Abstract
It is considered that the presence of infection during the course of treatment for cancer of the cervix can have a bearing of the prognosis (3, 5, 6, 7, 9, 14, 22). In a number of series the survival rate has been lower for such patients suffering from pelvic infection than it has for those without such infection. That agressive treatment of infection during the therapy can greatly improve the survival rate was observed by Heyman (9) and Kottmeier (14). Irrespective of the stage reached in the treatment of the cervical cancer, Kottmeier recommended immediate salpingo-oophorectomy in patients with acute salpingitis (15). He reported that this measure improved the 5-year survival rate for these patients from 14 to 66% (15). He also reported 5-year survival rates of 21 and 56% for patients with and without infection, respectively (14).
It has been debated whether, in view of the supposed hormonal dependence of cervical cancer (8, 19), the improvement of the survival rate for patients undergoing elective salpingo-oophorectomy might be due to the hormonal consequences of removing the ovaries (15). Arising out of these discussions, an investigation was undertaken in 1958 of the effect of prophylactic salpingo-oophorectomy. This operation was performed in all patients less than 60 years of age with cancer of the cervix, starting in 1959. It was carried out prior to their admission to the Department of Gynaecological Radiotherapy (15). The measure was discontinued in 1961 because an increase was observed in the incidence of intestinal complications.
Since the introduction of antibiotic therapy the incidence of severe pelvic infections has diminished. Still it was considered that an analysis of this logically designed series might throw light on infection prophylaxis and possibly also on a hormonal influence in carcinoma of the cervix.
The prognosis for cancer of the cervix is held to be poorer in younger women (2, 4, 10, 18, 21) and the explanation may lie in the hormonal activity of the ovaries. If this is the case the survival rate would presumably be higher for patients undergoing oophorectomy than in a control group where the ovaries had not been removed. It was also considered that an analysis of the case material might show whether, and to what extent, the incidence of radiation reactions is influenced by the fact that surgery has been performed prior to radiotherapy.