Large-Field Radiotherapy in Lethal Midline Granuloma

Numerous publications on lethal midline granuloma have recently appeared. We have one purpose in further encumbering the literature: to reinforce the plea for early institution of large-field, small-dose irradiation. Such treatment is aimed at modifying the localized “hyperimmunity” which in some still obscure way may be responsible for this relentless destructive process. That irradiation can suppress the immune response has been well demonstrated in other quite unrelated instances, e.g., in heterologous bone-marrow infusions, in organ transplantation, and in modification of the Sanarelli-Shwartzman phenomenon. Irradiation of lethal midline granuloma is not new. Its possible value was first suggested by M'Arthur and Dew in 1925 (18), was later brought up again by Ellis (6, 7) and by Glass (9), and more recently by Walton (27), Merrill (16), Wildermuth (29), and Dickson (5), among others. In addition, data gathered in a comprehensive review of the literature by Blatt et al. (1) reveal that 5 of the 6 “sur...