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RADIUM CENTRE FOR CARCINOMA OF THE UTERUS: LAMBETH
HOSPITAL.
Report for the year ending 31st December, 1934.
By the Consulting Gynœcological Surgeon—Sir Comyns Berkeley, M.A., M.C.,
M.D., F.R.C.P., F.R.C.S.(Eng.), M.M.S.A.(Hon.), F.C.O.G., with whom is associated
the Gynœcological Surgeon—Arnold Walker, M.A., M.B., B.Ch., F.R.C.S.(Eng.),
M.C.O.G.
Since a centre for the treatment by radium of carcinoma of the uterus was
established by the Metropolitan Asylums Board in 1928 and taken over by the
London County Council in 1930, five reports have been issued, and this is the
sixth. In the first five reports the clinical condition of every patient treated was duly
set down showing how they were classified into the four international groups. In
this report these clinical details have been omitted and there remains only the grouping.
Research workers and others interested in the reports from this centre will,
by reference to the former reports, know exactly how the patients are classified in
this centre, and there now seems no reason, therefore, to overload these reports in
the future with such a mass of clinical detail. It is as well to mention, however,
that it has been the custom in this centre from the start, when there is the least
doubt as to the group to which a patient should be allocated, to include such a patient
in what one may term a better group, that is, in a group in which by the international
grouping there should be more chance of a cure. It necessarily follows that by such
a method groups 1 and 2 are loaded with cases which, statistically, must make the
survival rate worse than if such cases, where there is a genuine doubt, were allocated
to the worse groups, namely 3 and 4. A comparison of statistics from various centres
must, and always will, be difficult to evaluate, since the clinical acumen of, and the
decision to which group certain patients should be allocated by various surgeons,
may differ considerably. If comparison is to be made by groups, such a difficulty
cannot be entirely obviated, although some of it may be, by a knowledge of the practice
of the individual surgeon in charge of the centre. It might be thought that a fair
comparison could be made by taking the total survival rate of all the groups combined,
but here a further difficulty arises, since at some centres patients may not be
treated because it is decided that the disease is too far advanced, while at other
centres such cases would be treated and allocated to group 3 or 4 as the case might
be. In addition, the class of patient, so far as the local condition is concerned, varies
at different centres. Cancer patients arrive at a centre by various routes; some
without any recommendation, some are sent by doctors and some by other hospitals,
and, with respect to the two latter routes, it all depends on the personal factor of those
who are recommending the patient as to whether the disease is thought to be too
far advanced or not; that is, patients sent by these routes may undergo a process
of selection so that some centres may be receiving more patients in whom there is a
chance of cure and vice versa. Moreover the practice of surgeons at the various
centres differs, and, perhaps unknowingly, there is a process of selection, so that a
patient who would be treated at centre A would be refused treatment at centre B.
Instances of such a selection are marked in some foreign centres. It will, therefore,
be seen how difficult it is to compare the results of one centre with another, and the
only method of arriving at a decision of the value of radium in the treatment of
cancer is to take a large sample, say some thousands of cases, from various centres.
This will give a fair estimate since, although it may be that there are centres where
the results are better than when such a total result is taken, it is impossible for every
patient to be treated at such a centre, even only because of its geographical position.
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