ROENTGEN RAY IN EPITHELIOMA

WILLIAM ALLEN PUSEY
1908 Journal of the American Medical Association  
No one doubts that epitheliomata can be healed with the x-rays. The statement, however, is frequently made that the results are not as permanent as when the lesions are radically destroyed by other methods of treatment. This is an important matter to settle, and we are now nearing the time when the permanency of the result can be established. I desire, therefore, to report the results in my series of epitheliomata treated with x-rays more than three years previous to July, 1907. The number of
more » ... 07. The number of cases is too large to recite each case in detail, but the results can be summarized quickly. The details of fifteen of the cases also are indicated by the photographs presented herewith, most of them in pairs, showing the original lesion and the result after three or more years. Lack of space prevents the publication of the photographs of about thirty additional cases. I have confined my consideration to epitheliomata. I have not included in my list epitheliomata which at the time of beginning treatment were complicated by demonstrable carcinoma in the neighboring glands. I have thus excluded a few hopeless cases of epithelioma of the penis with metastatic complications, and numerous cases of carcinoma of the neck following epithelioma about the face and mouth. I have, however, excluded no case in which glandular metastases developed after treatment was begun; fortunately I had no such accident. I have also not excluded any cases where the spread of the disease has been by continuity. The list, therefore, includes many hopeless cases in which there had been wide involvement of the orbit, other cases with deep destruction of the tissues of the face from the spread of lesions originally involving the nose only, and other extensive and very destructive cases. I may also say that in accepting the cases no effort was made at selection; the most hopeless cases have been treated regardless of a record whenever there was the remotest possibility of giving the patients any sort of benefit. The total number of epitheliomata in this list which I treated with _-rays more than three years ago is 119. Of these cases I have been unable to obtain the subsequent histories of only eight; of these eight, five, I think, should have been successes and three failures, but, throwing the entire number out of consideration, it leaves 111 patients treated more than three years ago whose histories up to July of this year are known. Of these 111 patients 80 either remain well to-day, have died without recurrence of epithelioma, or remained well more than three years after a healthy scar was produced, but can not now be located. As a matter of fact, 66 of these 80 patients were living with healthy scars in April last. Six were living without recurrence at least three years after they finished treatment. Eight of them are dead; two died from pneumonia, and one patient each from acute leukemia, apoplexy, nephritis, heart disease, acute bowel trouble, and carcinoma of the uterus, the last mentioned having symptoms before the treatment of the lesion on her face was begun. This patient died about a year after the lesion on her face Read before the Sixth International Dermatological Congress, New York, Sept. 9-14, 1907. healed, and she was the only one who died within a short time after the treatment of her epithelioma. Two other patients who are now dead lived from one and onehalf to three and one-half years. Omitting these eight patients who died from other diseases, one patient has been well over six years, 11 patients are well over five years, 22 over four years, 32 over three years, and 6 were well more than three years after treatment, but whether they are now living I do not know. The diagnosis in the cases is, I believe, beyond question. In all of my earlier cases the diagnosis was confirmed by microscopic examination. In the later eases microscopic examinations were made when there was any possible room for doubt. The unmistakable character of the lesions and the variety of the lesions treated are evident to the eye in almost all of the photographs shown. They varied from the most minute epitheliomata, about the size of a small pea, to lesions above the size of a hand. Many of the worst cases were primary as regards operation, but of the eightv successful cases forty-one were primary and thirty-nine were cases which had recurred after previous radical treatment, usually operation. For the purpose of further analysis I have divided all of the cases into the following four groups: (1) Successful, 80 cases; (2) practically successful, 2 cases; (3) distinctly benefited, 17 cases; (4) failures, 12 cases; total, 111 cases. PRACTICALLY SUCCESSFUL. In the group of practically successful cases are included two cases. The first case was a large epithelioma of the shoulder. This patient had had for twenty years a rodent ulcer, which at one time had reached an enormous extent, involving at least a square foot of the shoulder and hack. Under persistent treatment, extending over years, in the hands of the most competent men, it had been reduced in size to about that of the palm of the hand, but it had never been healed. This was the* first case that I treated with the a;-rays, and the treatment was undertaken because the case was regarded as hopeless. A symptomatic cure was obtained in May, 1901. Fifteen months after the disappearance of her epithelioma, this patient, a very old woman, received an injury from a fall from which she was compelled to go to bed, and in a few days died from pneumonia. At the time of her death there was no evidence of recurrence, except a point on her shoulder, which looked suspicious. I was able to obtain the skin from this shoulder, and it showed healthy scar tissue, except at this suspicious point, where I found an epitheliomatous mass the size of half a wheat grain. This could have been destroyed readily by arrays or a caustic or other destructive agent. The second case was epithelioma involving the entire concha and the outer half of the external auditory canal. A superficial ulceration, the size of a dime, has never disappeared in this case, and it is, I believe, an ai-ray burn and not an epithelioma. It showed no tendency to grow when I last saw the patient a year ago. In this case the lesion had been converted into a trivial ulcer with no tendency to spread, and the improvement had persisted for over four years. This case also was an epithelioma recurrent after operation. DISTINCTLY BENEFITED. Seventeen cases are classed as having been distinctly benefited. The improvement in each of these cases consisted in checking the course of the disease for a year or more, except in the case of a man over 80, who died within the year, and in prolonging the patient's life, in comfort, for at least that length of time. Every one of the cases was an epithelioma which had re-
doi:10.1001/jama.1908.25310280016002c fatcat:l6v5q2halrdkhlqwr34zioa5eq