pelvis should be given. This is necessary in more than the half of the operated cases of endometrial carcinoma. The indication for such a treatment has become more individual and 'high risk' cases are treated more intensively, but 'low risk' cases have to be excepted from unnecessary adjuvant therapy. In order to judge an individual case of endometrial cancer histopathologic prognosticators have to be considered. Typical adenocarcinomas have a five-year survival of more than 80%, but unfavourable subtypes (adenosquamous, clearcell, serous-papillary carcinoms) of only 40%, respectively. Tumorgrading and depth of myometrial invasion are of high importance for individual prognosis. (orig./MG)