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SEQUENTIAL STUDY ON THE EFFECT OF THE ADDITION OF HYPERBARIC OXYGEN ON THE 5 YEAR SURVIVAL RATES OF CARCINOMA OF THE CERVIX TREATED WITH CONVENTIONAL FRACTIONAL IRRADIATIONS

RICHARD J. R. JOHNSON M.B., B.S., D.M.R.T.1 and R. J. WALTON M.B., B.S., D.M.R.

1 Cancer Research Campaign Gray Laboratory, Mount Vernon Hospital, Northwood, HA6 2RN.

A pilot study has been conducted on 50 consecutive cases of carcinoma of the cervix Stage III and IV which were treated with 6,000 rads to the whole pelvis without the addition of radium. The first 25 patients were treated in air and the second 25 patients under HPO. The 5 year tumorfree survival rate of the air group was 16 per cent which is similar to other published series of patients treated with 6,000 rads without the addition of radium. The 44 per cent 5 year survival rate of the hyperbaric group compares favorably with, but is not greatly superior to, published reports of patients treated with external radiation followed by intracavitary radium. The serious bowel complication rate of 6 per cent in the air group and 17 per cent in the hyperbaric group supports previous animal studies which suggest that late bowel damage was increased by HPO.

The study supports the theory that human tumors contain hypoxic areas which can be either reoxygenated when fractionated radiation is used with subsequent radium or by the use of HPO pelvic irradiation.

The moderate gain in tumor control achieved with fractionated HPO in this series may be partly explained by the possible recovery from sublethal damage of temporarily oxygenated hypoxic tumor cells. However, oxygen vasoconstriction is likely to be a major factor.

Preliminary data using a thermodynamic device for measuring in vivo human tumor blood flow indicate that some tumor perfusion rates can be increased from 50 to 200 per cent 3 days following a conditioning dose of 400 to 700 rads. This evidence supports the use of large fractions with oxygen at 1 or 3 atmospheres in order to counteract the vasoconstricting effects of oxygen, and also suggests that conditioning doses of radiation used in conjunction with conventional fractionation might improve tumor reoxygenation.


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