Regression of Pulmonary Metastases from Mammary Carcinoma Following Inactivation of Ovaries by Irradiation

Abstract

It has been well established that certain mammary carcinomas recede definitely following the withdrawal of ovarian hormonal stimulation. Beatson (2), in 1896, reported shrinkage of primary tumors, regression of metastases, and improvement in the general condition of patients following oophorectomy. Wintz (8) appears to have first used roentgen castration as an adjuvant in the treatment of carcinoma of the breast. Ahlbom (1) reported the treatment of 163 cases with rather indeterminate results. Martin (4), Dresser (3), Smith (5), and Taylor (6) have reported regression of metastases in bone following roentgen castration and have given excellent reviews of the literature. Dresser observed regression of skeletal metastases in 30 per cent of cases, clinical improvement without evident regression in 43.3 per cent, and no response in 26.6 per cent of a total of 30 cases under 45 years of age. Pulmonary metastases from carcinoma of the breast present a dismal and distressing picture. The progressive, intractable symptoms of cough, pain, and dyspnea harass the patient and confound the physician. Treves (7) has recently shown that administration of radiotherapy to the lungs is deleterious rather than beneficial to the patient. Dresser (3) reported regression of pulmonary metastases in one case following 600 roentgens to the pelvis through anterior and posterior ports. We have observed striking and unexpected regression of pulmonary metastases with relief of symptoms in two cases following inactivation of ovaries by irradiation. Case Reports Case 1. V. S. Nebraska Methodist Hospital. Referred by C. R. Kennedy, M.D., on Feb. 3, 1933. Housewife, aged 35. A radical mastectomy had been done five years previously for a Grade III adenocarcinoma of the right breast. She entered the hospital with a history of gradually increasing unproductive cough, pain in the back, failing vision, and loss of 30 pounds in weight during four months. Examination showed numerous hard lymph nodes in the left axilla and dullness over the right chest. She was unable to count fingers at two feet with the left eye and an ophthalmoscopic study showed edema of the optic disc and congestion of the retinal veins. Roentgenographic study of the chest on Feb. 3, 1933 (Fig. I-A) showed infiltration through the upper two-thirds of the right pulmonic field with multiple small patches of deposit through each lung. There was extensive destruction of the ribs and lumbar vertebræ. The skull showed multiple metastases (Fig. 2-A). Therapy consisted of 475 roentgens anteriorly and posteriorly over the pelvis, 200 kv.p., through 0.5 mm. Cu and 2 mm. A1, 60 cm. distance, 20 × 20 cm. port. Also, 475 roentgens were delivered anteriorly and posteriorly to the spine and chest and 475 roentgens laterally to the skull. Pain in the back was relieved within a few days, vision gradually improved, and the cough was alleviated after six or eight weeks.