Radioisotope Hypophysectomy in the Therapy of Advanced Cancer of the Breast

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Abstract
Results obtained in 102 patients give indications on the value of radiological hypophysectomy in the treatment of advanced mammary cancer. The evaluation of the radicality of hypophysectomy is obtained by dosimetric measurements: in each patient the glandular volume submitted to a dose able to produce necrosis was calculated. Hypophysectomy was considered to be total when the whole gland had received a dose of 100,000 rad. The validity of this method was checked in a group of 6 patients where the destroyed hypophyseal volume could be measured by histological methods. Measured and calculated values were found to agree. Since only 87 out of the 102 mammary cancer patients had undergone irradiation of the whole hypophysis with 100,000 rad, the results obtained in the remaining 15 patients are not considered, due to the doubtful total destruction of the gland. Improvement of symptomatology and general conditions was obtained in the 51%, and in some patients (20% of all cases) objective and manifest regressions of the neoplastic changes were observed. Best results were obtained in fertile patients with a total improvement value of the 54 % especially among those patients treated by oophorectomy and ovaro-adrenalectomy followed by hypophysectomy (61% of improvements). As concerns the localizations, the best results were obtained in cases with a single type of localization. As to the histological nature of the neoplasm, results were somewhat more favourable in patients with adenocarcinoma (54 %) than in patients with solid carcinoma (45%). A comparison of the survival curves of patients treated by hypophysectomy, by ovaro-adrenalectomy and by medical or radiological pallation showed a good increase of the survival rates in patients treated by endocrinosurgery. Complications consisted in 4 cases (out of 120 interventions) of traumatic lesions in cranial nerves, ocurred in the first patients treated by such intervention; 5 cases of meningitis which caused the death of the patients; and 32 cases of lasting diabetes insipidus. In other patients a transient occurrence of meningitis and of diabetes insipidus was noted. The conclusion is drawn that the method fulfils in over half of the cases the requisites of a palliative therapy, improving the patients’ conditions without exposing them to remarkable disturbances. On the basis of the exposed criteria, it is to suppose that the selection of patients could improve the results.