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Primary vaginal cancer are infrequent and amount to 2 or 3 per cent of the gynecological cancers. Their diagnosis is difficult, because many other cancers metastasize in the vagina. The primary vaginal cancer arise mostly after climateric. Adjuvant causes would be a total hysterectomy in the past, prolapsus, prolonged use a pessary or a previous irradiation. The squamous-cell carcinomas, by far the most frequent (91%), are mostly situated in the upper third of the vagina on the anterior and posterior walls. Surgery, being difficult and mutilating is rarely indicated. So the treatment is mainly radiotherapic: external irradiation and intracavitary curietherapy. The radiation techniques are a little different according to the site of the lesion in the lower third or not. The upper lesion can be treated like a cervix cancer. The lower ones are more difficult to handle; for curietherapy, one must use molded apparatus, loaded with Iridium wire, adapted to each special case. The therapeutic results are rather poor:43 per cent for the 5-year cure rate and 36 per cent for the 10-year cure rate: less than for the cervix uteri. The upper lesions have a better prognosis than the lower ones. Results should be improved with an earlier diagnosis, a more accurate radiotherapy and a more precise dosimetry. The non-squamous-cell cancers (adenocarcinomas, sarcomas, mallignant melanomas) are generally rather radio-resistant. They are rare and their prognosis is very poor.

Pre-operative irradiation in operable cancer of the rectum remains controversial. This is a report of a retrospective study about 192 patients treated between 1958 and 1980 at the Institut Curie (Paris) for a rectal cancer. An abdomino-perineal resection was done in 144 patients, 83 as a primary procedure and 61 after a pre-operative irradiation. During the same period 48 patients had an anterior resection. We put in this study the only patients who underwent curative surgery. Irradiation was given with high voltage by a four field "box technique". The tumour received 40 to 50 grays in 5 to 6 weeks. The operation was done at least 6 weeks after the end of the irradiation. There was no difference for the sex, and age of the patients, and in the size of the tumour before treatment, between the patients irradiated and those operated on as a primary procedure. There was no difference in the operative mortality as well as the 3, 5, and 10 year survival in the two groups. Pre-operative irradiation did not change the number of perineal recurrences or the number of visceral metastases. The healing of the perineum was significantly longer in the irradiated patients (p less than 0.001). The survival was closely related to the Dukes classification. The number of Dukes A patients was significantly higher (p = 0.02) after irradiation: 26/61 (43%) vs 19/83 (23%) when the patients were not irradiated. In our experience pre-operative irradiation can shrink some large tumours helping the surgical act.(ABSTRACT TRUNCATED AT 250 WORDS)

Seventy-seven patients with inflammatory breast carcinoma were included in a randomized trial between march 1977 and september 1979. All patients were treated with the same association of chemotherapy and radiation therapy. Chemotherapy included adriamycin on day 1 (45 mg/m2), vincristine on day 2(1,2 mg/m2), cyclophosphamide on days 3, 4 and 5 (400 mg/m2/day) and 5 fluoro-uracil on days 3, 4, and 5 (500 mg/m2/day). Each course of chemotherapy was repeated every 28 days for one year. Patients were then given a maintenance course of chemotherapy for one year. Radiation therapy with CO60 was applied after 4 courses of intensive chemotherapy. The dose distributed was 70 Gy over seven weeks. During radiation therapy, chemotherapy was administered according the same scheme, but adriamycin was excluded. All the patients were randomly distributed into two groups before treatment: group I patients received chemotherapy and radiation therapy alone; group II patients received chemotherapy and radiation therapy plus living BCG vaccinations. After chemotherapy, inflammatory manifestations disappeared in 51% of cases. The mean of disease-free interval was 26 months and the overall survival mean 34 months. No difference in favor of the BCG treated group was noted. Lymph node involvement, age, hormonal status, response to tuberculin, and disappearance of inflammatory signs after 4 months of chemotherapy are of insignificant prognostic value.

The authors describe the sequelae and urinary complications of:--radiotherapy only in 524 patients, stage I to III treated between 1960 and 1974;--721 operations performed between 1968 and 1974, according to the protocol of treatment as used in the Fondation Curie. This reveals:--for irradiated patients, no iatrogenic damage to the upper urinary tract, whilst bladder complications were often present. No major complication was found in this group;--for operated patients, the surgical act was without harmful consequence in the 672 cases when the operation was foreseen in the initial protocol (0,6% of chief complications). On the other hand, surgery performed for persistent tumour or recurrence after exclusive radiotherapy showed 8 per cent of chief complications. In this group they analyse the factors that might influence ureterohydronephroses, especially the extent of node dissection and associated external irradiation.