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Roentgen therapy in Lymphadenosis and Sinusitis in childhood
RAHMAN ET AL
THE JOURNAL OF PEDIATRICS SEPTEMBER 2001
50 Years Ago in The Journal of Pediatrics ROENTGEN THERAPY IN LYMPHADENOSIS AND SINUSITIS IN CHILDHOOD.WITH TEN-YEAR FOLLOW-UP OF 349 CASES Levy H. J Pediatr 1951;39:223-36 Dr Levy describes the common practice in the early 1900s of using roentgen therapy as a means of decreasing tonsil and adenoid mass, with the primary goal of reversing eustachian tube obstruction and preventing hearing loss. In essence, instead of surgically removing the tonsils and adenoids, low-dose radiation was used to ablate or diminish the lymphoid tissue. The benefits of this practice were described as reducing hearing loss, decreasing the incidence and complications of sinusitis, and improving asthma associated with sinusitis. Before the use (some would say abuse) of antibiotics became common in pediatric patients, focused radiotherapy provided a therapeutic option other than surgery for tonsil and adenoid hyperplasia and sinusitis. Similarly, radiotherapy directed to the scalp was commonly used to treat tinea capitis. Low-dose irradiation was given either by an external source or by directly “painting” radium on the targeted tissue. The long-term effects of these practices were unknown. No significant sequelae were uncovered in the 349 patients (of a total 1400 irradiated) for whom Dr Levy had 10-year follow-up data. Subsequent studies have shown that radiation to the scalp or tonsils has resulted in an increased incidence of skin, brain, thyroid, and salivary gland tumors. Newer laboratory tests have shown that late neuroendocrine effects are common; development of myxedema was the only measure of thyroid dysfunction in Dr Levy’s analysis. Moreover, the risk of developing such complications may be lifelong, manifesting several decades after the initial radiation exposure. Significant late effects of scalp or tonsil radiotherapy are also increased with young age at the time of exposure, similar to the markedly higher incidence of late effects after radiation therapy for head and neck cancers in the youngest children. Five decades later, the impact of treating tonsil and adenoid hypertrophy and otitis media on preventing hearing loss remains controversial. We must remember that each therapeutic intervention has potential risk, both shortterm and potentially long-term. Although Dr Levy demonstrated no significant short-term risk, half a century later we are beginning to understand the long-term cost of such therapy. Robert Bash, MD Division of Pediatric Hematology-Oncology University of Texas Southwestern Medical Center at Dallas Dallas, TX 75390-9063 9/37/118187 doi:10.1067/mpd.2001.118187
458
THE JOURNAL OF PEDIATRICS SEPTEMBER 2001
50 Years Ago in The Journal of Pediatrics ROENTGEN THERAPY IN LYMPHADENOSIS AND SINUSITIS IN CHILDHOOD.WITH TEN-YEAR FOLLOW-UP OF 349 CASES Levy H. J Pediatr 1951;39:223-36 Dr Levy describes the common practice in the early 1900s of using roentgen therapy as a means of decreasing tonsil and adenoid mass, with the primary goal of reversing eustachian tube obstruction and preventing hearing loss. In essence, instead of surgically removing the tonsils and adenoids, low-dose radiation was used to ablate or diminish the lymphoid tissue. The benefits of this practice were described as reducing hearing loss, decreasing the incidence and complications of sinusitis, and improving asthma associated with sinusitis. Before the use (some would say abuse) of antibiotics became common in pediatric patients, focused radiotherapy provided a therapeutic option other than surgery for tonsil and adenoid hyperplasia and sinusitis. Similarly, radiotherapy directed to the scalp was commonly used to treat tinea capitis. Low-dose irradiation was given either by an external source or by directly “painting” radium on the targeted tissue. The long-term effects of these practices were unknown. No significant sequelae were uncovered in the 349 patients (of a total 1400 irradiated) for whom Dr Levy had 10-year follow-up data. Subsequent studies have shown that radiation to the scalp or tonsils has resulted in an increased incidence of skin, brain, thyroid, and salivary gland tumors. Newer laboratory tests have shown that late neuroendocrine effects are common; development of myxedema was the only measure of thyroid dysfunction in Dr Levy’s analysis. Moreover, the risk of developing such complications may be lifelong, manifesting several decades after the initial radiation exposure. Significant late effects of scalp or tonsil radiotherapy are also increased with young age at the time of exposure, similar to the markedly higher incidence of late effects after radiation therapy for head and neck cancers in the youngest children. Five decades later, the impact of treating tonsil and adenoid hypertrophy and otitis media on preventing hearing loss remains controversial. We must remember that each therapeutic intervention has potential risk, both shortterm and potentially long-term. Although Dr Levy demonstrated no significant short-term risk, half a century later we are beginning to understand the long-term cost of such therapy. Robert Bash, MD Division of Pediatric Hematology-Oncology University of Texas Southwestern Medical Center at Dallas Dallas, TX 75390-9063 9/37/118187 doi:10.1067/mpd.2001.118187
458