子宮頸癌に於ける術後断端再発防止に対するラヂウム後照射の意義
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概要
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The author has performed studies on the relations between the findings of histologic study of the vaginal cut edge of the specimens removed by surgery, the kind, of irradiation after-treatment, and the end-results of the treatment in 118 patients with cancer of the cervix uteri who had undergone extensive abdominal hysterectomy and after-irradiation treatment. Serial sections of the whole circumference of the edge of the vaginal stump that had been removed together with the uterus were prepared, and studied histologically to see if there were any evidences of cancerous growth. Then, the follow-up study on how all these patients fared was performed. The 118 patients under investigation have been classified into the following two groups: the first group which consisted of those to whom only X-ray after-irradiation had selectively been given on the basis of the judgment of the surgeon who believed that there was no cancer tissue left unremoved, and the second group which included those who had been treated indiscriminately by both X-ray and radium after-irradiation. (1) Among the 12 patients belonging to the first group, there was 1 patient who showed signs of the recurrence of cancer in the edge of the vaginal stump one year and seven months after surgery. Histologic sections of the vaginal cut edge of the Specimen of this patient that had previously been removed revealed evidences of cancer, though the sample looked quite normal to the naked eye. It would be impossible to prevent the recurrence of cancer in the vaginal stump in a case like this if the decision as to whether after-irradiation of X-ray only or that of both X-ray and radium should be given were left entirely to the judgment of the surgeon. (2) Of 106 patients belonging to the second group, 20 were positive for histologic evidences of cancer in the vaginal cut edge of the specimens. There were, however, only 2 patients who showed signs of the recurrence of cancer involving the edge of the vaginal stump. This will indicate the value of radium irradiation. Of these 20 patients, only 5 were found to have cancer tissue, which was recognizable to the naked eye, in the vaginal cut edge of the Specimens. If the system of leaving to the discretion of the surgeon the decision on the kind of after-irradiation to be given had been adopted, the majority of these patients would have been treated by X-ray only, and there would have consequently been many more cases among them of the recurrence of cancer involving the edge of the vaginal stump. There was no case of the recurrence of cancer involving the edge of the vaginal stump among the 86 patients who showed no evidences of cancer tissue in the vaginal cut edge of the specimens previously removed. It may be said that the recurrence of cancer in the edge of the vaginal stump may have been prevented by the use of radium irradiation, for there is no assurance that they will have been entirely free from the possibilities of the recurrence of cancer involving the edge of the vaginal stump. It is the view of the author that irradiation treatment by radium in addition to X-ray, if given to all the patients with cancer of the cervix uteri that are undergoing hysterectomy, would be of value for the prevention of the recurrence of cancer in the edge of the vaginal stump.
- 千葉大学の論文