Direct Current Combined with X-Ray Therapy: Case of Kaposi Sarcoma Thus Treated

Abstract

The use of direct current in combination with x-ray therapy in order to increase the efficacy of the latter has not been reported, although it has been known for some time. Our basis for this procedure is of necessity, therefore, purely theoretical. In the case to be reported treatment was given with the following x-ray therapy factors: 120 kv.p., 5 ma. filament current, 4 mm. Al filtration, 25 cm. distance. The output of the apparatus was 15 r per minute. Each area received a total of 1,500 r. The electrical apparatus consisted of an ordinary galvanic machine and a pair of electrodes made of felt pads soaked in normal saline. The positive electrode was placed over the tumor area and the negative electrode over a nearby area, so that the lines of force would travel as directly as possible through the region of the tumor. The positive electrode was made as small as possible but large enough to cover the entire tumor area. The purpose of this arrangement was to produce the greatest possible current density at the site of the lesion. The x-rays were directed through the positive electrode into the tumor area. The plan followed was to give direct current first for about ten minutes, then to begin x-ray irradiation while the current was still on and continue both until the desired x-ray dose (150 r) had been delivered. Direct current was applied to the limit of tolerance as judged by the sensation of pain or discomfort. V. R., a 67-year-old Italian tailor, was admitted because of edema of the left lower extremity and widespread involvement of the skin by the bluish tumors characteristic of hemorrhagic sarcoma. The patient had first noticed these lesions about five years prior to admission. Examination showed a brawny edema of the left lower leg and foot with purplish discoloration of the skin of that area. On the left plantar surface were numerous hemorrhagic verrucous lesions. The right foot also showed diffuse involvement by lesions of the hemorrhagic type, but this foot was not indurated or swollen. The right hand and wrist were edematous and indurated and several small hemorrhagic nodules protruded from the skin on the dorsum of the wrist. Scattered widely on different areas of the body were numerous circinate areas of purple color. Each area was made up of confluent groups of small, round, firm subcutaneous hemorrhagic nodules which faded only slightly on pressure. The patient was studied completely for systemic involvement, and all laboratory findings were negative, including blood serologic tests. Biopsy of lesions similar to those treated revealed a picture characteristic of hemorrhagic sarcoma of Kaposi, showing dense new capillary formation with increased cellular infiltrate, the so-called second phase of this type of tumor. On Jan. 25, 1943, two areas on the patient's right arm (Fig. 1) were selected for treatment.