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256
Radium
sible. The most radiosensitive form of tumor may have the least chance
of permanent cure if a rapid generalization is characteristic of the tumor
in question, as for instance, in the lymphosarcomata. Rapid growth of a
tumor possibly renders it more radiosensitive, though less curable. On
the other hand, a tumor of but little radiosensibility, as the squamouscell
carcinoma, is, as a rule, cured permanently by a fully satisfactorytechnique,
if it is still local and confined to the soft parts."
"The biological character of the tumor and its stage of development
determine the final result !o at least the same extent as the degree of its
radiosensihility."
"A high radiosensibility in conjunction with a limited growth and
well-nourished surroundings gives, of course, the best condition for a
permanent cure."
"In this assembly I do not need tn emphasize that the final as well
as the primary care mainly depends on the technique used, or rather on
the skill and experience of the radiologist."
"A most interesting problem is the -ause of recurrences following
radiological cure of growth, and to what extent the radio-therapeutic
technique is responsible for their appearance."
"I cannot here enter fully into this problem. I only want to point
out that, in my opinion, most recurrences are not new tumors, but are
developed from remainders of the primary tumor that have been overlooked
or impossible 10 find. Many 'recurrences' are. in my opinion, due
to the fact that the case has been wrongly interpreted as being cured. I
have often noticed cases of skin cancer considered as cured, in which
small typical rests of the tumor have been found on the border of ihe
tumor area. From such rests the 'recurrences' arise. Many an unsuccessful
'reatment i>. on the other hand, due to the treatment of late, reactive
swellings, wrongly interpreted a* cancer. This repeated treatment
often results in necrosis. If any rests of the growth are then present.
a radiological cure is. as a rule, impossible."
"We must bear in mind that the treatment may induce a chronic
dermatitis, which may lead to cancer. Personally, I have not seen a
single case in which recurrences of a cancer could be supposed to have
been caused by changes following radium irradiation. On the o'her
hand. I have observed 5 cases of cancer on the basis of a roentgen dermatitis,
none of which occurred in a scar following roentgen cure of a
tumor."
"Our experience from postoperative irradiation of cancer of the
breast has taught us that latent metastases may increase rapidly if the
body is debilitated by too strong an irradiation. In this way the technique
of irradiation may be to blame for the development of metatases."
"Neither can the eventuality be precluded that, under certain circumstances,
metastases may develop when a tumor is breaking down.
following irradiation."
'"We certainly hope, either by influencing the endocrine apparatus
or by means of immunization, to reach through radiotherapy a general
effect on the organism, and thereby to cure even extensive or disseminated
growths. Hut. at the same time, we must point out quite clearly
that wc cannot as yet count on a permanent cure in anv other cases but
those in which a limited growth is still accessible to a certain appropriate
dose. Further we must emphasize that it is equally as important not to
hurt the healing power of the organism, as it is to reduce the resistance
of the tumor."