The Roentgen-Ray Treatment of Inoperable Carcinoma of the Breast by the Method of Multiple Converging Beams

IN this paper, the term “inoperable carcinoma,” applying throughout to carcinoma of the breast, will include ulcerated carcinoma, carcinoma fixed to the thoracic wall, carcinoma with widespread cutaneous metastatis, carcinoma which could be extirpated surgically but accompanied by involvement of supraclavicular nodes, carcinoma with extensive involvement of axillary and supraclavicular nodes, carcinoma with osseous or visceral metastasis irrespective of nodal involvement, and carcinoma in the presence of such poor physical condition, due to complicating organic disease, that the risk of operation would be too great. The study concerns 41 patients treated in the Section on Therapeutic Radiology at the Mayo Clinic in the years 1925 to 1929, inclusive. Obviously, treatment in advanced stages of carcinoma of this type has little to offer in the way of cure. For this reason, radical surgical and radiologic treatments are not justified, even though they may give brilliant and unexpected results in a small percentage of cases. Treatment, therefore, is palliative only, and consists of measures to relieve discomfort from the tumor, to check its dissemination, to postpone or prevent fungation, to make fungation more tolerable if it already has taken place, and to maintain the patient in as good general physical condition as is possible until death ensues from visceral metastasis. Such treatment may consist of various measures, among which radiologic methods designed to hold the carcinoma in abeyance have a place. At the Mayo Clinic, such methods have produced results superior to those of all other methods investigated. Carcinoma of the breast may occur at any age and in persons of either sex. Of this group, three of the patients were between 20 and 30 years of age, five between 31 and 40, four between 41 and 50, eighteen between 51 and 60, seven between 61 and 70, and four were more than 70 years of age. In 19 cases the tumor was of the right breast; in 20, of the left breast and in two, bilateral. The group is too small to permit definite data to be obtained on the relationship of age to the virulence of the tumor, or to duration of the tumor. Three patients each had noticed a tumor in the breast from two to three months before they came to the Clinic; ten, from three to six months before; six, from six months to a year before; six, for thirteen months to one and one-half years before; five, for nineteen months to two years before; three, for two to three years before; five, for three to five years before, and three, for five to eight years before. With such wide variations in duration of carcinomas which had not received treatment, it is apparent that degrees of clinical malignancy varied widely, and that estimation of curative results or of degree of palliation, therefore, is difficult. However, since benefit from treatment and not cure was expected, the results of radiotherapy can, nevertheless.