The above considerations appear important in the radiotherapy of tumors. The tissular and systemic changes related to the intervention of fatty acids, especially when these changes are sufficiently intense, in themselves can act upon tumors. However, when abnormally intense, they can constitute a serious limitation for continuation of radiation. The manifestations that result from the pathogenic effect of abnormal fatty acids, if intense, can prevent the use of large doses of radiation which would otherwise be necessary to influence a tumor through a direct effect upon the lower levels of the biological organization, histones, nucleo proteins and even genes. Consequently, the appearance of abnormal fatty acids, which represent an important factor in the biological effect of radiation, can be considered as a favorable effect when we seek to bring about systemic changes and influence pain and metabolism, particularly at higher levels. At the same time, they can also represent a principal obstacle to the more effective use of this same therapeutic agent when one wants to obtain an effect at lower levels.

As for the effects obtained through the influence exerted by fatty acids, they can be decreased by changing the antagonistic relationship between the abnormal lipids and the defense mechanism of the adrenals. With small amounts of radiation separated by long intervals, the intervention of the adrenals, as long as they function normally, can overcome the effect of the fatty acids. With higher doses applied more often, the fate of the irradiated individual depends upon whatever antagonistic factor predominates. With high doses or with a relative adrenal insufficiency, the direct effect of the abnormal fatty acids can become predominant. In that case, the type D offbalance will be more pronounced. It is in such offbalance that subjects die from too intensive radiation. These factors can be of major significance in the intervention against accidental radiation as well as in guiding the therapeutic use of radiation.

Because of the intervention of abnormal fatty acids, systemic radiation does not seem to be the best procedure unless a very intense systemic effect is sought. If this effect is desired, it can be obtained through a method other than radiation. Furthermore, as we have noted above, the conjugating effect of radiation upon fatty acids is almost entirely limited to the production of trienes and dienes. The biological effects of such conjugated fatty acids are more apparent at the tissue level and above it. The energetic value of conjugated trienes and dienes seems to be too meager to permit them to act intensively at levels lower than the cells or nuclei.

In order to have a manifest fatty acid effect, it appears necessary to have an adequate application of radiation. Since an exaggerated systemic action of the abnormal fatty acids may even induce lethal effects, radiation does not appear to be the therapeutic method of choice for an influence exercised through fatty acids. Radiation, however, is more compatible even with a desired localized effect through the limitation of the field in which the changes in fatty acids are induced. In this case, fatty acids may intervene with a lower systemic influence. This accounts for the analgesic action of radiation which probably is related to an effect exercised by local fatty acids. Even here, however, the appearance of an alkaline pattern of pain can lead to undesired changes. In this case, radiation will increase the intensity of pain. This fact reduces the indications for use of radiation even at the tissue level.

Biologically Guided Radio Therapy

The knowledge of the important roles played by abnormal fatty acids and anti fatty acids in the biological effects of radiation has suggested a biological guide for radiotherapy. Urinalysis, by reflecting various systemic changes, can serve as a valuable indication of manifestations and processes present in subjects undergoing radiation. The persistence of a pattern related to predominance of fatty acids indicates that the patient has passed into an imbalance that can only be increased by further irradiation and, if it becomes sufficiently intense, may even prove to be lethal, causing the patient to die with symptoms of severe shock. In contrast, a pattern corresponding to the predominance of sterols could be considered as being consistent with a preponderant reactive response, which would indicate that higher amounts of radiation could be used without danger. From a practical point of view, the information given by the urinary surface tension has appeared very valuable. The moment when, and the amount of, irradiation to be given can be determined by these analyses. A low surface tension would contraindicate administration of radiation while high values would indicate that radiation should be increased.

The administration of lipids or lipid like substances would represent a method of controlling undesirable processes and allowing more effective use of radiation. If the reactive intervention of adrenals appears too strong, a lipoid with negative character could be added to counteract this and, consequently, could increase the desirable effect of the radiation. Subjects receiving fatty acids or sulfur preparations along with radiation have shown intensive local effects with very small doses of radiation. Epidermitis and mucositis were seen in such patients even with doses as low as 600 r. The same intensive effect could be seen in the tumors. The use of lipoids appears indicated when an intensive effect through fatty acids is sought, as in lymphatic tumors. On the other hand, if the effect of fatty acids is higher than can be accepted, and represents a handicap for the desired effect on proteins, then adrenal hormones or other anti fatty acids must be added. By reducing the effect of abnormal fatty acids, it becomes possible to obtain a more intense impact on proteins and, at the same time, to avoid the otherwise inherent undesired side effects. The choice of the anti fatty acid agent must be guided by the level at which the effects of the abnormal fatty acids would make themselves felt. While corticoids act especially upon systemic and organic levels, sterols and other positive lipoids act upon the lower levels. Butanol and similar agents are effective upon local changes, such as pain.

The guidance of radiation therapy, as an example of how this new view may be used to improve therapeutic approaches, will be discussed later.