Radio-active Substances and Their Therapeutic Uses and Applications

Abstract

Histologic Effects of Radiation (continued)1 AS IT was in France that the element radium was first recognized, and in France also that its therapeutic properties originally became known, just so it is to that country especially that we look for the most minute and exacting observations upon the successive steps which have marked the advance of radium therapy. This is especially true of that branch of radium technic which has to do with the treatment of cancer of the cervix uteri, for in France, more than anywhere else, this particular therapy has reached its highest usefulness, and it is to the workers there that we who speak the English tongue, both here and on the other side of the Atlantic, are constantly turning for instruction, inspiration and leadership. As far back as 1908 we find Dominici and Barcat, those pioneers in the therapeutic application of radium, discussing the histologic effects which the gamma rays produce upon carcinomatous tissues, and the relation which these bear to those previously noted when the gamma rays were applied to epitheliomatous neoplasms. In studying the histologic sequence of the regressive process, it was noted that the portions of the tissue which had been subjected to radium assumed a character essentially different from that displayed by tissues which had not been so exposed. This differentiation was especially noticeable in the alteration and variation in the direction of the connective tissue bundles. It was also pointed out by Degrais and Bellot that when the epitheliomatous cells are exposed to radium there takes place hypertrophy of the nucleus, degeneration of the protoplasm, and a certain amount of keratinization, which—after an interval of perhaps three weeks—advances until the entire epitheliomatous mass has been converted into keratinized débris. All the formed elements will have broken up and disintegrated, and there will be evident an infiltration with young fibroblasts and connective tissue cells, lymphocytes and polymorphonuclears, which appear to be carrying on a phagocytic function; while cicatrization is taking place at the expense of the cancerous growth's hyperplastic and regenerated stroma. Following the radium applications it will be seen that the cancer cells gradually shrink and lose their staining properties, but this atrophy does not correspond to the metamorphosis of these same definitely formed elements, but to their destruction, which is evidenced by keratinization or absorption. Thus the cancer cells seem to disappear either by progressive absorption of their protoplasm and nuclei, brought about by the leukocytic infiltration, or by a sort of granulardegeneration.