Radio-active Substances and Their Therapeutic Uses and Applications

Abstract

V. French Methods of Application THOUGH all French radium therapists are very punctilious in acknowledging that it was Abbe, of New York, who first applied radium to cancer of the uterine cervix, the practical demonstration of the peculiar adaptability of this element to the treatment of this particular lesion was the work of the French themselves, and even to-day it is to them that we must look for leadership in this most important branch of radium application. For this reason, the technical methods employed by the gynecologists and radiologists of France are of the utmost interest to all who are devoting any considerable part of their attention to this branch of therapy, and a careful review of these methods is essential to an intelligent understanding of the progress which has been made in the treatment of cervical malignancy. The earliest workers were Wickam, Degrais, Dominici, Rubens-Duval and Cheron, all of whom met with considerable success in combating the ravages of this deplorably prevalent neoplasm by means of the newly discovered element. Dominici, in particular, was able to employ the penetrating gamma rays—segregated by powerful filtration—with excellent effect, and as early as 1909 demonstrated the selective action of these rays upon the malignant cells of cervical cancer, while at the same time he was able to show their relative harmlessness to the cells of healthy tissue. As Mallet recently put it: “Because of its frequent occurrence and its easy accessibility, cancer of the cervix uteri has offered a peculiar suitability for the researches of curietherapists. Moreover, the fact that the conditions obtaining in this area are favorable for application of radium to the center of the neoplasm, as well as the histologic sensitivity of the lesion, have contributed not a little to the early success which attended this particular application of radium treatment.” Régaud, the associate of Madame Curie, is perhaps the best known user of radium treatment in France to-day, so it is natural that we, on this side of the Atlantic, should consider his technic as the most important offered by the country where our knowledge of this treatment had its origin. In the opinion of this authority the use of a large number of centers of radio-activity is a primary requisite to the efficacy of the therapy. These centers may be located in the cervical canal, in the vagina, in the rectum, in the parametrium—by means of implantation, or upon the external surface, where radio-activity may be brought into play by X-ray or flat radium applicators. But in practically all cases, the most useful sites for the location of radio-active centers are the uterus and the vagina. If the cervical canal is open and permeable without dilatation to an applicator of small caliber, this container should always be so fashioned as to occupy the entire length of the canal.