Further Experience with Roentgen Therapy for Bronchiectasis

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Abstract
IN A previous paper we reported the successful use of roentgen therapy in the treatment of chronic suppurative bronchiectasis (11), and the present communication is a report of our further experience in the treatment of this disease. Rationale of the Use of Roentgen Therapy for Chronic Bronchiectasis.—Although it seemed that early investigators of the action of roentgen rays on various organs reported that the lungs were relatively invulnerable to the action of the rays, the recent introduction of apparatus capable of delivering shorter wave length and larger depth doses has demonstrated that, within certain limits, definite tissue reactions can be produced in the lungs and pleural cavities (6). It was the thought that an analogy might be drawn between the salivary glands and the bronchial mucous glands in their reaction to roentgen rays that led primarily to this work on their use in bronchiectasis. Exposure of the salivary glands to roentgen rays brings about a diminution verging upon abolition of secretion. It was thought that if a comparable reaction could be induced in the bronchial mucosa of bronchiectatic areas, a comparable diminution of secretion and hence expectoration might be expected. However, that such an effect can be produced in the bronchial mucosa of human beings, although supported by some experimental work on animals, is problematical and perhaps unlikely (2). Further explanatory hypotheses may be adduced to explain the successful action of roentgen rays in suppurative bronchiectasis; such as, possible enhancement of immunity processes both through the action of the rays in stimulating antibody action, and the physico-chemical alterations of the local tissue reactions. It is, perhaps, most logical to assume that the results we have obtained in chronic suppurative bronchiectasis, so far as our present knowledge of the known reaction of tissues to roentgen rays can teach us, are due to the action of roentgen rays on chronic inflammatory processes (5). Clinical Application of Roentgen Therapy.—Based upon the above outlined concepts of the action of roentgen radiation upon the chronic inflammatory bronchial and peribronchial lesions and upon the mucus-secreting bronchial epithelium, roentgen therapy was instituted in a series of cases of chionic suppurative bronchiectasis (1), No acute case or cases with recent onset were treated, because it is of considerable importance to be certain that a patient is not suffering from an ordinary superimposed acute upper respiratory infection, which is making otherwise “dry” dilatations “wet.” It is well known that bronchiectasis may be characterized by spontaneous remissions and exacerbations with seasonal variations.

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