Simeon T. Cantril

Radiation necrosis of the mandible.

Even in the pioneer days of radiation therapy the problem of dental caries as a sequel to irradiation of lesions in the oral cavity existed. Despite technical advances and increasing experience, the problem persists. In many centers pretreatment extraction of teeth has become an established procedure to avoid subsequent dental complications. Yet disastrous mandibular necrosis as a complication to extractions after irradiation was reported as late as 1952 (1). Although bone has been considered relatively radioresistant, when it is in the region of a cancer it may be the limiting factor in the amount of radiation that can be delivered. In the oral cavity, a tooth-bearing bone in the treatment field provides an excellent mechanism for the introduction of infection and subsequent osteonecrosis if and when caries appears. After the vascularity of the bone has been compromised by irradiation, little response to bacterial invasion occurs, and the necrosis slowly progresses to involve the entire irradiated bony p...

Roentgen Therapy of Carcinoma of Female Urethra and Vulva

From a review of the literature, it seems that external roentgen therapy has not been used in a systematic way for the treatment of the primary lesion of either carcinoma of the vulva or urethra. Some radiologists have indeed expressed amazement that it can be used without deleterious by-effects. In a paper on carcinoma of the vulva by Smith and Pollack from the Gynecological Service of Memorial Hospital, we find as late as January 1947 this sweeping statement: “The inadequacy of x-ray and radium in treating either the primary or metastatic foci of this condition is well known.” A similar impression is gained from Bervens thorough discussion of the large group of vulvar carcinoma treated at the Radiumhemmet. The reason for this misconception is probably an insufficient appreciation of the importance of the quality of the radiations used. Some of these lesions, because of their superficial location, may tempt the therapist to employ low-voltage irradiation. This will not be tolerated by the vulvar mucosa ...

Tracheobronchial papillomatosis treated by roentgen irradiation. Report of two cases.

The two cases to be presented here contain much of clinical and pathologic interest. Papillomatosis of the larynx has been treated many times in the past, and with doses bordering on the cancerocidal. The results, however, have not been effective with any constancy. When these two cases came to our attention, we searched the literature for any leads on radiation therapy other than in laryngeal papillomata but were unsuccessful in finding reference to such treatment. The reasons for our embarking upon this project will be found in the protocol. It was of considerable interest to us that The New England Journal of Medicine reported, in September 1957 (1), a case with autopsy, in which the pulmonary findings were very similar to those in our Case II. This latter publication prompted us to believe that the condition is sufficiently rare, and the usual treatment so disappointing, that an attempt to use some other method than surgical relief of obstruction might be worthwhile. From the standpoint of radiation t...

Supervolt-Röntgentherapie der Krebse

In the patient with advanced cancer, effective symptom control requires a multidisciplinary, multimodal approach. Considerations involved in the control of pain can serve as a model for management of other symptoms, such as anorexia and dyspnea, as well.

Radiation Therapy of Carcinoma of the Vagina

IN 1935 TAUSSIG made the defeatist statement: “We acknowledge our total inability to do anything effective for primary cancer of the vagina,” and as late as 1947 McIlrath in a review of the literature on carcinoma of the vagina summarized: “Primary carcinoma of the vagina is acknowledged to be a rare and usually fatal disease.… All authors agree that primary vaginal carcinoma is difficult to treat.” This seems indeed to reflect a quite prevalent opinion. Yet results of the Institut du Radium as presented by Courtial in 1938 demonstrate that the prognosis in cases treated by adequate radiation therapy compares favorably with that of cancer of the cervix with comparable extension of the disease. Our own observations are in agreement with this conclusion. It is the purpose of the following discussion to evaluate the results of treatment in relation to the biological and clinical peculiarities of vaginal carcinoma and to the technics used. It is essential to differentiate clearly between primary carcinoma of ...

Supervoltage Roentgen Therapy of Esophageal Carcinoma

This discussion will be limited to a consideration of radiation therapy of epidermoid carcinomas of the thoracic portion of the esophagus. Carcinomas of the upper third, as well as adenocarcinomas of the lower third, are excluded, as they present a different therapeutic problem, and everywhere in cancer therapy progress has been hastened by the recognition of the different types of tumors which may occur in a particular organ. Carcinomas of the upper third or cervical portion of the esophagus are biologically, therapeutically, and prognostically to be considered in the same group as hypopharyngeal carcinomas. While technical advancements may still improve their curability, we feel that the principles of treatment here are established. For these carcinomas 200-kv. radiation offers today an approximate mean curability of 20 per cent. While this figure may eventually be improved by better technic and the application of higher voltage, we do not believe that the latter per se offers a fundamentally new approa...

Roentgen Therapy in Gas Bacillus Infection

Kellys statements (1) define our position relative to the status of x-ray therapy as an adjunct to surgery in the management of post-traumatic gas bacillus infection. Merritts description of experimental gas bacillus infection in sheep (2) should answer those (3) who state that “attempts to reproduce clinical effects in animal experiments thus far have failed.” The cases here presented2 are described in some detail to demonstrate that x-ray therapy can in itself, or in conjunction with surgery, save patients who have an overwhelming gas bacillus infection super-imposed upon the shock of severe trauma. The reports also indicate that, while the management of each case is as individual from the x-ray therapy point of view as from the surgical, underlying principles of radiotherapy are utilized in each instance as basically as are the fundamental precepts of surgery in its contribution to the treatment. We are grateful for the confidence and support of the orthopedic surgeons of our hospital, who consider x...

Comparison of the Use of Standard Depth Dose Data at 250 Kvp and 2 Mev by Direct Measurement of Tumor Exposure Dose in Vivo

It is well known that conventional depth-dose tables represent the distribution of exposure dose along the central axis of an x-ray beam in a homogeneous, unit density phantom of effectively infinite dimensions. Clinical material is rarely represented by this model and therefore the data thus obtained will be subject to corrections in many clinical situations. Corrections may be obtained by two different paths. One approach is to investigate the effect of limitations of dimension on depth-dose data by reducing the size of the phantom. Data obtained by this method have been described in the literature (1, 2). Such corrections are relatively easy to apply, but further corrections for inhomogeneities, such as bone, presuppose an accurate knowledge of the thickness, extent, degree of calcification, etc., of the interfering structure (3). Such information is rarely available. Another approach has been to measure tumor exposure dose in a number of standardized situations in vivo or in cadavers (4, 5, 6), compar...

The clinical usefulness and limitations of supervoltage roentgen therapy.

It is with due humility that we venture to discuss supervoltage roentgen therapy within the shadows of San Francisco and Berkeley. With the advent of newer forms of high-voltage accelerators, which seem to place no finite limits upon the energy of x-ray or particle beams, rays generated within the range of 1,000 kv. can now scarcely be classed as supervoltage. We make no apology, however, for attempting to evaluate our ten years of experience with radiation of this modest energy (1). In so doing we are brought face to face with the ever more striking fact that our biologic and clinical knowledge lags behind. technical development by many orders of megavolts. It is now approximately twenty-six years since Coutard gave to roentgen therapy the status of an independent and useful art. His medium-voltage equipment, archaic by present standards, provided him with a tool which enabled him to make radiobiologic and clinical observations, obtaining results still rarely surpassed and infrequently equalled by those ...

Irradiation in Cancer of the Cervix Uteri1

The choice of our subject, in response to an invitation to participate in a symposium “on the ideal versus the actual practical methods of irradiation in pelvic cancer,” has been carcinoma of the cervix uteri both because it is the most prevalent form of pelvic cancer and because, in spite of wide experience in its treatment, there remain unsolved problems in its management. The ideal treatment of carcinoma of the cervix at this stage of our knowledge might be defined as that one which permanently rids the patient of her disease with the least possible damage to other tissues than the cancer. The problem, however, is greatly complicated by the extreme variations of the disease—variations manifest in the site of origin in or on the cervix, the degree and routes of anatomic spread, and the biologic type of growth as the tumor extends or lodges in tissues which impose varying environments upon it. We come, therefore, to the obvious conclusion that there is no ideal treatment. The question resolves itself int...