Roentgen therapy has its established place as a valuable palliative procedure in the treatment of human leukemias, lymphomas, and allied diseases. Its general and local effects in these disorders have been the subject of numerous reports by expert radiologists and hematologists. In the last decade radioactive isotopes and recently the nitrogen mustards have been added to the therapeutic arsenal against these diseases. The purpose of this presentation is to furnish an introduction to the papers2 on treatment with these new methods rather than to contribute anything new. As a basis for comparison with the results, complications, ad vantages, and limitations of the therapeutic use of these new compounds, we have reviewed 337 cases of blood dyscrasias treated by external irradiation in Billings Hospital (University of Chicago). Material The 337 cases represent the number of patients accepted for irradiation therapy from 1929 to 1945. The total number of patients with blood diseases seen in the clinics and in the hospital during that period could not be determined. The series consists of patients with leukemia, Hodgkin's disease, lymphosarcoma, and polycythemia rubra vera. The small number of patients with polycythemia rubra is included because in this group strides forward with the new agents have been made. In all cases of Hodgkin's disease and lymphosarcoma the diagnosis was verified by biopsy. In 33 per cent of leukemias confirmation was obtained by bone marrow aspiration or biopsy, lymphnode biopsy, or autopsy. Table I shows the number of cases in each group and some pertinent data. The distribution of the diagnoses is similar to that reported by Craver for the lymphoblastomas seen at Memorial Hospital, New York (3). The most frequently treated condition in both instances was Hodgkin's disease. We were able to keep track of the largest number of patients, relatively, in the leukemia group. Therapy The routine treatment in all four groups of disease was roentgen therapy given as local irradiation. Table II indicates the limited use of total body or wide-field spray irradiation, radium therapy, and chemical agents supporting or replacing roentgen irradiation. The chemicals were Fowler's solution in myelogenous leukemia, used systematically over long periods, radioactive phosphorus in polycythemia rubra, and nitrogen mustards in selected cases of all groups. Radical excision of a localized enlarged lymph node, which was the only sign of the disease, was performed in a single case of Hodgkin's disease. Supportive treatment with blood transfusions, iron, vitamins, adequate diet, plenty of rest, exposure to fresh air and sunshine, was used on a large scale and found to be of great importance in all groups. The roentgen ray quality used by us for the treatment of these conditions is h.v.l. 1.5 mm. Cu (200 kv., 1.0 mm. Cu plus 1.0 mm. Al filter).
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A. Hamann (1948) studied this question.