Effect of direct irradiation on the course of pulmonary tuberculosis (using cancerocidal doses).

The primary objective of this study was to determine whether there is any hazard in the use of irradiation to the thorax for neoplastic disease coexistent with pulmonary tuberculosis. The association of lung cancer and pulmonary tuberculosis has become a problem of much significance. There has been in recent years a striking increase in lung cancer incidence and mortality. Tuberculosis which heretofore had been a disease chiefly of young adults has become a disease of middle age and older persons, predominantly men. Longevity has increased in tuberculosis patients. Lung cancer and pulmonary tubercu.losis are therefore prevalent in the same age and sex group, namely, the older man. The expectation is that the frequency of this coexistence will continue to increase. In the predrug era, there were few reports of carcinoma associated with tuberculosis, as many tuberculosis patients died before reaching the cancer age. In recent years, there have been a good number of reports of coexistent pulmonary tuberculosis and primary lung cancer.1-’3 In these, when therapy is discussed, the possibility of surgery for the neoplasm is considered. X-ray therapy for inoperable or unresectable carcinoma in the presence of tuberculosis is not recommended apparently because of the accepted opinion that irradiation of a tuberculous lesion will cause its reactivation. On theoretic consideration, it was our belief that pulmonary tuberculosis under effective control of antituberculosis drugs would not contraindicate the application of radiotherapy. A preliminary study of the effect of irradiation in eight patients with pulmonary tuberculosis under the cover of antimicrobial therapy was carried out in the New York City Municipal Sanatorium at Otisville, New York in 1953 and 1954. This study was stimulated primarily by Dr. Fred Elias, the roentgenologist. In this experience, it was found that with antituberculosis drugs being used, radiotherapy with small and moderate doses (400 r to 2000 r [air] and the mid-lung dose with the factors used averaged 30 per cent of the air dose) could be administered directly to active pulmonary tuberculosis of cavitary nature without danger of deterioration of the tuberculosis. It was, therefore, planned to carry this work a step further and we felt justified in using larger x-ray doses where indicated. In the present study, cases of inoperable lung cancer