HYPOPHYSECTOMY can be a valuable therapeutic measure in the management of advanced breast cancer. The operation, however, has not achieved its merited clinical position for a number of reasons. Two of these are examined here.I. Subtotal Removal of the Hypophysis.-In most published series residual gland, perhaps in macroscopic amount but more often in microscopic quantity, may survive operation to be detected at autopsy.Recently (Edelstyn, Gleadhill, and Lyons, 1964) we reviewed evidence on the ability of such tissues to reestablish endocrine function and concluded that this was a real possibility. As there is no reason to believe that such resumed hormone production is any less effective in supporting tumour activity than that of the undisturbed gland, it is unreasonable to perform the operation by methods less than thorough.2. An Indiscriminate Selection of Patients for hypophysectomy.-The operation almost by definition can only be effective in hormone-dependent growths. Apparently not all breast cancer falls into this category, for we are not alone in observing failure to respond amongst totally hypophysectomized patients. Clearly a method of deciding prior to operation which cases were likely to respond would possess great clinical value. This can in fact frequently be performed by a simple consideration of the clinical data and without recourse to complex biochemical studies.This communication describes an operation designed to produce total hypophysectomy and a method to assist in the selection of cases who should be submitted to it. The operation technique consists of an open surgical removal of the gland followed by a packing of the fossa with yttrium 90. Patients treated by this method have been compared with a control series having surgery alone. Additionally, a retrospective analysis of certain points in the patients' history was made and these findings compared with the outcome of operation. By this means it was hoped to devise a method for the selection of patients likely to respond.
MATERIAL AND METHODSHypophysectomy was performed in 172 patients with progressive metastasizing breast cancer. Surgery alone was used in 70 and the other 102 had surgery plus yttrium 90. The last 96 patients constituted a clinical trial comparing surgery alone with surgery plus yttrium. The initial 76 cases treated before and during the time the yttrium method was being developed had either method on a purely chance basis. Originally these groups were presented separately, but as their results were similar they have been considered together here.
OPERATIVE TECHNIQUEThis has been fully described in previous communications (Edelstyn, Gleadhill, Lyons, Rodgers, Taylor, and Welboum, 1958; Edelstyn and others, 1964) and is only mentioned briefly. By a right-sided frontal approach the surgeon achieved as complete a removal of the pituitary as possible. Then, using a syringe, 10 m.c. of yttrium, previously suspended in wax, was pressed into the fossa. Yttrium is a pure @-particle emitter so the risk of damage to surrounding ...
