Radium and the therapeutic roentgenray are today our

only effective means of retarding the progress of esophageal malignant

neoplasms. No permanent cures have been reported, but marked temporary

improvement in the swallowing function and prolongation of life have

been repeatedly observed. The combination of radium treatment applied

within the esophageal lumen and the therapeutic roentgenray through

the chest wall, has retarded the progress of some cases.

The dosage of radium or the therapeutic ray must be determined by the

radiologist for the particular individual case; its method of

application should be decided by consultation of the radiologist and

the endoscopist. Two fundamental points are to be considered, however.

The radium capsule, if applied within the esophagus, should be so

screened that the soft, irritating, beta rays, and the secondary rays,

are both filtered out to prevent sloughing of the esophageal mucosa.

The dose should be large enough to have a lethal effect upon the

cancer cells at the periphery of the growth as well as in the center.

If the dose be insufficient, development of the cells at the outside

of the growth is stimulated rather than inhibited. It is essential

that the radium capsule be accurately placed in the center of the

malignant strictured area and this can be done only by visual control

through the esophagoscope (Fig. 95)

Drs. Henry K. Pancoast, George E. Pfahler and William S. Newcomet have

obtained very satisfactory palliative effects from the use of radium

in esophageal cancer.

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