PROGNOSTIC SIGNIFICANCE OF CYTOLOGIC RESPONSE IN RADIATION OF GYNECOLOGIC CANCER

In 405 patients irradiated for gynecologic carcinoma the radiation response (RR) was evaluated by changes in vaginal cells and these results were compared with survival rate. Radiation response appeared to have definite prognostic implications in Stages I and II. In the good RR group the local recurrence rate was 8% as compared with 30% in the poor RR group. This significance decreases with more extensive disease. Correlation oi RR with survival was lower than in other reports. Including all stages and recurrent cases, the 3- to 8-yr survival rate in 52 patients with a poor response was 52% as compared with 58% in 120 patients with a good response. The highest RR was correlated with prognosis in 76 patients with carcinomas of the endometrium, ovary, and vagina. In 49 cases with endometrial carcinoma, 29 had a good response. Of these, 82% had no residual tumor following radiation as compared with 45% in 20 patients with a poor response. The practical value of cytologic response studies as an indication for operation was also studied. Of 24 patients with poor RR levels undergoing Wertheim procedures following radiation, viable tumor was found in operative specimens in 13 cases. Of these, 2 are living and well. Using the clinical response as the criterion for radical surgery, 29 patients were operated on. Viable tumor was found in 20 patients, 4 of whom are living and well. All patients with poor cytologic response who had residual viabie tumor had also a poor clinical response. (H.H.D.)