Through the routine analytical technique used for the study of the offbalances, we studied the changes occurring in a group of 56 subjects with different conditions, submitted to radiotherapy alone. We tried to correlate the clinical noxious effects of radiation to these offbalances.

Cancer of the breast

Fig. 270. L.N., 59 years old. Cancer of the breast. Mastectomy two months earlier. No recurrence. Treated with radiation, 125r per seance. Entirely uneventful except moderate erythema. Minimal or no changes in the analyses.

In this part of the study, we limited ourselves to the consideration of the immediate changes. Figs. 270 and 271 show the analyses in two cases in which no clinical, local or systemic changes were observed during and after the radiation. It can also be seen that no changes occurred in the analyses; they remained within normal limits during the entire period of observation. It is especially noted that the peroxides were present, almost constantly in high amounts in the urine.

Fig. 272 shows a case who died during the radiotherapeutic treatment, probably directly influenced by it. All the analyses show that a change toward offbalance type D had occurred. Among these, we want to single out the urinary surface tension and the urinary chloride index, both evidencing very manifest changes toward the patterns corresponding to type D. The peroxides were on the contrary almost completely missing from the urine.

Another case (Fig. 273) had severe clinical reaction to radiation which persisted until the death of the patient. Again, we judged these effects of radiation mainly through the changes occurring in the two analyses, urinary surface tension and chloride index, which show the same shift toward a strong offbalance type D. The peroxide reaction became negative at the end.

52 years old. Cancer of the hypopharynx

Fig. 271. K.L. 52 years old. Cancer of the hypopharynx. Treated with 300r for each session. The high specific gravity shows a tendency toward the type A, a month after the completion of the treatment.

While specific gravity and ST show a slight offbalance D during the treatment and the pH a manifest change toward the type D. following the radiation all the analyses show a change toward the type A, one month after completion of the radiation. Peroxides persisted in the urine. Clinically the entire evolution was eventless.

When the different tests were discussed, we mentioned that each one of the analyses used furnished information concerning changes which take place at a specific level of the organization. This would explain why the noxious effects are seen to be serious when the changes take place concomitantly in different analyses, that is, at different levels, indicating thus a more complete offbalance. When this concomitance does not exist, when the abnormal patterns concern only one analysis, the clinical manifestations are seen to be less serious. This was seen true in the case shown in Fig. 274. The importance of this concomitance in the changes present is seen in Fig. 275. In this case, although manifest changes corresponding to type D are seen for some analysis, they do not coincide. The peroxide reaction in the urine is constantly positive. This seems to permit the patient to withstand the noxious effect of radiation. The evolution of the changes induced by radium application is shown in Fig. 276.

The possibility to evaluate through urine analyses the noxious effects of radiations, has appeared especially important for the prevention and even treatment of the serious inconveniences during radiation therapy. By observing the changes in the analyses, particularly of the urinary surface tension and chloride index, valuable information can be obtained, permitting one to guide the application of these therapeutic agents. By being easily and continuously informed about the occurring changes, we need no longer consider the amounts of radiation to be administered as standard values for each patient. Through analytically guided radiotherapy one can replace the common pattern presently used for all patients by individualized treatments adapted to the need and the response of each subject.

58 years old. Cancer of the lung

Fig. 272. L.W., 58 years old. Cancer of the lung. After receiving only 1000r, very weak. Much worse after, with very rapid downhill course. After the treatment on 3/5, the patient entered into coma and died 3/7. The extremely high values for Cl I and high specific gravity characterize the analytical changes. It is interesting to note the negative reaction for peroxides for almost the entire time.

Cancer of the ovary with abdominal metastases

Fig. 273. W.M., 50 years old. Cancer of the ovary with abdominal metastases. Repeated doses of 100 and 120r. Almost uneventful for more than 1 1/2 months of treatment after which the specific gravity analyses pass into the D pattern. After two months, the CI index and ST show manifest concomitant changes toward the D pattern, a fact which coincided with a worsening of the general condition. In spite of changes in these analyses toward more normal values, the condition worsened with a lethal issue. The peroxide negative reaction—of bad prognostic in radiotherapy—is to be noted.

Continuously followed analyses permit their utilization as a guide for more general application of radiotherapy. When the surface tension and chloride index remain within normal values, treatment can be continued with administration of doses above those originally intended, without any danger of serious noxious effects. A change toward low surface tension below 65 dynes/cm. or high chloride index above 5, represents a warning which should not be ignored. The treatment should be discontinued, the dosage reduced or the sessions more widely spaced, even if the desired radiation dose has not yet been attained. Concomitant changes of the analyses should constitute a serious warning even when the general clinical condition does not indicate any abnormality. The bad prognosis of persistent strong "D" offbalance during radiation is related to the progression of the anomaly as described in the experimental studies. For this reason, a persistent strong offbalance D seen for the urinary surface tension and chloride index indicates the need for the administration of lipoids with positive character, even if the clinical manifestations are not too serious.

Cancer of the cervix intensively irradiated

Fig. 274. Cancer of the cervix intensively irradiated. Although changes occur in the analyses, the passages in offbalance D do not coincide in the different tests. With the continuation of the treatment, the patient passes in offbalance A. No clinical, noxious manifestations were seen.

Cancer of the larynx

Fig. 275. Cancer of the larynx. No changes in the analyses. Entirely without clinical noxious reactions. (The CI Index values are inverted.).

Cancer of the fundus of the uterus

Fig. 276. F.E., 64 years old. Cancer of the fundus of the uterus, treated with 45 mgr. radium for 122 hours in situ, with a total of 5490 mgr. hours. Felt subjectively well after radiation without any complaint. The analyses show a manifest change for almost one week from the type A to type D. For the S.T. it starts 2 days after the insertion of radium with the values dropping from 70 to 55. For the pH, the change started a few days later with the values passing from 7.8 to 4.6. The changes of CI I show values as high as 7 without however, having the changes coincide with the pH and S.T. 16 days after radium was taken out, the analyses went to previous values, except the peroxides, which remain present.