A Technic for Intensive Roentgen Irradiation

The radiation treatment of intra-oral cancer involves technics combining intra-oral radium applications directly to the primary seat of the disease and external radiation to the glandular regions of the neck. The problem of the primary lesion has been successfully met by electrosurgical methods, radium seed implantations directly into and about the site of the disease, and by heavily filtered radium applicators immediately in contact with the diseased tissues (1). External radiation to the glandular region of the neck is generally considered essential even in the absence of palpable nodes. Heavily filtered radium packs applied over long periods of time -200 to 300 hours (1)-and short wavelength roentgen rays in massive and divided doses have been widely used with a moderate degree of success. Isolated nodes have been treated successfully with gold seed radon implantations and also with platinum needles (0.5 mm. wall thickness), using weak intensities (1 mgm. per 15 mm. length of needle) over continuous periods of six to seven days. The ideal procedure for treating cervical metastases is still a mooted question. Block dissection in the absence of palpable nodes is rapidly being abandoned, while adherents of block dissection in the presence of enlarged nodes are gradually showing preference for radiation first. When the nodes are fixed, and with bilateral involvement, there is no choice other than radiation. Whether radiation be employed preoperatively or postoperatively, or only as a palliative procedure, the fundamental principle is dosage to the limit of skin tolerance as well as the physical tolerance of the individual. At least 2 skin erythema doses ( 2 E.S.D.) of high-voltage roentgen rays can be administered through the skin to the primary tumor site in the mouth or throat. When this quantity of radiation from without is supplemented by interstitial and contact radium applicators, intensities approxi-