This section is from the book "Research In Physiopathology As Basis Of Guided Chemotherapy With Special Application To Cancer", by Emanuel Revici. Also available from amazon: Research In Physiopathology
Fig. 188. Anteroposterior view of the chest of the patient A.B. after ten months of treatment with hexyldiselenide.
At the beginning of February, the mass in the right lower lobe was almost entirely gone. The interlobular thickening of the left lower lung still persisted. In April, further clearing of the right lower lobe was seen. (Fig. 188) The patient received treatment with hexyldiselenide for a few more months. He continued in excellent condition without further treatment for the next three years. At the end of that time, there was a recurrence of pain and the mass in the right lower lobe reappeared and grew rapidly. Treatment with hexyldiselenide was resumed. The pain disappeared again within a short time, and the tumor again regressed.
I. A.—This 58-year old patient had diabetes beginning at the age of 30. It was controlled by insulin. At 35, he had rheumatic fever and remained in bed for 6 months. Angina developed at 53. In January 1956, he was awakened by a pain in the right side of the abdomen. The pain continued to be severe for months and the patient lost weight. Barium enema revealed nothing. He entered Jewish Hospital in Brooklyn with jaundice in April 1956. Upon operation, the gall bladder was found enlarged to twice its normal size and the common duct was dilated. With a finger inserted through the foramen of Winslow, a hard, stony mass involving the head, body and most of the tail of the pancreas, was felt. The tumor involved almost the entire pancreas. The lymph node of the common duct was enlarged. The liver showed no evidence of metastases. The general condition of the patient, in spite of the extensive involvement of almost the entire pancreas, did not justify a total pancreatectomy. Therefore, a palliative surgical procedure was done. The gall bladder was anastamosed to the jejunum.
The post operative course was good. No other treatment was prescribed. When the patient came under our care at the end of May 1956. the jaundice had disappeared but the pain was the same as it had been before operation. A mass occupying the upper abdomen was felt. Treatment was started with a dose of 30 micrograms of hexyldiselenide a day. This dose was increased later to 300 micrograms a day. The abdominal discomfort lessened; pain in the upper abdomen disappeared. The patient remained on this treatment until 1957 when epichlorohydrin was added to the hexyldiselenide. With the mixed treatment, the patient continued to improve and the tumor, which had been palpable in the upper abdomen, disappeared after a few months. Except for diarrhea, which occurs from time to time, the patient has made a very good recovery. He has continued on hexyldiselenide and epichlorohydrin and, at present, four years later, is in good general condition. No tumor can be felt and he is at his regular job.
C. M., 52 years old, male. In 1946, the left breast of this patient was removed because of a malignant tumor. In 1947, the right breast was removed but the tumor proved to be benign. In 1954, the patient, showing blood in the urine, was admitted to the Presbyterian Medical Center where a right kidney tumor was diagnosed. In February 1955, the patient underwent surgery. A tumor of the right kidney with extensive lymph node involvement above and below the renal vessels was found. A simple nephrectomy was performed, the lymph nodes being considered inoperable. The pathological report revealed "clear cell carcinoma of the kidney with extension into the renal vessels and surrounding tissue." There was no evidence of pulmonary or other metastases.
The patient did not undergo any treatment at this time and felt well until September 1955, when he experienced increased fatigue, flatulence, slight pain in the right kidney region, and some abdominal pressure. No abdominal mass or lymph node involvement was found. He was treated with hexyldiselenide, starting with 200 micrograms a day. This dose was increased progressively until it reached 2 1/2 milligrams a day.
Under this treatment, most of the patient's pain disappeared and no palpable mass could be found. The patient continued treatment, with the same dose, until October 1957, when epichlorohydrin was added. At first, with the new medication, the patient was more tired and there was a noticeable increase in perspiration. However, after a short time, he continued to improve. At present, he is still taking 15 milligrams of epichlorohydrin, and 100 micrograms of hexyldiselenide daily. He feels well, continues normal work, and no tumor is palpable now four and a half years since the beginning of the treatment.
W. H.—In March 1954, at the age of 11, this boy had the first of three brain operations at the Jersey City Medical Center. He had complained of persistent headaches for about a year. A brain tumor was removed and on pathological examination, was first thought to be benign, but later proved to be malignant (spongio blastoma). By August of 1954, his symptoms recurred and a swelling appeared in the area of the scar. At the second operation, it was possible to remove only a part of the recurrent tumor. In November 1954, local swelling and headaches returned. X ray treatments failed to give relief and a third operation was performed, but only a piece of tumor was removed. It showed the same pathology.
He came under our care May 3, 1955, and was treated, because of low sulfhydryl urinary index, with hexyldiselenide, in dosages ranging from 300 micrograms to 1 milligram per day. This treatment was continued for one year. He has done remarkably well since. He has had no headaches, is more alert and less drowsy than at any time since he first became ill. There has been no evidence of recurrence. Since treatment, there has been a definite reduction in involuntary movements of his head, extremities and body, which appear to have been related to the tumor growth. There have been no abnormal manifestations to date, five years since the beginning of the treatment. The patient goes to school and engages in all the activities of a normal boy of his age.
Mrs. A. L.—This patient first noted a lump in her neck in the summer of 1953 when she was 26 years old. In February 1954, a second lump appeared. Surgery was performed at the Ottawa Civic Hospital. The pathological examination showed a cancer of the thyroid (papillary adenocarcinoma). It involved both sides of the gland and many of the lymph nodes. The entire thyroid gland was removed and bilateral lymph node dissection was done in two stages. Since the surgeon felt that he had not removed all the affected areas, the patient received deep neck X ray therapy following the operation. However, by July 1954, a new mass developed on the right side of the neck and this was removed in November. The pathological examination proving it to be the same type of tumor.
The patient was first seen by us on January 10, 1955. Although it was only two months since the last operation, there were several recurrent tumor masses in the lateral right side of the back of the neck, as well as infiltrations into the area of the last operative wound. The patient was treated with hexyldiselenide, in doses ranging from 300 micrograms to 1 milligram daily. Under this treatment, the masses progressively decreased and, after 3 months, disappeared. She continued the treatment for another six months. Now, after 5 1/2 years, she is feeling well, has had no recurrences, and is carrying on her usual activities as a housewife and mother.
Hexyldiselenide, although it produces impressive results, very often is not of itself able to provide enduring benefit. Many other patients have had recurrences, some in spite of impressive first results and continuation of treatment as shown in the following observation. J. D., 10 years old, came under our care in a preterminal state, after an exploratory laparotomy revealing an extensive carcinoma of the liver. (Fig. 189) The response to hexyldeselenide treatment was impressive with the patient making a perfect recovery. His liver which had filled the abdomen, returned to normal dimensions. The patient continued a normal life for 2 years when, in spite of the continuation of the treatment, generalized recurrences appeared. These could no longer be controlled.