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Radiotherapy for the Treatment of Pulmonary Complications of Paraquat Poisoning

Department of Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan, R.O.C. 50022

M.R. Barnes

Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan, R.O.C. 50022

The effect of radiotherapy on the pulmonary damage caused by paraquat (24% solution of 1,1'dimethyl-4,4'-bipyridylium dichloride) was investigated in a preliminary series of nine patients. Paraquat intoxication was diagnosed by quantitative analysis of urine and plasma using colorimetry after extraction of a cation exchange column. The irradiation was given as a planned procedure from day 2 in cases 1 to 7, and after changes in chest X-ray were recognized in cases 8 and 9. A cobalt-60 unit with opposed anterior and posterior portals was used to give a total dose of 12.50 Gy (uncorrected) over 10 fractions, sparing the pericardium and mediastinum as much as possible. Each fraction consisted of 1.25 Gy (125 rad) given once a day, alternating between the left and right lungs.

Radiological diagnosis consisted of clear chest X-rays (cases 2 to 4), pulmonary oedema (cases 7 and 9) and interstitial infiltrates (cases 1, 5, 6 and 8). Cases 1, 5, and 8 survived. Case 8 had residual interstitial infiltrates three months after ingestion but these had cleared one month later, suggesting that the diagnosis of irreversible fibrosis should only be made after a follow-up period of at least one year. The results have failed to show a definite benefit, but do support the fact that radiotherapy should be assessed carefully in a randomized trial which is now in progress.

Human & Experimental Toxicology, Vol. 7, No. 4, 325-332 (1988)
DOI: 10.1177/096032718800700405


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