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4 R a d i u m
In March, 1924, practically two years after ihe treatment, there was no
sign of recurrence. Patient died of pneumonia at this time.
Miss HH. November 25. 1922. Referred on account of growth
at the junction of the upper lip in the alveolar membrane in the median
line. It had been increased in size in the past six months until it was
impossible for her to wear her dental plate. About a month previous
to my examination an attempt had been made to remove the growth. It
had been cauterized and curetted. At 'he time of my examination there
was a mass 2 cm. wide and 1 cm. thick pushing out the upper lip. and
firmly fixedto the bone. Patient was given an anesthetic, and the entire
area treated by electro-coagulation, following which four 12.5 mg. radium
needles were buried for eight hours. For three months the patient suffered
a great deal of pain, but six months later the pain had ceased. At
this time there could be seen an area of devitalized bone. .5 cm. in diameter,
surrounded by normal pink mucous membrane. There was no induration,
and now. nearly two years later, there is no sign of recurrence.
Pieces of sequestrum have been removed from time to time, and there
is a small permanent opening between the sulcus beneath the lip and
right nares.
Mr. TR. September 12, 1923. For seven years a gradually increasing
area of leukoplakia on the inside of the right cheek, opposite
the molars, and involving the sulcus between the cheek and alveolar
membrane. During the past nine months this had become thickened.
rough and furrowed, and finally developed granular processes on its
surface. At the time of examination area involved was 4 x 2.5 cm. on
the cheek, the narrowest point being at the junction of the buccal mucous
membrane and the ramus of the jaw. The mucous membrane over
the alveolar process of the last three teeth was also involved. Treatment:
Molar teeth were removed by a dentist, following which the entire area
above described was treated with electro-coagulation under procaine
anesthesia, following which six radium needles were buried throughout
the entire area for 10 hours. This treatment was followed by considerable
pain for about tvvo months and was accompanied bv sloughing of
the tissues which had been treated, together with some destruction of the
alveolar process. On December 21. 1923. the cavity left after removal
of the slough was radiated with 75 mg. of radium, screened with 2 mm.
rubber, for two hours, and the glandular area immediately beneath the
jaw was radiated over two 2-inch area with 75 mg. of radium, screened
with 2 mm. brass, 2 mm. rubber, and 2 cm. of cork. After this there
was progressive healing. Sequestrum was removed from the jaw about
July 1st. 1024. This entire area in the mouth now looks clean and
healthy.
In cancer of the mouth, perhaps more than elsewhere, should one
refrain from any form of treatment, particularly radiation, when the
disease has obviously advanced beyond a reasonable chance of cure. It
does, however, require nicety of judgment, and considerable experience
to be able to decide whether or not a patient can receive real benefit
from some form of treatment. My failures in oral cancer I believe have
been due to my inability to accurately judge curability, but fortunately
each failure has taught its lesson.
Cancer of the lip, unless involving a considerable portion of the
deeper structures, can be treated as well with radium, probably more
effectually, and with less deformity. The lymphatic area should receive
external radiation coincidently. It is unnecessary to remove the cervical