X-ray Therapy of Carcinoma of the Lip and Skin

Abstract

THE Brooklyn Cancer Institute, a unit in the Department of Hospitals of New York City, cares for patients received from other hospitals or referred by its own staff of physicians. The hospital beds at our Institute are limited to the care of those cancer patients requiring urgent surgical or radium therapy. Chronic cases are sent to the Welfare Island Custodial Cancer Hospital. Due to the present necessity for economy and because our bed service is limited, we have found x-ray therapy the most efficient method of treating these ambulatory cases. In many instances such treatment is given with radium emanation. Generally speaking, the radiosensitivity of any cell, including the tumor cell, ies in direct relationship to its nuclear or chromatin substance. The usual basal-cell growth is rich in chromatin substance, and, being on the surface, an exact dose can be given without fear of injury to overlying structures, while if a non-penetrating or long wave length x-ray beam is used, damage to deep structures may be avoided. The relative penetration of the x-ray into tissues has been carefully worked out by physicists and roentgenologists; for instance, the estimation of the half value layer in aluminium by William H. Meyer (1) and the penetration of x-ray beams of different voltages as measured in a water phantom by J. L. Weatherwax (2). Measurement of the biologic reaction in absolute roentgens (3) showed a variation with unaltered rays of longer wave length from 400 r, increasing with harder filtered rays to 700 r, as marking a threshold erythema, without backscattering. This has led to a most accurate estimation of dosage to the surface plus a good estimation of the depth in tissues. In spite of these accurate physical and biologic comparisons, it has been demonstrated definitely that much more than one surface erythema dose is necessary to produce a normal erythema to a lesion 2 cm. or less in diameter. This increased tolerance is carried up the scale in larger doses which would normally give vesiculation and total destruction, a knowledge of which has been taken advantage of by F. Liberson (4), who treated deeper lesions with increased doses of x-radiation without injury to the overlying skin. J. M. Martin (5) compared the results following surgery and his own results in radiation in lip and mouth cases, reporting a large percentage of five-year cures. B. P. Widmann (6) demonstrated how the underlying structures will tolerate very large doses to the surface, as high as 35 skin erythemas in a single case. This irradiation was delivered in divided doses, being given over relatively large areas. The present report covers a group of cases composed of all types of epitheliomas of the skin and lip.