COMPLICATIONS OF INTENSIVE RADIATION THERAPY FOR CERVICAL CARCINOMA. WITH EMPHASIS ON SUPERVOLTAGE RADIATION AND SUPPLEMENTAL RADICAL PELVIC OPERATION

A comparison was made of the complications following conventional and telecobalt radiotherapy of 75 patients with cervical cancer. The most frequert complication of telecobalt therapy was subcutaneous lignification, which occurred in 24% of the patients. Other severe reactions were noted in bladder (5%), rectum (5%), and vagina (4%). Fracture of the femoral neck occurred in 5%, infection in 5%, and death (attributable to therapy) in 2%. No severe skin changes were noted below the 4000-r level, but 50% of patients receiving 4000 to 4999 r and 75% receiving 5000 r or more developed acute or severe chronic skin reactions. The changes are more likely to occur with high dosage increment, 500 to 800 r every fourth day, rather than with an increment of 300 r every second day. It is suggested that supervoltage radiation must be limited to the known tolerance of the exposed organs, including the subcutaneous tissue. At intensive dose levels the frequency and severity of complications precludes continuation of such therapeutic prograrns, such as additional radiation or radical operation for persistent cancer. A total lateral pelvic wall dosage of 5000 r, including intensive intracavitary radiation, is the suggested tentative limit above which complications increase markedly. (H.H.D.)