It is generally agreed that pulmonary resection offers the patient with bronchogenic carcinoma his best chance for cure. Unfortunately, most cases are inoperable when first seen. Of the 400 patients with bronchogenic carcinoma seen at the Veterans Administration Hospital in the Bronx (N. Y.) in the past four years, 90 per cent came too late for surgery. At the Hines Veterans Hospital, 95.4 per cent of 1,057 such patients admitted from 1937 to 1947 were already beyond any attempt at salvage by surgical resection (1). This distressing picture is reflected in other hospitals and clinics. It may be estimated that in 1949 there were in this countrya bout 28,000 new patients with bronchial cancer, compared to 10,000 in 1939 (34). Unless treated by irradiation, inoperable bronchogenic carcinoma runs its lethal course rapidly and inexorably, complicated by distressing signs and symptoms, both local and systemic. Of 584 non-irradiated inoperable patients, not one survived more than one year after the onset of the disease, according to the combined reports of Leddy and Moersch (18) at the Mayo Clinic, Widmann (31) at the Pennsylvania General Hospital, and Ariel et al. (1) at the Hines Veterans Hospital. On the other hand, our own experience with the roentgen treatment of 605 inoperable cases in the last fifteen years has demonstrated that, when radiation therapy was feasible, effective relief from intractable local symptoms was often possible. Indeed, prolongation of useful life for many months, and even years, was sometimes accomplished, particularly when the patient's physical condition was such that cancerocidal doses (5,000 to 6,000 r) could be approached. An occasional rare cure may be achieved. These observations are supported by the experience of others in a group of 508 roentgen-treated cases reported in the literature (6, 18, 28, 31). It is not possible, however, to give to every inoperable patient the benefits which irradiation can offer. At intervals in the course of the disease irradiation may seem to be ineffective or, for various reasons, even unfeasible. An effective adjunct to radiotherapy would therefore, appear, to be most desirable during these periods. The object of this paper is to present the results of our investigation of nitrogen mustard or HN2,—methyl-bis (beta chloroethyl) amine hydrochloride—employedin this role.4 Rationale of Nitrogen Mustard Treatment The early investigations of Gilman (11), Goodman (12), Jacobson (13), and Karnofsky (14 and 15), and their co-workers, with nitrogen mustard in human lymphomas, excited our interest in investigating its role as an adjunct to radiotherapy in a variety of malignant disorders. The study was begun in the Radiation Clinic in January 1947, in collaboration with the Committee on Growth of the National Research Council. Bronchogenic carcinomas were included because of scattered reports of clinical benefit by other investigators (33).
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