At the local x-ray [treatment] department attempts have taken place for several years in the radiation treatment of inoperable tumors of the fornix- and corpus ventriculi, following a technique devised by Dr. Renander. As a rule, with somewhat declining patients it usually proved difficult now and then to carry out the the planned treatment, at least without interruption, since in the course of treatment a rather pronounced leukopenia occurred, despite satisfactory initial values of the number of white corpuscles and that the hemoglobin content and red corpuscle count had nevertheless indicated a halt of the increase in tendency for occult bleeding.
In these patients, with their gastrointestinal disturbances and achylia, one has cause to expect hypovitaminosis C, since vitamin C in these situations is probably destroyed to a large extent before it could be absorbed.
It occurred to me to attempt to increase the resistance-strength of these patients through parenteral administration of vitamin C. A further suggestion was from individual observation of one of the leukemia patients, with whom each administration of vitamin C, taken together with the prescribed Aneurin, prompted a significant, though temporary, increase in the number of white blood corpuscles.
So far only 10 patients have received this supportive vitamin C treatment; however the results were so encouraging that a short provisional participatory [study] might be authorized.
To economise, in no instance did we supply vitamin C at the beginning of radiation treatment, but rather only when such a marked leukopenia occurred that interrupting the treatment became necessary. The patients then received usually 5 ml vitamin C* intravenously (= 0.5 g or 10 000 I.E. ascorbic acid), initially daily, later every second day. In mild cases, they received vitamin C only every second or third day. To ensure that the supplied vitamin C was really absorbed, intravenous administration was selected. X-ray irradiation was carried out as planned.
Under these conditions it is scarcely to be expected that a real increase in the white blood corpuscle count takes place; nevertheless this occurred in a few cases. In other cases the rapid depression of the leukocyte count was halted, and either held at the same level with moderate variation, or the depression was insignificant; the scheduled irradiation could in all cases be carried out.
Indeed, one can never foresee which patients will develop radiation leukopenia to such a degree as to jeopardise further treatment. Therefore the objection will probably be raised that our patients would perhaps do as well without vitamin C treatment, which I do not believe. In all cases we would have been compelled, in accordance with our experience acquired without vitamin C treatment, to take a shorter or longer break in the radiation treatment; whereas we could now carry it out continuously.
On what the effect is based, I do not know; also no attempts were made to determine the vitamin C equilibrium of these patients. Should our experience be confirmed, then we should hope that a colleague experienced in vitamin research will investigate the theoretical basis.
Recently Cramer and Brodersen (Münch. Med. Wochenschr., v. 88: 619, 1941) treated leukopenia in connection with X-ray irradiation with follicle hormone in doses of 50 000 E Progynon in accordance with their specification, with good effect. We checked this preparation in two cases, but found it ineffective.
In conclusion are some cases presented graphically (Fig. #4).
Es ist Verf. bei zehn Patienten gelungen, einer bei langwieriger Röntgenbehandlung von Ventrikelkarzinom auftretenden, ausgesprochenen Röntgenleukopenie durch intravenöse grosse C-Vitamin-Dosen Einhalt zu tun.
The writer succeeded in ten cases in checking a pronounced x-ray leukopenia, which had appeared in connection with protracted x-ray treatment of cancer of the stomach, by means of large intravenous doses of vitamin C.
Chez dix malades 1’auteur a réussi à arrêter par de grosses doses intra-veineuses de Vitamine C une leucopénie accentuée, due aux rayons roentgen, qui s’était manifestée au cours du traitement radiothérapique prolongé de cancers de l’estomac.
Markings in the figures. |
| Stepped Line = X-ray dosage; labels on right. Solid Line = Leukocyte count; labels on left. Dashed Line =Hemoglobin count; labels on right. Black Rectangle =Vitamin C* injections Data on the abscissa. |
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Figure 1. 67 year old man in rather good overall condition, the x-ray examination showed a hen’s egg- sized, coarsely-studded tumor approximately around the cardia and beneath. Treatment was with 200 r daily (Thoraeus filter; 50 cm FHD). After a total dose of 6 400 r the leukocyte count had dropped from 7 900 at the start of treatment to 3 100. The patient then received 2 ml Vitamin C* daily. At the end of treatment the leukocyte count was 3 800 after a total dose of 11 800 r. |
Figure 1 |
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Figure 2. 65 year old woman, who had received an ad modum Billroth II gastrectomy. In the distal part of the remaining stomach a wall infiltration had spread. The patient received treatment with 300 r daily (Thoraeus filter; 50 cm FHD). After a total dose of 6 400 r the leukocyte count had dropped from 9 400 to 3 200. The patient the received every second day 5 ml Vitamin C*. With a total dose of 13 800 r, upon the final treatment the leukocyte count was 5 800. |
Figure 2 |
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Figure 3. 49 year old woman with a half year-old stomach anamnesis and a large /body/ carcinoma. Treatment with 300 r daily (Thoraeus filter; 50 cm FHD). After a total dose of 6 800 r the leukocyte count had dropped from 9 000 to 3 100. The patient received thereafter 5 ml Vitamin C*, mainly daily. The leukocyte depression was halted and remained at approximately 3 000 till the end of treatment. |
Figure 3 |
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Figure 4. 50 year old woman with a large fornix carcinoma of the stomach and moderate trouble in swallowing. Patient received treatment with 200 r daily (Thoraeus filter; 50 cm PHD). Practically from the beginning, this patient received large doses of Vitamin C*, and the leukocyte level was satisfactory throughout the entire period. From beginning to end of treatment, a total of 11 800 r administered, the white corpuscles [were at] 4 400 per mm3. Three months thereafter the leukocyte count was 11 300. |
Figure 4 |
From Acta Radiologica, February 28, 1942, Volume 23, Binding 1, Number 131, pp. 95-98
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