Conservative Surgical Measures Facilitating Radium Implantation

Abstract

Irradiation may fail to control epidermoid cancer of the head and neck because of the omission of certain aids, chief of which are the various conservative surgical procedures. Many tumors require both external and interstitial irradiation to produce cure. In such cases surgical measures are indicated for exposure, drainage, and dealing with complications in adjacent bony structures. Removal of the bulky, raised portion of a skin tumor, for example, may make possible more effective radiation of the active base, while exposure of deep-seated growths is an aid to accurate implantation of radon, as in early neoplasms of the nasal accessory sinuses. Similarly, a justifiable substitute for radical neck dissection in metastatic carcinoma of the neck consists in exposure and implantation of gold-filtered radon seeds. Reduction of inflammation in tumor areas may be accomplished by a group of conservative surgical procedures which facilitate drainage, as by enlarging the opening or by removing the greater part of the irradiated area. Resection of bone secondarily invaded by cancer is advised because of its radioresistant character. Carcinoma of the Skin: The majority of superficial growths may be advantageously treated by external irradiation providing the application can be made with physical exactness for a sufficient dosage. Certain squamous-cell and basal-cell growths, however, which tend to infiltrate deeply, as well as those involving bone or cartilage, may require supplementary interstitial radiation. Some skin epitheliomas are elevated and bulky. When these occur directly over cartilage or bone a minimal lethal dose cannot be delivered with regularity without the expectation of a degree of devitalization of the underlying structures. Accurate dosage for this group of bulky tumors is greatly facilitated by removal of the protruding portion. More direct radium application to the active base is then possible with a smaller and more effective total dosage than if the full thickness of the growth were penetrated with a correspondingly greater dosage.