Radiation Castration in the Treatment of Malignancy of the Breast

The changes in the last few years in the treatment of carcinoma of the breast by surgery alone, radiation alone, or by an intelligent combination of the two methods indicate that neither the surgeons nor the radiologists are particularly well satisfied with the results obtained. No doubt part of our failure is to be found in the fact that the radical operation is too often not complete, but this also seems to be just as true of radiation. When the operation is most meticulously carried out, and when radiation is just as meticulously given according to the methods best accepted to-day, we can honestly look forward to a higher percentage of cures, far in advance of the present average figures. In a recent article, Professor Hans R. Schinz points out that, in his surgical clinic in Ziirich, 50 cases of carcinoma of the breast were seen in 1931. Only two of these cases were considered by the surgeons to be in an early enough stage for treatment by the radical operation alone; 11 were considered to be borderline cases, which were operated upon and received post-operative radiation, and eight cases became operable after a full course of radiation. In other words, less than 50 per cent of the cases of carcinoma of the breast seen in this important surgical clinic in 1931 received some form of surgery, and a high percentage of these became surgical only after radiation. Undoubtedly there will be a large number of cases in this group which sooner or later will be candidates for palliation therapy of some kind, and undoubtedly the experience of this clinic is not radically different from any other similar clinic abroad or in this country. A summation of all these cases in this country alone would leave a tremendous number of unfortunate patients for whom any form of palliation, other than a mutilating procedure or heavy drug therapy, would be most welcome—and to their attending physicians as well. We as radiologists are fortunate enough to have at our disposal such a method for patients who have not reached the menopause. Roentgen-ray castration represents such a method. It is well known that a definite relation exists between the activity of the ovaries and the histology and physiology of the breast; that the parenchyma of the breast may undergo rapid growth and transformation under certain physiologic conditions of ovarian activity, and that there is strong support for the theory that ovarian hormonal influences may play a large part in producing hypertrophy, hyperplasia, and neoplasms in the breast. These are axiomatic to-day and need no further discussion.