Radium and Surgery in Cancer of the Tongue

Abstract

THE BORDERLINE CASE. In view of these experiences it would seem that the borderline case-that is, the doubtful case as regards la(lical op)eration-provides a useful, perhaps the most useful, field for irradiation. A cure may result from i-radiationi, or the local condition may be so irnprqyed that radical sur gery becolmies possible. RECURRENCE FOLLOWING RADIATION.In all branches of surgical irradiation it happens, unfortunately, that cases of apparent cure relapse, or that a tumour shrinks to small proportions and then resumes actixve growth. Such results no doubt will become less frequent -with increased experience. So far as my own1 experienice goes, a recurrence is more likely to follow the use of radon seeds than needles; it is probable that the (liminishinog intensitv of radon, as opposed to the constant intensity of radium, is the causal factor. It may be possible to orvercome the factor of diminishing intensity by reinforoement-that is, by adding additional radon seeds at short intervals, which can be done in certain situations, especially when general anaesthesia is riot required. Another method is to combine intrarectal seeds with perirectal needles, a method which minimizes the loss of inltensity, though it does not give a uniform intensity.In several instan -hei-retrugreSIUl Tofthe ¶OL has-appeared toibeomplete (or nearly so) and recrudescence has followed, irradiation has been repeated (in a few cases more than once), but in most instanoes the result has not been very satisfactory.Without doubt, primary irradiation increases radioresistance to secondary radiati*on. Relapses following apparent success become more noticeable as the number of cases increases. It is evident that if we are to make further advance we must improve technique and explore the possibilities of radium i,n combination with x rays, lead selenide, etc., more fully. CONCLUSIONS.1. In young people, in increasing ratio from the age of 40 downwards, rectal carcinomas grow rapidly, metastasis occurs early, and the end-results of radical surgery are not good. An actively growing carcinoma in a young subject responds well to radium, and far better than a slow-growing carcinoma in an elderly subject. Enld-results in comparison with surgery are not available.2. If a growth is adequately barraged with radium and shows little evidence of retrogression after two months, it is probably useless to repeat irradiation. On the other land, if the growth responds to radium and readily retrogresses, though it fails to disappear completely, further irradiation is indicated on the ground that the dose 1ias been insufficient in respect of amount, time, or distribution.3. Secondary irradiations are less likely to produce a good final result than an adequate primiary irradiation, and are nmore pirone to produce pain of a neuralgic tvpe, which may be very severe and last for long periods.4. Wihen the growthl has been exposed by open operation, an overdose may riesult ini perforation of the bowel with secondary sepsis, anid when healing takes place-be follo...