Present Methods of Treating Neck Metastases by Radiation at the State Institute for the Study of Malignant Diseases at Buffalo, New York

Abstract

THE State Institute was founded primarily for the purpose of research concerning the causes and the treatment of cancer and allied diseases. At the present time our therapeutic researches are chiefly concentrated on the radiation treatment of cancer to determine if possible, the exact rôle that irradiation plays in the treatment of this group of diseases. While we do not wish to enter into any controversy in regard to the relative merits of surgery, it is our opinion, based upon our observations, that in most cases radiation is the preferable method of treatment for metastatic deposits in the neck. For treatment purposes we have at our disposal 7,770 milligrams of radium, distributed approximately as follows: four grams in a large pack, two grams in solution, ten tubes each containing 100 milligrams and seven tubes each containing 50 milligrams of radium salt, 165 cells each containing from 1 to 5 milligrams, which when placed in platinum needles may be utilized for implantation. We have also three x-ray machines of 200 K.V. capacity at 25 milliamperes. The personnel consists of a surgeon, a radiotherapist, a physicist, and a pathologist, supplemented by other specialists interested in cancer therapy. Our methods of radiation treatment have naturally been modified from time to time to meet the advances made in this type of therapy and also in accordance with our experiences. In the early days, large single doses were the rule. However, when it was found that more radiation could be introduced into the lesion by the divided dose method without injury to the skin, the single dose method was discarded and divided dosage introduced. Filtration experiments were carried on by our physicists and advancement was made along these lines. Many cases were treated by implantation of radon and needles containing radium salt, either alone or combined with external radiation. It would be useless to go into detail concerning the methods formerly used. I should like, however, to describe a few cases, illustrating each of our methods of treatment of metastatic nodes in the neck. Implantation (Gold Seeds of Radon) The first case, a male patient aged 68 years, had a squamous-cell carcinoma of the floor of the mouth, associated with a metastatic node in the right submaxillary region. Both the primary lesion and the metastasis were treated by implantation with gold seeds containing radon. The node received a total of 660 millicurie-hours. The primary lesion healed and the node disappeared. The patient has remained free from any clinical evidence of the disease up to the present, a period of more than six years. While we had no biopsy of this node, we were quite certain from the clinical findings that it was a true metastasis.