Comparative Evaluation of Radioactive Colloidal Gold and Nitrogen Mustard in the Treatment of Serous Effusions of Neoplastic Origin

Abstract

Since its introduction by Müller in 1949, intracavitary radioactive colloidal gold therapy for carcinomatous effusions has become an almost universally accepted mode of treatment. A substantial body of literature (1–12) attests to the fact that this isotope can be expected to control the production of neoplastic effusions in 50 to 70 per cent of all cases. Most authors have agreed that it is most effective when the primary neoplasm originates in the ovary or breast. Those who have worked with colloidal Au198 realize, however, that there are certain disadvantages inherent in its use: (a) the treatment is rather costly to the patient; (b) the short half-life and local unavailability necessitate careful planning and sometimes entail considerable delay in treatment; (c) the amount of radioactivity involved dictates certain precautions against exposure of nursing personnel which militate against optimum nursing care for the patient; (d) even with the best apparatus currently available for instillation, there is a distinct radiation hazard to persons administering this treatment. Several authors (13–17) have called attention to nitrogen mustard (HN2) as an agent which is also effective in the control of malignant effusions. Since nitrogen mustard is much less expensive than radioactive colloidal gold, and since no radiation hazard is implicit in its use, it is the purpose of this paper to compare the efficacy of mustard and radioactive gold therapy, with a few observations concerning the use of the two in combination. Method of Nitrogen Mustard Therapy Immediately prior to the instillation of HN2 the patient is given Seconal and Thorazine. In cases in which there are pleural or peritoneal effusions of cancerous origin, nitrogen mustard is administered in a single injection of 0.4 mg. per kilogram of body weight, in 50 to 100 c.c. of sterile normal saline. If an excessive volume of fluid is present at the time of the therapeutic tap, all but a small amount is removed. A free flow of fluid must be present before instillation of HN2 in order that sufficient remain to insure dissemination of the mustard and to guard against the introduction of the substance sub-cutaneously or into a loculated pocket, where it might cause local tissue damage and necrosis. Mustard is instilled intraperitoneally through a small rubber catheter inserted through the paracentesis trocar, and in cases of pleural involvement through the thoracentesis needle. For pericardial effusion, a dose of 0.2 mg. per kilogram of body weight is generally employed. Following administration of HN2 the patient's position is changed every five to ten minutes for a period of one hour, as is done in the radioactive colloidal gold therapy routine, to insure uniform distribution throughout the involved serous cavity.