Pyridoxine Hydrochloride (Vitamin B6) in the Control of Radiation Sickness: Preliminary Report

Abstract

Since 1934, we have used the protracted fractionated method of deep x-ray therapy in the treatment of practically all types of malignant neoplasms that have been referred to us for treatment. As in most general radiological clinics, carcinomas of the uterine cervix and breast are by far the most frequent types of lesion encountered. From 1934 to 1941, we used the old Drum type of equipment unit, operating at 200 kv.p., 5 ma., 50 cm. distance, 0.5 mm. Cu plus 1.0 mm. Al filter, with an output of 17 r per minute in air, not including back-scatter. During that seven-year period, the control of x-ray sickness was quite a problem. We used face masks (1), nembutal (2), fruit juices (3), good ventilation of therapy rooms (4), and many other measures recommended by various authors, with variable results. In 1941, we installed a modern shock-proof 220-kv.p. unit, operating at 200 kv., 20 ma., 50 cm. distance, and an r output of 50 per minute, with 0.5 mm. Cu plus 1.0 mm. Al filtration. From that time on, radiation sickness ceased to be a major problem unless we increased our daily dose from 300 to 500 or 600 r. It was about this time that we began to administer nicotinic acid (5) and thiamine chloride (6) routinely to patients receiving 200 kv. x-ray therapy. This probably helped to prevent some cases of radiation sickness, but in other instances it was wholly ineffective. It is generally recognized that the larger the daily dose of radiation with a 200-kv. unit, the greater is the possibility of x-ray sickness. The size of the field, the area treated, and the general nutritional state of the patient also play important roles (7). It has been our experience that when two areas of the pelvis or breast are treated, with fields up to 15 × 15 cm. and a daily dosage of 150 r measured in air to each area, severe radiation sickness rarely develops, provided proper attention is given to the patient's general nutritional state (8). Diarrhea practically never occurs under these circumstances. If, however, the epigastric area or right and left hypochondriac regions are treated with 150 r, using 15 × 15 cm. fields, radiation sickness occurs much more frequently and usually requires special attention if therapy is to be continued (see Case 18). Lesions of the extremities can be given large doses of radiation without signs of radiation sickness (see Case 5). In April 1945, we decided to double the daily x-ray dosage of 300 r, so as to give 600 r. In this way we hoped to decrease the time necessary for adequate treatment of cases of carcinoma in the hospital, to make possible a more rapid turnover of cases, and to reduce the hospital expenses proportionately. Economics plays an important part in the management of any type of malignant disease, especially among people whose average economic status is low. Two questions immediately confronted us: (1) How could we control the x-ray sickness that we felt would most probably develop?