Henry Schmitz

Technic in Pelvic Irradiation1

THE criteria of an adequate radiation tissue dose delivered into a carcinoma are a rapid resolution of the growth, a restoration of the normal surface epithelium, and a limited fibrosis. From clinical observations it appears: (1) that a uniform or homogeneous distribution of the radiation intensity of known dosage throughout the invaded area is desirable, and (2) that the tissue dose should be lethal to the carcinoma cells. Thereby a greater permanency of good end-results and a decrease in the number of primary failures are achieved. The good end-results, however, depend not only on a homogeneously distributed and lethal radiation tissue dose, but also on the anatomic or clinical extent of the tumor, the location of the growth, the degree or grade of the histological malignancy, and the presence or absence of a complicating infection. This paper will deal solely with the technic of the application of rays in cancers of the pelvic organs, namely, the uterine cervix, the uterine body, the ovaries, the urina...

Histological Structure, Clinical Grouping, and Prognosis of Cancer of the Uterine Cervix and the Breast

MANY of the most important facts about the prognosis of tumors can be learned only by the earnest cooperation of the surgeon, the radiologist, and the pathologist. The microscope determines the finer structure of the tumor, and enables it to be classified. From a certain type of structure, a certain behavior of growth may be predicted. But confirmation or refutation of the pathologists prognosis must be verified from a study of the clinical course of the tumor. The pathologist sees only the tissue, the surgeon and radiologist observe the patient and thus know the eventual end-result. The clinicians most important contribution to medical science will be the publication of his final results. In carcinomata treated by surgery or radiology the questions to be studied are: Did a recurrence of the growth ensue? Was the recurrence due to the nature of the growth, or the inadequacy of the operation or radiation treatment or the dissemination of the cancerous disease? It seems safe to say that if a tumor be comp...

The Prognostic Value of the Histological Malignancy Index and the Clinical Grouping of Carcinomata of the Uterine Cervix

IN 1926 the preliminary results of a study on the significance of the “Histological Malignancy Index” for the prognosis and treatment of carcinomata of the uterine cervix were published by us (1, 2). The histopathology of 139 cases of cervical carcinomata was studied, observing and evaluating nine factors, namely: the special cell type; the irregularity in the size and shape of the cell and nucleus; the distinctness in the outline of the cell; the functional activity of the cell; the hyperchromatism of the nucleus; the number of mitoses and prophases. The details of the determination of the numerical values were also given in the report. Of the 139 cases the end-results were known in 58 cases. The latter were used to establish the relation of the histological malignancy index to the prognosis and treatment. The malignancy index values ranged from 10 to 40 and were arranged in four groups from 10 to 20, 21 to 25, 26 to 30, and 31 to 40. The percentages of good end-results for these histological malignancy ...

The Relation of the Degree of the Histological Malignancy to the Prognosis and Treatment of Carcinoma of the Uterine Cervix

THE type of cell and the degree of differentiation and anaplasia play an important part in the degree of malignancy of tumors. Many attempts have been made to correlate the histopathological findings with the clinical prognosis of carcinoma, also, to determine thereby the prognosis of surgical and radiological treatment. An investigation on the relation of the histopathological findings to the prognosis of radiation treatment in carcinomata of the uterine cervix forms the purpose of this communication. Martzloff (1) reported a better five-year end-result from surgical treatment in the spinous cell carcinoma of the uterine cervix, namely, 47 per cent; in the transitional cell types, 24 per cent, and in the basal cell types only 9.5 per cent. Broders (2) showed a very definite connection between the cellular differentiation and undifferentiation of carcinoma and the good clinical end-results obtained after treatment. He recognized four grades of carcinoma: Grade 1, in which differentiation ranges from 100 t...

The Effect of Radiation Technic and the Early Diagnosis of Carcinoma of the Uterine Cervix on the Five-year Good End-results

THE radiological and surgical methods of treatment of carcinomas of the uterine cervix have been technically so perfected that further improvement in the five-year good end-results, commonly called cures, may probably not be expected. The absolute curability percentages, reported from different clinics, vary from 20 to 25 per cent, while the relative curability percentages of the clearly localized carcinomas vary from 75 to 90 per cent. If the patients came for treatment during the early stage, then the control of cancer would be achieved. Therefore, a study of five-year good end-results obtained in 488 primary carcinomas of the cervix was made (1) to investigate the influence of radiation technic on the end-results, and (2) to discuss the possibilities of very early diagnoses. These studies are herewith reported. In 19282 the writer reported the five-year good end-results obtained with the technic of combined radium and roentgentherapy in 332 cases of primary carcinomas of the uterine cervix. It was show...

Radiation Therapy in Carcinomas of the Uterine Cervix

THE five-year good end-results of radiation treatment in carcinomas of the uterine cervix are contingent on the size of the growth and on an adequate radiation dose. The histologic malignancy index and the constitutional or systemic reaction, also, influence the percentage of good end-results. However, the relation between these last factors and the results of treatment has not as yet been definitely confirmed. The extent of the tumor and the technic of radiation therapy and their influence on the five-year good end-results will be briefly described. The extent of the growth is expressed in four clinical groups: Clinical Group 1.—The clearly localized growth. It is on an average about 1 cm. in diameter in all directions. Clinical Group 2.—The doubtfully localized growth. It is characterized by an edema or infiltration of the paracervical connective tissue and hence a decrease in the degree of downward displacement of the uterus. Clinical Group 3.—The invasive growth. It is marked by definite invasion of t...

The Five-year End-results in Carcinoma of the Breast1

TWO hundred fifty carcinomas of the breast were treated in the clinic up to the end of the year 1923. Two of these occurred in males. One hundred seven of the cases were primary and one hundred forty-three recurrent tumors. The diagnoses were corroborated by microscopic examination. The treatment, which consisted of a combination of surgery and radiations, was preceded by a routine X-ray examination of the chest organs and the skeleton, as such extension of the carcinoma may be found though the primary breast growth may be small. Operability was determined from the clinical extent of the growth, while fixation of the tumor mass in any one of its regions usually meant an advanced and hopeless carcinoma which should not be treated with the expectation of attaining a good end-result. The indicated method of treatment was, therefore, determined by a clinical examination. To facilitate this procedure an outline for history-taking and a clinical grouping has been evolved which is presented in Tables I and II. T...

A Preliminary Report on the Effect of Ultra-High Voltage in Gynecologic Carcinomas

A REPORT on early clinical results of ultra-high voltage roentgen therapy in cancers of the female pelvic organs may be of interest, though the scientific and clinical value may be questionable and only speculative. However, such reports may give one an idea on the justification of applying such short wave roentgens in the treatment of large and deep-seated cancers. From 400 to 1,000 kv. maximum roentgen therapy may be destined to solve the therapeutic problems twofold: (1) Replacing radium bombs, as there is not sufficient radium obtainable to meet our present needs; (2) solving the economic aspects of distant radiation therapy, as such roentgen rays would replace very expensive radium bombs. It should not be overlooked that the technic of the treatment is in an experimental stage. Future observations may compel one to modify the treatment either toward a decrease or an increase in the total radiation dose to assure the highest possible percentage of five-year cures. The number of all cancers admitted fr...

The Treatment of Tuberculosis of the Female Genitalia with Light and X-rays

IN 1896 Finsen published his investigations on the therapeutic efficacy of carbon arc light treatment in skin; bone and joint tuberculosis and demonstrated the superiority of actinic therapy over the purely medical or surgical methods. Since then many reports have been issued sustaining the conclusions of Finsen. It was obvious that actinic therapy might, also, be a curative agent in tuberculous infections of other regions of the body, especially those of the genital organs of women. Clinical observations were carried on with various methods of light therapy. For instance, Rollier, Pestolozza and Myll use sunlight; Reyn employs the carbon arc light or artificial sunlight; Haussman and others use the ultra-violet rays produced by the mercury vapor quartz light, while Gauss, Bircher, Hoenicke and others apply the X-rays. It is interesting to note that Parker, an American, was the first to recommend the use of ultra-violet and X-rays in the treatment of abdominal tuberculosis. Actinic therapy is gaining rapi...

The Reaction of Carcinomas of the Cervix to Known Doses of 800 Kv. Roentgen Rays: The Five-, Four-, and Three-year Survival Rates

THE part assigned to me by your chairman in this symposium is a report on the clinical observations made in carcinomas treated with 800 kv. roentgen rays. The clinical observations should comprise: (1)The technic, including the factors used in the production of the roentgen ray, especially the half value layer. These determine the quality. (2)The output of r per minute. (3)The approximate distribution of the radiation intensities as the beam traverses the tumor, by determining the equal intensity curves or isodoses. (4)The method of application of the radiation dose, which should consider the spacing and time duration of each fraction. (5)The action of the roentgen rays on the tumor and carcinoma cells. (6)The five-year good end-results or survival rates. The final proof of the adequacy of the treatment consists of the disappearance of the tumor, the degeneration or destruction occurring in the cancer cells, and the survival rate at stated time intervals, usually five years. The factors of x-ray productio...