Responsibility in Radiotherapy

Abstract

Sometime since, a letter appeared in the British Medical Journal from a well known consulting surgeon to the London Hospital concerning his own history. He had an epithe1ioma of the left tonsillar lingual fold and was treated with x-ray by a well known American radiologist, a total of 3,540 r units being given in fourteen exposures, or about 250 r per treatment. This was supplemented by the insertion of ten radium seeds in the tonsillar pillar and fifteen seeds in the left side of the neck. The radiation produced a first-degree erythema and the tumor disappeared temporarily. The patient's point in making the report was that he suffered severe pain for eight months and even after that time was very uncomfortable. This letter set in motion a long correspondence in the same journal, some of the writers discoursing on the intense suffering which follows the application of heavy therapeutic doses of radiation; others denying unpleasant results if the treatments are properly administered. Some of those writing were physicians who had been treated; some were radiologists who protested that the radiation was given too rapidly; one, the well known surgeon of the Cancer Hospital in London, Mr. Cecil Rowntree, took a conservative position, and pointed out that a certain amount of pain follows radiation as it follows surgery. Finally, Sir Leonard Hill, the head of an institute for physical therapy, suggested that it would be for the good of mankind if the radium which is in possession of the British Government and has been concealed underground to avoid destruction by bombing were left and never again brought to light. This letter was widely publicized by the press in this country. The whole discussion was closed by the death of the original correspondent from his carcinoma of the tonsillar fold. There is a good deal of practical interest in such correspondence. It reveals first the fact that there is a great divergence of opinion as to the technical methods of handling radiation. It also calls attention to the fact that the current method of x-ray therapy with a fairly rapid rate of administration, with or without supplementary radium applications, may give rise to prolonged neuralgic disturbances over a long period, and it raises the question of the proper selection of patients for surgery or radiation. In addition it shows the necessity for frank discussion with the patient who is to be treated by radiation, of the possibilities of prolonged discomfort. The chief significance of this discussion is in connection with tumors of the oropharyngeal region, in which severe discomfort is much more likely to occur than, for example, after treatment of carcinoma of the cervix.