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Radium 15
I he duration of the remission varies very widely. In some cases the
disease will remain quiescent for twelve, fifteen or eighteen months, in
others a repetition of the treatment may he found necessary at intervals
of six months, but none the less radium treatment is to be advocated, as
it will prolong the patient's life considerably, and postpone the appearance
of a secondary anemia and its accompanying symptoms.
3. Lymphosarcoma.—This is a variety of of round-celled sarcoma
originating in lymphoid tissue. It is most commonly met with in the
superior mediastinal region and in the cervical lymphatics, but it also
occurs in the lymphatics of the intestinal canal. The tumors grow with
great rapidity and speedily infect the neighboring lymphatic glands.
When commencing in the mediastinum, pressure symptoms quickly
develop, dyspnoea, dysphagia, congestion of face and neck, pleural effusion,
etc.. Incoming evident. When the cervical glands are the starting
point of the disease the investing skin becomes adherent and discolored,
and in later stages it may ulcerate and fungation of the growth occur.
The tumors speedily becomes fixed by reason of the direct extension of
the disease to the neighboring structures. Microscopical examination
shows the growth to be comi>osed of small round cells, with an abundant
delicate intercellular fibroid network. The disease is highly malignant,
and. unless treated, rapidly progresses to a fatal termination.
It is in the treatment of lymph-sarcoma that the most spectacular
results of radium therapy are to be seen. The lympho-sarcoma cell i*
l>eculiarly susceptible to gamma radiation and its degeneration rapidly
occurs. Lympho-sarcomatous masses appear, literally to melt away under
the action of radium and patients who ha\e presented themselves for
treatment with enormous lympho-sarcomata of the mediastinal and
cervical regions producing dyspnoea, dysphagia, congestion of face and
neck, etc., their condition on admission being grave in the extreme, responds
in a fashion that is often amazing. The masses commence to
shrink within a few hours of the application of the radium, and within
a week or ten days the symptoms of pressure ami obstruction are greatly
relieved, and the change in the patient's appearance is most remarkable.
The rapid degeneration and absorption of the lymphosarcomatous cells.
however, necessarily produces an autotoxemia. and the systemic disturbance
is generally considerable, sickness, lassitude, headache, and a
rise of temperature being pronounced features. The patient should be
kept strictly .it rest, and laxatives and diuretics judiciously administered,
until the symptoms have subsided. If is not necessary or advisable to
treat lymphosarcomata by the burying of radium tubes in the substance
of the growths. The tumors exhibit a great tendency to fungation when
once any breach of the covering skin has occurred, and for this reason
the surface should be kept intact as long as is possible. "Cross-fire"
radiation will do all that is required, and it is justifiable, in view of the
extreme malignancy of the disease, to use a very large quantity of radium
—400 to 700 mgrs'of radium element, screened with 2 mm. of lead, and
a total exposure of thirty hours have been employed in some extreme
cases with most gratifying results.
It appears better to give an intensive dose at the first ex|iosure
rather than smaller doses of successive intervals. In a few instances the
remission has been of very long duration, the patient keeping in comparatively
good health for one or two years. Patents are, however, instructed
to report at regular and frequent intervals for examination, so
that if any remission occurs it may be dealt with promptly.