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many very valuable treatises dealing with the measurement of irradiation that is
delivered under given circumstances to the different parts of any irradiated area.
In the treatment of cases of carcinoma at the clinic an attempt has been made
to estimate the number of r. delivered to every part of the irradiated area, whether
the treatment be by means of X-rays or radium, and an attempt is always made to
deliver at least 6,000 r., in from 3 to 6 weeks, to every part that may be presumed
to be infested by the tumour. When a patient is to be treated by X-rays only,
this is not always possible, the local reaction being too violent to allow that dose to
be reached. When part of the treatment is by radium and part with X-rays, and
still more when only radium is used, it is generally possible to reach and even to
exceed 6,000 r. to every part of the tumour. An attempt is also made to limit the
reaction caused by such treatment to superficial lesions that heal in from three to
six weeks after the end of the treatment, but it is inevitable that a small percentage
of the cases treated get reactions that are more serious than was intended, and
troublesome ulcers may result. These are often very trying, but will generally
yield to treatment by diathermy, excision or U.V.R.
The metastatic deposits of tumours present two problems, the first to prevent
them occurring, and the second to treat them when they have occurred. As regards
the latter, it is generally easier to treat secondary deposits than the primary tumour
from which they come, providing that the deposit is accessible to radium or X-rays.
With the exception of a small minority, metastatic deposits generally require a
smaller dose of radiation to cause them to heal than the primary tumour. The
prevention of secondary deposits, however, is a very formidable problem. When
it is remembered that cancer cells may spread from the primary growth either by
a direct infiltration into the tissues that surround it, or by growing along or flowing
along the lymph vessels which lead away in all directions, or by travelling in the blood
stream to distant parts of the body, the factors that are concerned in the occurrence
of secondary deposits must clearly be very complex, and some of them probably
not within our control. It is well known that secondary deposits are much more
likely to occur with some forms of growth than with others, e.g., in tumours of the
breast, the greater the proportion of fibrous tissue the less likely are secondary
deposits to occur, but while this is true it must be remembered that a carcinoma
may change its characteristics of growth the moment it invades a new tissue ; so
that while one part of the growth may be little likely to cause metastases another
part may be continually doing so. There are, however, two methods of preventing
metastases which should always be employed. It should be a cardinal rule that no
growth should be incised or wounded, or in any way disturbed by unnecessary surgery,
and, secondly, that the part of the body in which the growth occurs should be
rested as far as possible. In many cases this is difficult to accomplish, as in growths
about the mouth and throat, but it may be done for carcinoma of the breast and
sarcomata of the extremities.
It is in the hope of lessening the incidence of metastases that it is preferable
always to start treatment of tumours by external irradiation (radium or X-rays).
It is hoped that by so doing any tumour cells, that may be dislodged during the
manipulations necessary for the surface or interstitial applications of radium, may
suffer devitalisation to prevent them forming a secondary deposit.
In addition to the cases of sarcoma and carcinoma many other diseases have
been treated at the radiotherapeutic clinic. With the exception of metropathia
hemorrhagica, uterine fibroids and exophthalmic goitre, the statistical analysis
of these cases is not made for more than two years after treatment. In many of
these conditions X-rays and radium are valuable agents for treatment, and give
nearly perfect results with little inconvenience to the patients. Painful corns and
callosities, warts, nsevi and a very large number of skin lesions can be made to heal
satisfactorily, and a large number of these have been treated during the year. In
osteoarthritis and many chronic inflammations, the effusions are absorbed and pain
is relieved without discomfort to the patient. It is proposed to collect and analyse
particulars of these non-malignant conditions for a subsequent report.