Complications following radiotherapy in gynaecological carcinoma: comparison between X-ray and megavoltage therapy

The use of megavoltage therapy has in some investigations been shown to be associated with improvement in the prognosis of gynaecological carcinoma. Our purpose was to clarify whether the character or number of complications has changed with the increased effectiveness of treatment. During the years 1967-1970 a total of 449 cases of gynaecological carcinoma (cervical, endometrial, ovarian) were treated at the Department of Obstetrics and Gynaecology and the Department of Radiation Therapy, Turku University; tele-Cobalt was used for external radiation. The comparison period was the years 1963-1965 when 289 patients were treated, the external radiation then in use being X-ray therapy. Intracavitary radiation was given in both groups using the modified Stockholm method for cervical carcinoma and the Heyman method for endometrial carcinoma. Operative activity was about the same in both periods. Patients with cervical carcinoma treated with tele-Cobalt appeared to have a higher frequency of severe intestinal complications (12.4%) than patients receiving X-ray therapy (6.0%); the difference was not, however, statistically significant. The same is true concerning the treatment groups of ovarian cancer (4.8% and 0% respectively) and those of endometrial carcinoma (5.2% and 1.2%). However, if all the patients as a group are considered and also those with urological complications, the difference was significant (p less than 0.05), the frequency of complications being 7.6% for patients treated with tele-Cobalt and 4.2% for those treated with X-ray therapy. One must take into account that in all cases the most difficult complications were seen in patients treated with tele-Cobalt, where surgical treatment was necessary in 29%.