Radium treatments of lesions

The following notes for the treatment of lesions using radium (beginning 1928 in Queensland) are taken from KM Hoffman’s The History of the Queensland Cancer Trust and the Queensland Radium Institute. Radium was most frequently used for surface lesions:

Most treatments of surface lesions were with radium moulds, radium being mounted on columbia paste (consisting of bees wax, paraffin wax and sawdust mixed) and set in 2 cm. thick layers. Several of these moulds were made and kept in stock and on the day of treatment were placed in an incubator to make them pliable and then moulded to the shape of the lesion. Radium needles were applied on the outside of the mould. The needs were heated in a small flame and applied to the wax. These needles would then be covered with sticking plaster and the mould applied to the lesion. Moulds were usually kept on for seven days and after removal the area would be dressed with Eusol every two to four hours and the patients would be nursed under mosquito nets to prevent them from infection from flies. An accurate record was always kept of the amount of radium that was used. There were few clinical or physical guidelines at this stage to help the therapist and treatment initially was partly experimental. If a lesion did not appear to respond the therapist would order further radiation and in some cases underdosing occurred whereas in others necrosis resulted.

Radium was also used in conjunction with diathermy and surgery:

Radium moulds were used in the treatment of breast carcinoma after surgery, and as much as 200 mgms. of radium would be used in these moulds on some occasions. The moulds would be removed every four hours and the patient’s skin would be patted gently with methylated spirits and talc powder applied to relieve pressure points and then the mould was reapplied and kept in position with crepe bandages. This was a seven day treatment. As the moulds were heavy patients were kept in bed as much as possible so that the mould would remain in position.

“Distance radium” treatments were used for nodes:

Sometimes a 100 mgm. radium “bomb” was constructed to treat lymph nodes in the neck, groin or other sites. For lesions of the palate a dental mould would be made and radium needles would be inserted in these moulds which would be worn for a few hours daily.

Those dosage system was far from clear and doses were usually spoken of as milligram hours but the dimensions of the lesion and the distance the radium was from the lesion was not always clearly stated so that the dose in roentgens was not recorded.

There was also treatments of deep-seated volumes:

… there were “interstitial radium” needle methods in use: the needles being threaded and implanted into lips, vagina, breast, lymph nodes, tonsil and other sites. Radium tubes would be inserted in the vagina and cervix, this latter work being done by a gynaecologist in the general theatre but a radium sister would be in attendance. Urological procedures were also done in the general theatre by a urologist with the radium sister responsible for the radium.

Three strengths of radium needles were provided. For interstitial work:

Unit Strength [needles] with bullet points each centimetre of active length containing one milligram of radium which meant there would be one milligram of radium or two, three, four, etc. according to the active length of the needle, the overall length would be a little greater.

For moulds or distance work:

Double Strength needles with conical shaped ends and 2 mgms. of radium for each centimetre of active length. Therefore, a 5 c.m. active length needle would contain 10 mgms. of radium.

Triple Strength needles with trocar points containing 3 mgms. of radium per centimetre of active length.

Hoffman questioned whether the occupational exposure could have been reduced with improved practices but notes:

The radium sister had a blood count every month. She had senior sister status, received extra pay, was given extra nourishment such as liver and bacon for breakfast and extra salad and vegetables and she worked 35 hours a week and had six weeks holiday annually.