Pituitary Destruction by Injection of Radioactive Substance and Section of the Pituitary Stalk for Advanced Cancer

Abstract

TRANSFRONTAL hypophysectomy is an established surgical procedure in the treatment of advanced cancer. Results of this operation have been reported by Perrault, Le Beau, Klotz, Sicard and Clavel (1952), Shimkin, Boldrey, Kelly, Beirman, Ortega and Naffziger (1952), Luft and Olivecrona (1953) and by Pearson Ray, Harrold, West, Li, Maclean and Lipsett (1956). Luft and Olivecrona (1953) All the available evidence indicates that only those cases of breast cancer which are hormone dependent benefit from removal of the pituitary. The present difficulty in selecting patients with breast cancer for operation is to determine those whose growths are in fact hormone dependent.Two possible tests are available. In one (Pearson et al., 1956) oestrogens are given and the effect on the mammary cancer noted, an increase in activity indicates that the growth is influenced by oestrogens and that hypophysectomy might be of value. The second test is the estimation of the mammatrophins in the urine (Hadfield, 1956). Further work on these methods is awaited with interest. It should be noted however that while patients who have had a favourable response to oophorectomy or to androgen therapy are likely to have a favourable response to hypophysectomy, failure to respond to androgen or oestrogen therapy does not necessarily mean that the patient will fail to respond to hypophysectomy.In view of the reported results of hypophysectomy in advanced cancer, it was decided to attempt to destroy the pituitary gland by local irradiation in cases of malignant disease where the tumour was likely to be hormone dependent. Chromic phosphate was injected into the gland, the phosphorus being in the form of the radioactive isotope p32. This method was described by Rothenberg, Jaffe, Putnam and Simkin (1955). It appeared a less severe procedure than hypophysectomy in a seriously ill patient. Radioactive colloidal chromic phosphate seemed theoretically an ideal substance for pituitary ablation by radiation. It is precipitated upon injection and

Necrosis of Anterior Pituitary in Humans (Part II)

“…Theoretically, this compound should be the ideal substance for pituitary ablation for the following reasons: it is precipitated upon injection and remains at the injection site; it emits beta radiation with a maximum effective penetration of only 0.8 mm in body tissue; is has a half life of 14 days, which is very con venient when planning the operation. In spite of all these advantages, radioactive chromium phosphate has not proved suitable, because it is not possible to achieve significant or complete pituitary destruction with it: severe pituitary damage ensues only if the pituitary stalk is also injured during the surgical manipulation, i.e., if the blood supply to the pituitary is disturbed [D avies and Buxton, 1957; J o h n so n et al., 1968].…”

The Pituitary and Adrenal Cortex in General Medicine

“…The endocrine changes resulting from this operation have been followed, and have confirmed some of the reported results of animal experiments on the control of pituitary function. (Preliminary accounts of these cases have been given by Davies and Buxton, 1957;Buxton et al, 1958. ) Pituitary-Stalk Section This operation was performed on 15 patients between September, 1956, andMarch, 1957.…”

The Pituitary and Adrenal Cortex in General Medicine

“…Total hypophysectomy by the transfrontal, transseptal-sphenoid (Heck et al, 1957), and trans-antrosphenoidal (Hamberger et al, 1959) (Tobias et al, 1958 Davies and Buxton, 1957;Buxton et al, 1958. ) Pituitary-Stalk Section This operation was performed on 15 patients between September, 1956, andMarch, 1957.…”