X-ray Treativient of Bone Tumors, with Special Reference to Tumors of Unconfirmed Diagnosis

Abstract

THE object of this communication is to call attention to the fact that, although diagnosis is unconfirmed in a certain group of bone tumors, radiation may produce arrest or healing and the patient remain symptom-free and clinically well for a number of months or years following treatment. It is well to emphasize that surgery in some cases is the method of choice, and we feel that when it is combined with deep radiation in such instances, the results may be improved. The treatment of both benign and malignant bone tumors by deep X-ray is of value. Of the benign tumors, the giant cell tumor appears to have responded well and there have been cases reported with excellent results. In contradistinction to the malignant tumors, pain and swelling are very apt to be increased at first in the treatment of the giant cell tumor, symptoms which may persist for from four to six weeks. About this time both these symptoms begin to subside, and this is followed by recalcification with more or less solidification of the bone shell. Osteomyelitis and syphilis of bone in our experience do not respond well to deep radiation and are best treated surgically or by other suitable methods. Of especial interest is the treatment of tumors wherein the diagnosis is unconfirmed by biopsy. The difficulty in the surgical treatment of tumors involving the skull, shoulder, pelvis, hip joints, and spine is manifest, and this difficulty is increased when there is at the same time considerable infiltration of the surrounding soft structures. It is not unusual for such tumors to have the X-ray and clinical appearance of malignancy, with the history suggesting malignancy. Biopsy is apt to stimulate metastasis and increase the rapidity of the growth of these tumors, and in these cases it should perhaps best not be done. From the scientific standpoint biopsy is essential for a correct diagnosis. From the clinical standpoint the results from deep radiation are sometimes excellent, and, as mentioned before, the patient may remain clinically well and symptom-free for a number of months or years. Some tumors treated with deep X-ray respond quickly, namely, there is lessening of pain and regression of the tumor and the surrounding infiltration following the first few treatments. Sarcoma frequently involves the long bones, and, where practical, amputation or resection offers good results. Prophylactic deep X-ray treatment over the lungs in these cases is strongly advised. Myxoma, in our experience, does not readily respond to radiation and the results up to the present have been disappointing, although one case appears to have responded fairly well to both deep X-ray and colloidal lead treatments. We have had practically no experience in the treatment of multiple myeloma. There is no other agent so helpful as the X-ray in carcinomatosis. As a brief illustration, recently a patient presented herself for examination six years following surgical removal of the breast for carcinoma.