Ulrich K. Henschke

REMOTE AFTERLOADING WITH INTRACAVITARY APPLICATORS.

In spite of its proved value, radiation therapy with intracavitary applicators is running into mounting opposition because it is difficult to hold radiation exposure of personnel and visitors to permissible levels. By “afterloading,” which we have previously described for uterus applicators (1, 2) and for other intracavitary and interstitial technics (3), radiation exposure during insertion of the applicator can be avoided. In afterloading procedures, an unloaded applicator is inserted first and the radioactive sources are introduced later. Afterloading has been utilized in many recently described uterine applicators (4–7), but the radiation exposure of physicians, nurses, and visitors during the treatment remains a serious problem. In principle, complete elimination of all unnecessary radiation exposure is possible by “remote after -loading,” which has been used for small teleradium bombs for more than twenty-five years (8) and is widely applied in industrial radiography with gamma-ray sources. No satisf...

Alarming increase of the cancer mortality in the u.s. black population (1950–1967)

The U.S. cancer mortality per 100,000 for both sexes rose, from 1950 to 1967, for blacks from 147 to 177, an increase of 20%, while it remained unchanged for whites at 150. The female cancer mortality rate declined for blacks from 146 to 142, a decrease of only 3%, while it declined for whites from 139 to 126, a decrease of 9%. The male cancer mortality rate rose for blacks from 147 to 220, an increase of 50%, while it increased for whites from 158 to 181, an increase of only 16%. In 1950, the cancer mortality rate for both sexes was 2% lower for blacks than for whites, but, by 1967, it had become 18% higher. Of the 58 most frequent U.S. sex‐specified cancer types, 29 increased slower in whites, 9 decreased faster in whites, 14 showed no significant differences, and only 4 (malignant melanoma and reticulum cell sarcoma in both sexes) increased faster in whites. Environmental factors are the most likely causes for this alarming rise of cancer in U.S. blacks.

“Afterloading” Applicator for Radiation Therapy of Carcinoma of the Uterus

The main feature of the applicator to be described here is the elimination of radiation exposure during its introduction into the uterus and vagina. This is accomplished by “afterloading.” In the operating room, only the empty applicator is inserted. After the patient has returned to her room, the radioactive sources are introduced through three tubes which extend from the applicator through the vagina to the outside. The applicator, as used in an uncomplicated cervical carcinoma, is shown in the accompanying figure. Uterus and vagina are schematically outlined. To place the applicator, the empty central tube is first introduced into the uterine cavity. Next, the two lateral balls with empty tubes attached are inserted, one after the other, into the right and left vaginal fornices. These lateral balls are guided into position by an alignment plate which has holes for the central and the lateral tubes. The position of the inserted applicator is maintained by additional balls on the central tube and by the ...

Local Recurrences after Radical Neck Dissection with and Without Preoperative X-Ray Therapy

Radical neck dissection is today considered the treatment of choice for resectable neck metastases and has become one of the most frequent cancer operations. In 1961, 402 such operations were carried out at our Center (Memorial Hospital for Cancer and Allied Diseases), a number which was surpassed only by 445 radical mastectomies. The main drawback of the radical neck dissection is the high rate of local recurrence in the dissected neck. The lowest reported rate, to our knowledge, is that of the Mayo Clinic with 26 per cent recurrences within one year (1). Preoperative irradiation has been used in the treatment of many cancers, and retrospective analysis has indicated the potential value of this combined therapy. In our Center, we have been particularly impressed by the higher five-year survival rate in a group of patients with rectal carcinomas in Dukes Stage C, who received preoperative irradiation (2, 3). In 1960, the Head and Neck Service and the Department of Radiation Therapy of the Memorial Center...

Value of Preoperative X-Ray Therapy as an Adjunct to Radical Neck Dissection

In 1960, the Head and Neck Service and the Department of Radiation Therapy of the Memorial Hospital Center, New York, N. Y., instituted a controlled clinical study to determine the value of preoperative irradiation in the prevention of recurrence after radical neck dissection. To avoid a significant delay in surgery as well as complications, a tissue dose of 2,000 rads to the subcutaneous tissues of the neck was chosen. This was given by 5 treatments, each of 400 R in air, on five successive treatment days immediately preceding the operation. All therapy was administered through one large lateral field which covered the whole neck and included the primary except when it was in the maxilla, the palate, or the nasopharynx. The Allis-Chambers betatron was employed, with an electron beam of 18 Mev maximum energy. Patients born on an odd day received preoperative radiation, while those born on an even day did not, thus constituting a control group. It was agreed at the outset of the study that the patients in ...

INTERSTITIAL IRRADIATION OF APICAL LUNG CANCER.

Fifty-three patients with previously untreated apical lung cancer underwent exploratory thoracotomy at Memorial Hospital from June 1941 to December 1968. Partial resection of the lung lesion with interstitial implantation into the residual disease in the chest wall was carried out in 15 patients; the remainder were judged to have unresectable tumors and were treated by implantation of radioactive seeds. Nine patients survived five years or more after treatment, without evidence of recurrence. No five-year survivors were counted among 9 additional patients referred to Memorial Hospital because of recurrence after definitive treatment elsewhere.

Clinical Experience with Long Half-Life and Low-Energy Encapsulated Radioactive Sources in Cancer Radiation Therapy

THE TREATMENT of localized cancer by-small radioactive sources permanently placed in the tissue is generally recognized as an effective modality of radiation therapy. In the past ten years, we had the opportunity at Memorial Hospital to use various radioisotopes for permanent interstitial implants in cancer patients. These radioisotopes may be divided into two groups: those with short half-lives, radon 222 (3.8 days) and gold 198 (2.7 days); and those with long half-lives, iridium 192 (74 days) and iodine 125 (60 days). The radioisotopes with long half-lives, iridium 192 and iodine 125, present a number of practical advantages for permanent implantation. The first advantage is the greater availability of the seeds. With radon-222 and gold-198 seeds, the activity decreases so rapidly that the seeds must be ordered for a specific day and usually have to be discarded if they cannot be used within a day or two. This fact limits permanent implants with radon-222 and gold-198 seeds in most hospitals to tumors w...

Effect of Total Body X-Irradiation on the Parakeet.

Summary The LD 50-30 for adult parakeets exposed to total body irradiation by x-rays at the rate of 23 r per minute is 1800 ± 75 r. The destruction and regeneration of the hematopoietic tissue is similar to that observed in mammals. The kidneys may be more susceptible and the intestinal tract less so than the same organs in mammals.

Radiogold seeds in clinical radiation therapy.

During the first year of application of seeds containing radioactive gold 198 (1–7) in clinical radiation therapy at the Ohio State University Medical Center, 100 patients were treated with the new types of gamma-ray sources. Although insufficient time has elapsed for a definitive evaluation of clinical results, it is felt that enough experience has been accumulated to warrant a review of the place of radiogold seeds in the practice of radiation therapy. No appreciable differences have been noted clinically in the reactions to therapy with radiogold, radiocobalt, radium, and radon. Radiogold seeds were found to be convenient replacements for the radon seeds formerly employed at this center. The simplicity of protection and the ease and speed of preparation of radiogold seeds of uniform strength were valuable in many situations. Whether radiogold seeds should be used in preference to needles or nylon applicators containing radiocobalt or radium will depend largely on the clinical situation. For example, in...

Five Years' Experience with the Gold Button Technique for Intraoral Interstitial Implants with Iridium-192 Seeds

To simulate crossing of the ends in standard removable interstitial implants, we used the loop technique for intraoral tumors when treating them with afterloading interstitial removable implants. Because of technical problems, we changed to a straight tube method with heavy end-loading to compensate for the uncrossed ends. High doses to the normal mucosa close to heavy end-loading is reduced 2.5 times by the use of gold buttons in place of standard stainless steel buttons, thus decreasing unnecessary mucosal reactions and morbidity.