A FOUR-YEAR EXPERIENCE WITH TOTAL-BODY IRRADIATION.

Abstract

The concept of total-body irradiation goes back many years. In 1905, Dessauer (1) described a set-up which would employ multiple x-ray tubes distributed around a room to achieve uniform irradiation of a whole body centrallyplaced. This was theoretical only; it did not become a reality for several years. In 1927, Krause (2) suggested total-body irradiation for the treatment of disseminated neoplasms, and in the same year, Werner Teschendorf (3) described the use of the procedure in leukemia. He administered a dose of 200 to 250 R with but one x-ray tube placed at some distance from the body; a unit functioning at 180 kvp at a distance of 150 em. In 1932, Heublein (4) in a preliminary report described a specially designed room at the Memorial Hospital for total-body irradiation. Twenty patients had been treated in this chamber, receiving doses from 37.5 to 225 R. Some improvement resulted in the lymphomas treated, no response was elicited in the leukemia patients, and slight improvement was noted in patients suffering from cancer. Unfortunately, Heublein's untimely death interrupted the study and it was not continued. Osgood, Seaman and Tivey (5, 6) reported in 1952 and 1955 on the use of titrated whole-body irradiation delivered internally from radiophosphorus and externally from x-rays in the treatment of leukemia. In 1953, a unit designed to achieve uniform total-body irradiation was described by the Naval Medical Research Unit of Bethesda, Md. (7). Initially it was for large animals; later it was redesigned for use in man. The City of Hope unit was designed in 1958, and construction was completed in 1960 (8, 9). The Oak Ridge Institute of Nuclear Studies unit came into service simultaneously (10, 11). In 1960, the City of Hope Medical Center instituted a program which employed the chamber specially designed to deliver whole-body irradiation. One of the prime uses planned for this chamber was an attempt to ablate body immune mechanisms and relate this phenomenon to homologous tissue grafting. During the course of this study, drugs replaced radiation for these purposes. The total-body irradiation project was continued, however, in the hope that some palliation might be achieved in leukemia and disseminated cancer when other modalities had failed or could not be employed. Fifty-two patients have received treatment, and the results are presented here-with. The diseases treated are listed in Table I. Of the seven chronic leukemia cases, 3 were diagnosed as lymphocytic and 4 as granulocytic. The dose given was measured at the midplane of the body. Dosage, response, and survival periods for chronic leukemia patients are given in Table II. The whole-body irradiation was a useful adjunct in 3 of the 7 patients. Nodal masses decreased, but the disease was not truly controlled and other treatment was required.