Combined irradiation and extensive operations in the treatment of stages I and II carcinoma of the cervix uteri.

Since 1947, carcinoma of the cervix uteri, Stage I, has been treated at the Ochsner Clinic with intracavitary irradiation and a radical hysterectomy--Wertheim type--and pelvic node dissection. If metastasis to the lymph node is demonstrated, external irradiation is administered postoperatively. Carcinoma of the cervix uteri, Stage II, has been treated with intracavitary radium and external radiation, followed by the same surgical procedure. All patients were treated surgically, except those with medical conditions precluding extensive operation. Five and ten year survival rates for Stage I cancer were 81.5 and 68.7 per cent, respectively; for Stage II, these rates were 64.5 per cent and 54.0 per cent, respectively. There were moderate complications from the combined therapy, with a ureteral fistula rate of 1.9 per cent. Although the combined use of irradiation and operation for carcinoma of the cervix uteri has been looked upon in this country with disfavor because of poor healing and complications, we have not found this to be so. With improvement of both radiation therapy and surgical management, these patients can be offered treatment based upon sound physiologic principles and can live in freedom from fear of recurrence in later years. The outlook is good for continued improvement in the complication rate, surgical technique and possibly, chemotherapy.