Radiumtherapy

(4) Distant Radiumtherapy.—The increase in the available quantities of radium has made it possible to establish foci con taining several grammes of radium, and to increase the distances at which they operate, so that deep-seated cancers can be treated in the same manner as by X-rays. These appliances are so powerful that the focus has to be enclosed in a leaden case with a thick wall. This makes them very heavy, so that mechanical apparatus has to be used, which renders the appliance independent of the patient. Great results may be anticipated from this method, which is quite a new one.

Indications and Results.

The same diseases as are suc cessfully treated with X-rays may be treated with radium. In the days when only small quantities of radium were available, and when no means of producing X-rays of great penetrative power was known, radium was reserved for the treatment of cancers by introducing foci into the natural cavities, and for strictly limited applications, chiefly in cases of small super ficial lesions. Both agents can now be used, and it makes little difference whether the lesion is superficial or deep-seated.

In the treatment of dermatoses, inflammatory processes, tumours and benign hyperplasias, the same results can be se cured more easily and inexpensively by the use of X-rays. This is also true of the treatment of the more radiosensitive neo plasms (seminomata, lymphosarcomata, myelosarcomata) and the less malignant epithelial cancers ("basal-celled" epithelio mata).

On the other hand, the treatment of the less radiosensitive cancers by radium has the advantage, that the normal tissues are much less affected by the gamma rays than by the X-rays, at the high concentrations that are essential if a cure is to be brought about.

It is far from true, however, that all kinds and all cases of cancer yield the same favourable results to radiurntherapy.

The pathological condition in the treatment of which radium therapy has produced the most striking advance is the stratified "pavement" epithelioma developing epidermoidally (spinocellu lar, squamous-cell carcinoma). Whatever may be the site of

this cancer, in the skin, in the lip, in the mouth, in the cervix of the uterus, etc., it can now be treated with prospects of cure as good as, if not better than, those afforded by surgical treat ment in operable cases. On the other hand, cancers of the glandular organs (breast, prostate, liver, etc.), the prismatic celled epithelia (stomach, rectum, etc.), the moulded connective tissues (fibrosarcomata), the nervous tissues, etc., are much less radiosensitive, and in such cases palliative results are obtained, but cures are infrequent.

Further, it is clear that, since radiumtherapy is a form of local treatment, its chances of success are greater where the lesion is a small one. Hence the practical importance of early diagnosis.

With its present methods radiumtherapy, as a means of attack ing cancer, is difficult. It calls for very extensive and special knowledge, and requires the assistance of experts in various branches. For this reason there is a very proper tendency for it to be monopolized by special establishments which possess the equipment and staff required. (CL. R.) BIBLIOGRAPHY.—There exists at the time of writing no complete treatise on radiumtherapy, but some of the latest and most important contributions to the literature of the subject may be found in the fol lowing publications: Acta radiologica, Stockholm ; The American Jour nal of Rontgenology and Radium Therapy, New York ; Archives d'ilectricite medicale, Bordeaux ; The British Journal of Radiology, London ; Journal de Radiologie et d'Electrologie, Paris ; Radiologica medico, Milan ; Radiology, Chicago ; Radiophysiologie et Radiother apie, Paris; Strahlentherapie, Berlin.