Reticulo-Endotheliosis of Children: Treatment with Roentgen Rays

Publisher Website
Google Scholar
Abstract
Reticulo-endotheliosis is characterized by the presence of collections of hyperplastic reticulo-endothelial cells in bone and soft tissue. Clinical and pathologic manifestations of this disease may vary, but three general types are recognized: Letterer-Siwe disease, Hand-Schüller-Christian disease, and eosinophilic granuloma of bone. Hodgson, Kennedy, and Camp (1) have pointed out the difficulty of assigning a particular case to a single category because a single patient rnay display characteristics of more than one type. This discussion will deal with cases of reticulo-endotheliosis which fit best into the category of Hand-Schüller-Christian disease. Sosman (2), in 1930, reported 3 cases of Hand-Schüller-Christian disease in which treatment with roentgen rays was successful. Wallace (3), in 1949, stressed the important role of irradiation in control of this disease. Both Sosman and Wallace emphasized that there is a marked tendency to remission in reticulo-endotheliosis and that the role of irradiation therapy is to arrest progression of the disease, to prevent deformity, and possibly to induce remission. However, the general impression still conveyed by most texts (4–7) on radiotherapy is that this disease is fatal, and the usefulness of ionizing radiations in its control does not seem to be generally recognized. It is the purpose of this paper to report the experience of the Mayo Clinic in the treatment by irradiation of reticuloendotheliosis of children. Twenty-eight children with reticuloendotheliosis have been seen at this institution. Of these, 12 received a significant portion of their radiation therapy in the Section of Therapeutic Radiology and are the subjects of this report.4 The first patient of the series (Case 1, Table I), who was first seen in 1927, was treated with radium. Fifty milligrams of radium element, with filtration of 2 mm. lead and 1.5 mm. monel metal, were used at a distance of 2.5 cm. One-half to three-quarters of an erythema dose was delivered to the skin overlying each lesion, at intervals of from one to three months, from October 1927 to October 1928, with marked beneficial result. Fifteen years following the last treatment, the patient was normal in every respect and apparently free from disease. The remainder of the patients received roentgen therapy under a fairly uniform technic. On the initial visit, the various lesions which had been identified on physical examination and in roentgenograms of the skeletal system were treated. The patients then were seen at intervals of from one to three months and an attempt was made to treat every lesion which appeared to be active at each visit. For superficial lesions of the soft tissue and for lesions of the skull, mandible, or long bones, a single portal over the affected region was used.

This publication has 0 references indexed in Scilit: