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242 RADIUM
Carcinoma of the Accessory Sinuses will sometimes yield to radiation.
Recently a young man of twenty-one years was referred to me
by Dr. John B. Deaver. Dr. Ralph Butler and Dr. K. Bauer, with carcinoma
involving especially the ethmoid region. A section examined
by Dr. Stanley Reimann showed prickle-cell carcinoma, with a chain
of metastatic lvmph nodes extending down the left side of the neck. So
far as any of'us can tell, all evidence of the disease has disappeared
under thorough cross-fire with the high voltage x-ray*. This will serve
as an example of what will likely be the method of choice in the future
in treating carcinoma and sarcoma of the accessory sinuses.
Carcinoma of the Larynx will sometimes yield to radiation. I have
found the introduction of radium into the tumor, through the thyrohyoid
membrane, to be helpful.* It is advisable to do a tracheotomy in advance
so as to prevent complications. Then a preliminary course of
x-rays covering even- part of the disease should be given. Radium
needles can afterward be inserted through the thyrohyoid membrane
into the diseased area, and ten milligram needles can be left in place
about six hours. Wc have been at least favorably impressed with this
line of action.
Carcinoma of the Esophagus.—Heretofore, these cases have been
looked upon as hopeless. The brilliant work done by Drs. Mills and
Kimbrough' gives us some encouragement in their radiation treatment.
Their general result* are:
Cured o
Total 45
Palliative result good 12
Palliative result fairly good 12
Palliative result fair 14
Palliative result poor 4
Palliative result negative 3
Xo cures are recorded, but one patient lived three and a half years.
dying finallyof tuberculosis and exhaustion. This was one of the cases
rated as "palliative good." It is significant that only three cases failed
to obtain some palliative result. Dr. Mills referred to one case that.
three months previously, was thought to have about three weeks to live.
and who. at the time of the report, was walking twelve miles a day as
an inspector. Some additional help may also be obtained by treating
with high voltage x-rays.
Carcinoma of the Breast.—The treatment of primary carcinoma of
the breast with radiation is not new, and the primary cases referred for
treatment have been nearly always very far advanced; but when one of
these advanced cases is cured we feel that a great deal has been accomplished.
Possibly we may some day be able to consider fairly the relative
value of surgical extirpation and treatment by radiation primarily.
but this will be possible only when the surgeon and radiologist can see
patients together, preliminary to treatment. The diagnosis should then
be made by them jointly; or better, a diagnosis made without reference
to treatment. The patients should be carefully classified and then a considerable
number of each class treated by each method. The operations
should be performed by a thoroughly competent surgeon and the radiation
should be given by an equally competent radiologist. Such an ideal
arrangement is most difficult to obtain, but until such conditions prevail.