Many radiotherapists believe that protracted or fractionated courses of radiotherapy are more effective in the treatment of malignant growths than courses of shorter duration. It has been suggested that the average skin tolerance dose varies roughly as the cube-root of the overall time (T0·33), while the median lethal dose for epidermoid cancer depends on a factor between T0·22 (Strandqvist, 1944) and T0·25 (Cohen and Kerrich, 1951). For practical reasons a course of radiotherapy is rarely protracted longer than six to eight weeks and if we assume that Strandqvist's formula is at least approximately applicable, the therapeutic ratio (here defined as the ratio of normal tissue tolerance dose to the median tumour lethal dose) increases by no more than T0·33−0·22, that is the ninth-root of the overall time. A significant improvement in this ratio could be obtained only with very much longer treatment times. By using permanent implanes of relatively weak sources of moderately long-lived, γ-ray emitting, chemically inert radionucleides, it is possible to deliver extremely protracted continuous irradiation at unusually low dosage rates. The equivalent overall treatment time and the corresponding optimal dosage for an exponentially decaying source is readily calculated (Cohen, 1950).
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