This is obviously important for 
avoidi.ng the leading of current through the myocardi­
um. Tb~ structures of the trJ:ated organ also are impor­
tant in direct current treatment , because they affect 
the pathways for current. For example, Fig. XVII: 22 a illustrates the cathode positioned across the 
vascular bundle central to a lung tumour and inside 
the same segment or lobe as the tumour, assuring 
favourable conductivi ty and spatial distribution of cur­
~nt. Fig. XVII: 22 b, however, shows the cathode 
positioned beyond the interlobar pleura, which 
hinden current Oow. Any air leak into the pleural 
space will further enhance the hindrance, so that the 
current must pass in a wide arc over the hilar tissues. This broad and indirect course is unnecessary. Resis­
tance to Oow will be increased and may even theoreti­
cally produce unexpected reactions, ~.g., from nerves 
in the hilum. Pneumothorax is a likely complication of traru;thora­
cic insertions of electrodes. In order to contrOl this 
complication, one should int.roduce a pleural drainage 
rube before the electrodes •~ to be implanted. When 
the pleural tube is connected to a suitable suction 
device, collapse of the lurtg can be prevented. During 
the treatment, pressure in the pleura must be continu-ously maintained at subatmospheric levels, so that the 
lung is maintained expanded . Constant size and posi· 
tion of involved lung are necessary to prevent a pneu· 
mothorax from dislocating the electrode from the tu· 
mour. Absence of pneumothorax is also obviously nec­
essary for respirator y comfort and safety of the patient. The pleural drainage tube should be kept in place a 
day or two under constant suction after conclusion of a 
treatment with direct current. 6. Voltage and current 
In experiments on animals, up to 40 volts have been 
applied between electrodes in the lung. ln patients, usually 10 volts (range, l.S-15 volts) 
have been used. Initially, current should be applied by 
evenly elevating the voltage from 0 to the desired level, 
which in practice has been performed during one 
minute. Similarly, the current should be lowered slow· 
ly, e.g., over about a minute, on concluding the treat· 
ment. Otherwise the patient will experience pain or 
unpleasant contractions of local muscles by faradic 
stimulation . The actual amount of current passing through the 
circuit increases continuously in the beginning, as a 
function of continuousl y increasing ionization of tis· 
sue. Electroosmotic, electrolytic and electrophoretic 
phenomena associated with deposition of material on 
the surfaces of the elecuodes will then diminish the 
rate of increase in conductivity. The current may even 
suddenly become interrupted, usually as a conse­
quence of gas forming at the electrode surfaces. As 
voltage and current increase, the likelihood of newly formed gas blocking the flow of current also increases. Sudden pain will then be felt by the patiem. Increase 
in voltage may then temporarily restore conductivity 
until a new spontaneous interruption takes place. This 
method of restoring current should be avoided. ln· 
stead, one should either wait until the accumulated gas 
on the electrodes has spontaneously resorbed, or re­
move the gas, e.g., by suction and infusion of saline 
solution. These procedures require electrodes such as 
those described with a channel available for suctioning 
and injection. The total quantity of coulombs passed between the 
electrodes must be determined, as it offers an expres­
sion of the "dose" delivered. Because the current is 
continuously changing , continuous integration of cur· 
rent and time is necessary to determine the dose in 
t'Oulombs. In order to deliver about 200 coulombs at I 0 volts to 
a patient with a lung tumour, 2-3 hours has been 
found necessary when the distance has been 5 em 
between two platinum electrodes, each with a total 
surface of 20 mm1• The initial current has usually been 
5 to 10 rnA, which then increased spontant'Ously to a 
maximum of 30 to 40 rnA. Because control of applied voltage and current is 
critical for the qualitative effects of DC treatment, a 
DC Treatment Processor2 (Fig. XVII: 23) has been 
constructed. This processor automatically adjusts cur· 
rent and voltage not to exceed predetermined values. 1 IXvc:Joped in cooperation with Mr Jerker Ob;son and Tekniska 
Ri. 'tntgencentnJc: n AB (TRC). The instrument is manufactured and 
.sold by Teknisk:a ROntgcncentralen AS, P.O. &x 50100, S-10405 
Stockholm, Sweden. Fig. XVII: 23. Processor developed for direct current treatme.nts. (a) External display of variables in a course of DC 
treatment. (b) Block diagram of the apparatus . • 
• II i 1!! !1 . ~~I!!! . • • • . =0 ~ frC 
-o 
~ .. -A -C• 
-·-:-"c. l:::::::!~o. J l~:;;r.) 
t t 
Jt!N• I Jl•'tl"'',. I~;~~ 
I~! ;~~ 
1,. ... _ 
·~· 
I~~ ....... <N-
I~~ ... ,., .. ...... .,, 
1-l~::.f·i~to; 
I~::~:. ;- · I ~~··~" ol·llt Oy I I ~~,:~~:: I 
,....,.,_.,. ro.o-""''" • 
L rl, ... : .... 
..... H_ 'tO! "'f"' , ........... ·••d·l ~>l' 
Treatment of cancer 293 Within chosen limits, the apparatus can keep current 
and voltage constant. The actual current is measured 
and integrated over time. Current, voltage and accu­
mulated charge are presented in a digitized form and 
can be displayed on a chan writer. In the event of 
undesired changes of currents, alarms are activated. Initial and concluding currents are modulated gradual­
ly, to prevent pain and muscle spasms for the patient. 7. Discussion 
For definite control of a cancer, the specific quantities 
of current and voltage needed are still in the process of 
defmition. It does now appear clear that at volt"'ges of 
10 volts or less, heat produced around the electrodes is 
only a minor consideration. At higher voltages, sparks 
can produce considerable local heat. Prominent destructiv e effects are known to take 
place around the cathode at "high" voltages, while very 
minu.te but permanent changes are produced at "low" 
voltages (31). The most destructive effect around the 
cathode is produced by alkalinity, wh.ich may locally 
reach a value of pH 12. Blood pigment is then trans­
formed into dark alkaline haem. Some of the destruc­
tive effects are produced by the pressure of hydrogen 
evolved at the cathode. Inflowing electroosmotic water 
around the cathode also elevates the local turgor pres­
sure, wh.ich causes compression of vessels. Arou11d the electrodes interactions also take place be· 
tween blood flow and electric field forces on charged 
partides, as described for cathodic accumulation of 
leukocytes (Chapter XIV). Arou11d the anode relatively extensive changes in tis­
sue are obtained also at fairly low voltages (below 10 
volts). The destructive effect around the anode is pro­
duced by an abundance of protons, liberated by elec­
trolysis at the surface of the e.lectrode. After the pro­
tons diffuse and migrate in the electric field, a region 
of dark acid haem is produced (pH">2). Centrally 
around the anode the dark material is bleached by 
liberated chlorine gas. This gas and liberated o•xygen 
incre.ase the pressure around the anode, leading to 
cavitation. Electroosmotic dehydration of the de­
stroyed, dark anodic area produces a rather well de­
marcated border against surrounding tissue. To these cathodic and anodic primary destructions 
of tissue around the electrodes are added several, easily 
distinguishable, acute biological reactions (Chapters 
XII, XIV) around the cathode. Considerab le local oe­
dema develops around the cathode. The tissue is soft, 
partly dark coloured or pinkish and shows a decreased 
amoumt of red blood cells and leukocytes. Around the 
anode the tissue is dry and shows extensive throm­
boses in capillaries, contractions of capillaries, d.iape­
detic haemorrhages, discolouration of vessels and ac-
294 Treatment of cancer cumulation of large numbers of leukocytes, which are 
both intravascular and perivascu lar. Such accumula ­
tions of leukocytes occur preferably at low electrode 
potentials (e.g., 0.1 V). After intravascular injection, a 
charged chem.ical compound m:ay accumulate selec­
tively around one of the electrodes , indicating that this 
principle also may be utilized for therapy. The anodic and cathodic reactions described form the 
basis for the hypothesis that direct current can be used w 
control tumour growth. The amtrol derives partly from 
desrrucrion of tumour tissue and pa.rt/y from field-induced 
modificatioiiS of the environmtllt of the tumour. There are many d.ifficulties in defming proper dos­
age for treatment with d.irect current. The amount of 
current flowing between the electrodes is not a conclu­
sive way to measure the magnitude of treatment. Th.is 
effect can be explained as follows: 
When anode and cathode are placed very close (e.g., 
I em,) to each other, large amounts of current may 
pass through the circuit and yet the spatial extent of 
biologic and destructive effects will be quite lim.ited. When large distances (e.g., 10 em) separate the elec­
trodes, local densities of current per unit volume of 
tissue are lower (with an equivalent flow of current) 
than when the electrodes are closer. A treatment may 
nevertbeless be produced by some primary destruction 
of the tumour supplemented by biochemical alter­
ations also in a relatively large volume of tissue. The 
positioning of the electrodes is in any case an exceed­
ingly important factor to consider in direct current 
treatment. Moreover, the influence of the electrode 
technique also correlates directly with the conductivity 
of tissue, buffering capacity of tissue fluids and influ­
ences by tissue circulation. Because direct current in 
many ways influences and interferes with biological 
reactions, extensive destruction of tissue by direct cur­
rent docs not necessari ly correspond with beneficial 
biologic influences on surroundi ng tissue. As an exam­
ple, many leukocytes can be attracted to the anode at 
relatively low electrode voltages (2-3 volts) but are 
massively destroyed in the anodic field at 10 volts 
(Chapter XIV). Varied reactions of other cells and 
tissue components have also been observed under the 
influence of direct current (Chapter XIV). Conducting 
properties of different tissues may also produce un­
foreseen pathways for the current. The interactions of many variable factors can there­
fore explain why different effects can be obtained in 
tissues even with essentially comparable amounts of 
current. Furthermore , it seems likely that DC treat­
ment should be most beneficial when the technique 
approaches the mechanisms of dosed circuit transport 
in spontaneous healing. This consideration implies 
the use of energies perhaps in th.e range of a few volts 
and a few microamperes over long time periods. It also 
implies a fururc introduction of slowly fluctuating , attenuating potential differences between diseased and 
healthy tissue. Knowledge about beneficial effects of 
such approaches can obviously be obtained only from 
extensive, systematic , experimental and clinical trials. D. Direct current treatment 
of malignant tumours in lung: 
experience in 20 patients 
l. Case material 
Direct current treatment of cancers in lungs of the ftrst 
five patients in this series was reported by the author 
in 1978 ( 41 ). This initial trial series proved that DC 
treatment could lead to regression of cancer in patients 
who, for various reasons, were unsuitable for opera­
tion or other established forms of treatment. After these initial experiences, the clinical series has 
been enlarged to 20 patients and a total of 26 treated 
cancers. A survey of this ease material is presented in 
Table XVII: 2 (pages 310-312). The ages of the patients varied between 20 and 76 
years. Ten were women, 10 men. Fifteen had meta· 
static cancer in one or both lungs. Five had primary 
lung cancers. Seven were considered unsuitable for 
surgery because their general physical condition was 
poor. Other patients have been unsuitable for radio· 
therapy or failed to respond to treatment with cytosta· 
tic agents. Eight patients have also suffered from other 
major diseases, including coronary atherosclerosis, hy­
pertension, diabetes, emphysema or respiratory insuf· 
ficiency (post poliomyelitis ). In one instance (patient 
no. 10) treatment was performed for a solitary pulmo· 
nary metastasis from a breast carcinoma. This patient 
was in excellent condition but she refused surgery, 
radiotherapy and treatment with cytostatics. 2. Preparation of patients 
All patients gave their consent after they were in­
formed that the treatments were part of a preliminary 
clinical trial. Each patient was examined with cardiore­
spiratory function tests, blood chemistry tests and 
radiograph ic studies appropriate to performance of a 
thoracotom y. Because pneumothorax commonly com­
plicates needling of a lung, it was found suitable to 
insert a large pleural drainage tube prophylactically 
into the pleural space before treatment. All treatment s 
were performed under local anaesthesia at the sites of 
insertion of the electrodes and after medication of the 
patient with Valium® and morphine-s copolamine . In 
this way it has been possible for the patient to report on pain or other reactions during the course of the 
treatment. 3. Technique of treatment 
The platinum electrode (anode) has always been im­
planted percutaneously In the rumour under biplane, 
televised, fluoroscopic control. The cathode (same 
electrode as anode type I or 2) has been implanted (see 
Table XVII: 2) at a distance of at least one diameter of 
the tumour from the edge of the tumour. The site of 
the cathode has been either between the tumour and 
the hilum (18 instances) or it has been inserted 
through a catheter from a femoral vessel into an ipsila­
teral branch of the pulmonary artery (5 instances), in 
the subclavian vein (2 instances) or into the aorta (6 
instances). The aortic location of the cathode was cho­
sen with the intention of utilizing the bronchial arte· 
ries as a selective pathway for current in primary 
pulmonary malignanc ies, which are known to have 
their main blood supply derive from the bronchial 
arteries (77). The DC Treatment Processor contains appropriate 
safety circuits and has been connected to a Grass direct 
writing instrument for continuous recording of volt· 
age, current and time during treatment. Facilities for 
recording of ecg and respiration have been available. Five patients have been treated for more than one 
tumour. Only a single treatment has been applied 
to each tumour, except for three tumours. Patient no. 17 (Table XVII: 2) received three treatments of one 
tumour and two treatments of another. Patient no. 19 
received two treatments of. one tumour. The first treat· 
ments of these patients' tumours were performed at an 
electrode potential of 10 volts and the last at 1.5-3.5 
volts. In spite of the low current densities, 400, 665 
and 710 coulombs could be given, during 2-5 days, in 
the ward. Five, 7 and I 5 volts have each been applied 
in one patient. The amount of current has varied 
between 65 and I 330 coulombs. The diameter of the smallest tumour was I 0 mm, 
the largest 75 mrn. Because few indications existed to 
guide an optimal choice of voltage and amount of 
electric energy to be given, an arbitrary amount of 
current of I 00 coulombs per em of tumour diameter 
(at 10 V po[ential ) was chosen as the preliminary dose. This amount means that in case this dose will be found 
sufficient to arrest growth of small cancers, a diameter 
should be encountered above which growth is not 
arrested, because volume increases exponentially in 
relation to diameter of a tumour (Fig. XVII: 1). Col· 
lecting information about dose requires, of course, a 
large number of patients. Several factors make it also 
necessary to modify the treatment s. In fact, pain or 
fatigue in several old or weak patients made it impossi· 
Treatment of cancer 295 ble to follow the preliminary setting of treatment dose. An average of only 80 coulombs at 10 volts potential 
could be applied per em diameter of the tumours 
(Table XVIl: 2, see also Fig. XVII: 43). One of the most difficult factors to evaluate are the 
local circulatory conditions around a tumour. Good 
circulation means, for example, efficient buffering, 
dilution and disappearance of anodic protons and 
hence a decrease in direct, destructive effects on ru­
mour cells. Technical problems arise when obscuring 
structures, e.g., thickened pleura, make it difficult to 
position the tumour electrode in the centre of a ru­
mour. If the electrode is not located centrally, an 
unnecessarily large treatment dose will be required to 
obtain reliable treatment. Movement s of the patient 
also can easily dislocate the rumour electrode. This 
problem is particularly the case in cavitary tumours 
and cancers with soft consistency, e.g., melanomas 
and oat cell carcinomas. Many technical factors can be 
improved. The results in the patient group are there­
fore far from representative of the full potential of the 
method. All treatments except four have been performed in 
the radiologic laboratory under biplane fluoroscopic 
control. Duration of these treatments has varied be­
tween one to three and a half hours. Three tumours 
(patients no. 17, 19 and 20) were treated in the ward 
by delivery of 400, 665, 710 and 1330 coulombs at 
1.5-5 volts .. These treatment s each lasted two to five 
days. 4. Case analysis of treated patients 
Five primary and 21 metastati c cancers have been 
treated in 2() patients. a) Mortality 
None of the patients has died in connect.ion with the 
direct current treatments. Thirteen patients have clied 
during the observation periods after the treatments. The deaths of nine of these will first be analysed in 
connection with some comments on the treatments. These patients are numbered as in Table XV!l: 2. Causes of d.eaths of the other four patients (3, II, 14 
and 15) are listed in Table XVII: 2. Patient no. 4. This patient suiTered from hyperten­
sion, severe coronary arteriosclero sis, diabetes mellitus 
and a pelvicc sarcoma with multiple metastases in the 
lungs. Two· of these metastases were treated and re­
gressed during observation times of 485 and 444 days, 
respectively. Multiple other small metastases in the 
lung parenchyma, distant from the sites of the elec­
trodes, also appeared to regress after treatment of the 
two larger metastases . These fmdings are analysed in 
296 Treatment of cancer detail later (see also Fig. XVII: 36). The patient died 
from local recurrence of her pelvic tumour and metas­
tases to the brain. Patienr no. 6 had been operated for an osteosarcoma 
of the right leg in 1978. One metastasis (I) of 23 mm 
diameter in the right upper lobe was treated with 130 
coulombs at 10 volts, the cathode in the lung paren­
chyma. After 50 days of observation the tumour had 
decreased in size, while the untreated metastasis (II) of 
about equal size in the left lung had increased in 
volume about 2.5 times. Because of this rapid growth 
and the seemingly beneficial effect of the DC treat­
ment of the rightsided tumour, surgical removal of the 
untreated tumour deserved serious considerat ion. Un­
fortunate ly, the treated rightsided tumour was then 
surgically removed instead of the left one and the 
specimen was lost. The patient subsequent ly died 
from his disease. No autopsy was performed . Patient no. 8. Previously a cutaneous malignant me­
lanoma and one brain metastasis had been resected. She appeared with one metastasis in the right lung. During treatment with DC current a pneumothorax 
developed slowly, causing displacement of the plati­
num string electrode in the rumour. The patient's 
concljtion was not affected by the treatment but she 
developed various cerebral :symptoms 3 weeks later 
and clied. Autopsy revealed many large metastases in 
the brain, one of which had bled into the ventricular 
system. The part of the lung tumour where the anode 
had been positioned showed complete necrosis over a 
diameter of I 0 mm. An intermediate zone of partial 
cellular destruction was seen in a 2-3 mm broad zone. Beyond this zone, melanoma cells appeared micro­
scopically unchanged. Patienr no. 9. After a right lobectomy for a pulmo­
nary adenocarcinoma, local r.ecurrence was verified by 
percutaneous needle biopsy ~ DC treatment was per· 
formed but positioning the anode was difficult because 
thickened pleura partly obscured visualization of the 
tumour. The tumour continued to grow rapidly after 
treatment. The patient died from multiple metastases 
in the right lung. At autopsy local scar tissue was seen 
anterior to the large metastasis. It was assumed that 
the anode had not been correctly positioned in tumour 
tissue. Parienr no. 12. A large metastasis from a testicular 
teratocarcinoma was present in each lung. Treatment 
of each metastasis was attempted with direct current. Pleural thickening precluded an implantation of an 
electrode into the right lesion. The left metastasis was 
treated and stopp<. "<< growing during an observation 
time of 410 days. The patic:nt died from widespread 
metastases. Autopsy was not performed. Pariem no. /3. The treatment dose for this solitary 
metastasis became less than originally planned due to 
the patient's poor general condition. 180 days after Fig. XVII: 24. Histologic 
section, edge of large prima­
ry carcinoma of lung (pa· 
tient no. 18), three weeks 
after treatment when the pa­
tient suddenly died from a 
cororulry infarction. Tu· 
mour cell" :.p~r probably 
viable. Fibrosis is abundant. Clusters of calcification are 
also e\•idc:nt. the treatment , the size of the tumour had increased 
considerably. The tumour showed a large central cav· 
ity. After 345 days the tumour had partially collapsed 
and decreased in size. The patient died shortly there· 
after of cerebral metastases. Patient no. 16. This 54-year-old patient with poorly 
differentiated squamous cell carcinoma of lung was not 
a candidate for surgery because of ventilatory insuffi· 
ciency after poliomyelitis. During direct current treat· 
ment, only 200 coulombs at 10 volts could be given to 
the 40x45x57 mm large tumour. The patient died of 
multiple metastases after I year, 10 months. At autop· 
sy the primary lung tumour had increased in size to 
6Sx6Sx6S mm. Patient no. 17. This 56-year·old woman had an ad· 
enocarcinoma of the uterus resected in 1977, followed 
by radiation treatment. Intrapelvic scar tissue then 
developed and blocked the ureters bilaterally. Perma· 
nent bilateral nephrostomies were established. One 
large metastasis developed in the lower lobe of the 
right lung and one in the upper lobe of the left lung. The right metastasis was treated three times with a 
total of 1135 coulombs (ele.ctrodc voltage 3.4-10 V). The left metastasis was treated twice with a tOtal of 560 
coulombs (I. 5-10 V electrode potential). Despite these 
considerable efforts to arrest tumour growth, both 
metastases continued to grow rapidly, the more vigor· 
ously treated right one even more rapidly than the left 
tumour. New met:t$tases appeared and death occurred 
soon thereafter. Patient no. 18. Cardiac insufficien cy from previous 
myocardial infarctions was a contraindication to sur· 
gery for this patient's primary lung cancer. He tolerat· ed DC treatment (400 coulombs, 10 volt~) very well. Three weeks later he died suddenly from a new myo· 
cardia! infarction. Autopsy revealed widespread re· 
gions of necrosis in the treated tumour. Cancer cells, 
probably viable, were found at the edge of the tumour 
(Fig. XVII: 24). b) Beneficial effecu of DC treatment 
Although each of the above nine patients died, DC 
treatment appears to have been locally effective in 
patients no. 4, 6 and 12. We will, however, also review 
some more obvious beneficial effects of DC treatment. Each patient's number corresPonds lO those in Table 
XVII: 2. Patielll "0· /. This 66-ycar-old woman represents 
one of the longest observation times. A bilateral sal· 
pingo-oophorectomy was performed in 1973 for me­
sonephroid adenocarcinoma of the ovary, stage lA, 
histologically class IV. 4 000 rads of external radiation 
were given. Routine chest radiography in February, 
1978, revealed a 20x ISx IS mm tumour in the lingula. In April, 1978, screw needle biopsy showed polymor· 
phic carcinoma, strongly probably metastatic from the 
ovarian tumour. In Fig. XVII: 25 cytologic material is 
shown from the lung tumour (a) and histologic matcri· 
al from the ovarian tumour (b). Operative removal of 
the pulmonary metastasis was rejected because of se­
vere ~rdia c rliseAse. By June, 1978, the pulmonary tumour measured 
2Sx 17x 17 mm. Mter Valium* (10 mg) and mor· 
phioe-scopolamine (50 mg) were admimstered intra· 
muscularly, DC treatment was performed under local 
Treatment of cancer 297 Fig. XV II: 25. Adenoe<~rcinoma of ovary, metastatic to lung 
(patient no. 1). (a)Cytologic preparation, screw needle biop· 
sy, pulmonary metastasis. Papanicolaou stain. (b) Histologic 
section from the primary tumour of lhe ovary. Haematoxy .. 
lin-eosin nain. anaesthesia with Xylocaine <!>. A cardiac catheter was 
introduced percutaneously via a femoral vein and 
passed into the left pulmonary artery. A normal pul· 
monary angiogram was obtained before the rreatmcnt 
(see Fig. XVII: 28 a). Two platinum electrodes, each 
0.2 mm in diameter, were introduced percutaneously 
via a biopsy needle 1.0 mm thick. The noninsulated, 
distal part of the platinum thread was 25 mm long. Five mm from the tip the thread was bent to form a 
hook to secure its position. The anode was placed in 
298 Treatment of cancer the tumour, the cathode in adjacent tissue separated 
from the tumour by a distance of approximately its 
diameter (Fig. XVll: 26). DC treatment was started at 10 volts between the 
electrodes. As seen in Fig. XVII: 27, current initially 
was 10 mA. Then it increased to about 20 rnA. At the 
first dotted line (a), the current was spontaneously 
interrupted and gas could be seen fluoroscopically 
around the electrodes. The patient then complained of 
pain, which disappeared quickly when the current was 
switched off. Because the cumulative amount of cur­
rent was considered insufficient, the treatment was 
then continued at 15 volts between the electrodes. The 
current started again at about 35 mA and the patient 
did not notice any pain. It increased to about 55 mA 
when new gas again interrupted the circuit and the 
patient reported some pain. Mter another period of 
rest (b), 15 volts was again applied. Shortly thereafter 
the patient reported pain again. As the total amount of 
coloumbs now was 180, the treatment was interrupted 
and the electrodes were pulled out. Other than pain, 
the sole complication was a minimal pneumothorax, 
which resorbed spontaneously within a day. No pain 
was reported by the patient after the conclusion of the 
treatment . A new pulmonary angiogram was performed imme· 
diately after the treatmem. Compared to the study 
before treatment, it showed that several vessels ap· 
peared narrower and displaced away from the cathode 
(Fig. XVII: 28b). Radiograph y the next day showed diffuse haziness 
around the site of the electronegative electrode, an 
appearance suggesting local oedema. Fig. XVll: 29 
chronicles the decrease in .size of the treated metasta· 
sis. Fig. XVll: 29 a shows the metastasis before treat· 
ment. Fig. XVU: 29 b shows an infiltration at the pre· 
vious site of the cathodic electrode. Around the tu· 
mour, the tissue is also infiltrated and surrounded by 
radiating, probably fibrous, structures. Two momhs 
after the treatmem (Fig. XVII: 29c) most of the ca· 
thodic infiltrate has disappeared and the tumour has 
Fig. XVII: 26. Direct cur· 
rent treatment of metastatic 
ovarian carcinoma in the lin· 
gula of a 66-year-old woman 
(patient no. 1). Largest dia­
meter of the tumour was 
2.5 em. (a) Anteroposterior 
view. (b) Lateral view. Per· 
cutaneous platinum elec· 
U'Odes: anode in the tumour, 
cathode in lung tissue 2.5 
em distant from the tumour. A cardiac catheter is posi­
tioned in the pulmonary ar­
tery for angiography . slightly decreased in size. It is now surrounded by 
thicker radiating structures. In Fig. XVII: 29d, e pro· 
gressive decrease in size of the rumour is seen after 
seven and fifteen momhs. A small residual of probable 
scar tissue is indicated by an arrow in Fig. XVII: 29 f 
(after 2 years, 5 months). The patient has to date (after 
4 years, 4 months) presented no new pulmonary me· 
tastases or metastases elsewhere. One diameter of the tumour vs. time is ploncd in 
Fig. XVII: 30. The size of the tumour decreased over 
an interval of greater than 2.5 years. More rapid de­
crease occurred during the first six months than dur­
ing the later period of observation. Patient no. Z. A mesenchymal fibrolipasarcoma of 
the uterus was excised from this 20-year-old woman in 
1977. She received chemotherapy (Oactinomycine , 
Cyclophosphamide and Vincristine ) after the opera· 
tion. Shortly thereafter , two metastati c tumours ap­
peared in each lung (in 1978). One metastasis in the 
right lung was treated by electrocoagulation (see Fig. XVU: 5), the other three were treated by direct cur· 
rent. The ceUulnr material shown in Fig. XVII: 31 a, b 
was taken from a large tumour (35 x 37 x 42 mm) in the 
right lower lobe. Well differentiated (a) and moder­
ately well differentiated (b) cells are shown. Fig. XVU: 31 c, d shows a comparable morphologic appear· 
ance of histologic sections f10m the primary intrapelvi c 
sarcoma. Fig. XVII: 32a shows the tumour before treatment, 
(b) one year and (c) 3 years, 9 months after treatment. The volume of the tumour diminished to less than one 
fifth of its volume before treatment. The treatment was performed under medication and 
loeal anaesthesia, like the previous case. Fig. XVJI: 32 d shows the pOsitions of the two platinum 
electrodes at the beginning of the treatment. Immedi­
ately after the treatment (Fig. XVII: 32e), cavities 
containing gas (white arrows) are seen at the sites of 
the electrodes in the tumour and pulmonary parenchy­
ma. A circular, diffuse haziness is also seen in the lung 
around the site of the cathode, representing oedema 
(hydropic "B" zone). A radiolucent "A" zone also 
developed around the anodic neoplasm (Fig. XVII: 
32/). 250 coulombs were delivered at 10 volts. The 
flow of current vs. time is shown in Fig. XVII: 33. The patient tolerated the treatment without difficul· 
ties. Some fluid, however, was observed in the pleural 
space during and after the treatment. It resorbed spon· 
taneously within a few days. No pneumothorax or 
other complications occurred. Two other metastases in this patient, each in the left 
lower lobe, were also treated with di.rect current. Their 
sizes also decreased (Table XVII: 2). Comp uteri~ed 
tomography proved useful in determining the pOSition 
of these lesions (Fig. XVII: 34a, b). Each tumour, mA 
60 
. . \b 
50 \j 
40 
30 • 
20 
101-IL---~---~----,~----,~--+ 
0 20 ~ 60 60 -
Fig. XVJJ: 27. Current supplied to the lung tumour of pa­
tietu no. 1. Ar 10 v()lrs. currenr increased from tO to 20 rnA 
during Lhe first 55 minutes, when gas, accumulaling at lht 
electrodes, imerrup1ed the curreoc (a). Applied pocential 
was elevated to 15 voles and flow of current resumed, in­
creasing from 35 to 55 mA over 30 minutes, when a new in· 
terruption occurred (b). After a few minures of waiting, ad· 
ditional currenl could be supplied a1 15 volts. Tocal dose was 
180 coulombs. Fig. XVJJ: 28. Left pulmonary angiogram of patient no. l. 
(a) Before treotmenc, tile pulmonary arteries show normal 
size and calibre. (b) Immediately after t.reatmentche lingular 
artery Is displaced medially and small vessel branches are less 
prominent around the ·:a thode. Treatment of cancer 299 Fig. XV II: 29. Serial radiograph s of mclaSI:IIic ovarian carci· 
noma in the left lung of pa1icm no. I, before .m~..l af1cr dircc1 
current treatment. (a) BcftJre 1n:atrncn1. (h) .lO tla)'S after 
treat..mem. The tumour and I he 1i~~ol!oUC at 1hc Mtc o( plucc:· 
mcnt oft he en thode. arc Mlrrounded by rodhulng, pmbabl\• 
300 Treatment of cancer fibrou), structures . (c) 60 days after Lrcauncnt. Regression is 
dc:.arly observable . The Ubrotk st..rnmJs apJ)\.~r more promi· 
ncm. (d} Af1cr 210 d•ys, (e)4SO d11ysun~ (/) 885 <lays, a very 
small residual or scar" is seen a1 1he sitf of the 10mour (ar­
row). Fig. XVl/:30. After direct 
curr.ent treatment, decrease in 
one diameter of the metastatic 
ovarian carcinoma, patient 
no. I, over a span of 2 yean;, 
5 months. 20 
10 Diameter 
of tumour. mm 
o+----------. ----------.----------.---------,r- -------
0 200 
Fig. XVI/:31. Patient no. 2. Comparison between cytologic 
samples obtained by screw needle biopsies from a pulmonary 
metastasis (a, b) and hisrologic sections of primary mesen­
chymal fibrolipOSarcoma of the uterus (c, tl). (a) Well differ­
entiated sarcomatous cells. (b) Moderately well differentiated 
b 
-. "5' 
0 •• ,... ~· •• 50J.1m 400 600 800 days 
tumour cells. Observe numerous lipid granulations. Air­
dried smear. The cellular morphology in (c) corresponds to 
that in (a), that in (ti) to that in (b). May-Grunewald-Giemsa 
stain (a, b). Haematoxylin~sin stain (c, tl). Treatment of cancer 301 Fig. XVIJ: 32. Pulmonary metastasis, right lower lobe, pa­
tient no. 2. (a) Before tre-•tment , (b) 380 days after, and (c) 
1370 days after treatment. The tumour has diminished ro 
less than one fifth of its previous volume. (d) Positions of an· 
odic intrarumoura l electrode and cathodic parenchymal elec .. 
mA 
50 
•o 
30 
20 trode. (e) Immediatel y after treatment . Gas cavities at sites of 
electrodes (white arrows). New parenchymal opacity (hydro· 
pic "8" zone) in the cathodic region. (f) A radiolucent "A" 
1.one around the anodic tumour is also evident immediately 
after [teatment. Fig. XVIJ: 33. Current supplied to the largest pulmonary 
metastasis of patient no. 2. At 10 volts, a total of 250 cou· 
lombs was delivered. 10+---------,---------,----------r---------.---------. ----------+ 0 20 40 60 80 100 min Fig. XVII: 34. Decrease in 
size of two pulmonary me· 
tastases, left lower lobe, pa· 
tient no. 2, after DC treat· 
mem. These two tumours 
were 2 em apan in the left 
lung close to the diaphragm 
and stomach. Abdominal 
contents hid them from 
fluoroscopic view in the lat­
eral projection . Computer ­
ized tomography (with pa· 
tient in prone position) aid­
ed planning che direction 
and depth of imp!Jillration of 
electrodes. (a) Computer · 
ized tomogram of the small· 
er, more superior metasrasis 
(thin arrow). (b)Computer ­
iz.cd tomogram of the larger, 
more inferior tumour (thick 
.a.rrow). (c) Implanted elec­
trodes for treatment of the 
smaller rumour. Radio· 
graph, shallow righc anterior 
oblique projection . (d) The 
larger tumour (thick arrow) 
before treatment. (e) De· 
creased sil.es of the more su­
perior tumour (thin arrow) 
1290 days afcer treatment 
and the more inferior tu­
mour (thick arrow) I 020 
days after rreatme.nt. The 
centre of the more superjor 
metastasis is now calcified, 
indicating healing of injured 
tissue. 13xl5xU nun (II} and 16Xl9Xl8 mm(UI) respec· 
tively, was positioned deep in lung in the costophrenic 
sulcus, near the diaphragm and gastric fundus. The 
adjacent abdominal contents obscured fluoroscopic 
viewing in the lateral projection. The computer-ized 
tomograms, however, indicated clearly the sites of the 
lesions. The most suitable direction and depch for the 
insertion of each cle<:trodc could aJso be determined in 
this way. Fig. XVII: 34r illustrates the positions oftbe 
two electrodes during th~ treatment of the smaller of 
the two metastases. The larger tumour (Til) is seen 
before treatment in Fig. XVII: 34d. The smaller ru· 
mour {II) received 100 coulombs at 10 volts. Its size 
had decreased slightly and calcium accumulated in its 
centre 3 years, 6 months after treatment (Fig. 23-814586 NOI'dntstriiM XVII:34e ). Tumour Ill received only 65 coulombs at 
10 volts but its size also was clearly decreased 2 years, 
10 months after treatment {Fig. XVII: 34e). After each treatment the patient was hospitalized 
only one or two days and then returned to work as a 
nurse's assistant. She is in good condition and has 
received no supplementary treatment. To date (after 4 
years, 8 months) no new metastases have been ob· 
se.rved. Patient no. 4. A selective effect of the electric field 
on multiple small tumours is suggested by observa· 
tions in this patient. An intrapelvic stromal sarcoma was resected from 
chis woman in 1964 at age 46. Since 1970 she has been 
treated for diabetes mellitus, systemic hypertension 
Treatment of cancer 303 and atrial fibrillation. In May 1978, two tumours, each 
appro><imately 1. S em in diameter, were found in the 
lower lobe of the right lung (Fig. XVII: 35 a, c). Sever­
al 3-4 mm diameter nodules, presumed to be metasta­
ses, were also apparent in the posterior basal segment 
of the right lower lobe (Fig. XVII: 36a). Before DC treatment of each of the two large tu­
mours, screw net-die biopsies were obtained, confirm­
ing the diagnosis of metastases from the intrapelvic 
stromal sarcoma (Fig. XVII: 37). Fig. XVII: 38a illustrates an electrode implanted in 
the more anterolateral of the two largt.,;t tumours and 
the screw needle inserted in the tumour for cytologic 
verification of the diagnosis. Fig. X VII: 38 b and c 
shows anteroposterior and lateral photofluorographs of 
the position of the electrodes in the tumour and in the 
pulmonary parenchyma before treatment. 304 Treatment of cancer Fig. XVII: 35. Decrease in 
si~e of two pulmonary me­
tastases, right lower lobe, 
patient no. 4, after treat­
ment with direct current. Primary intrapelvic sarccr 
ma. Radiographs , right pos­
terior oblique projection . (a) Before treatment, one 
metastasis is anterolateral 
(black arrow), one medial 
(white arrow). The diameter 
of each tumour is about 1.5 
em. The anterolateral tU· 
mour was the first to be 
treated with direct current 
(100coulombsat 10 volts 
electrode potential). (b) 153 
days later, the anterolatera l 
tumour has disappeared. A 
3 mm piece of platinum 
electrode (black arrow) 
shows the previous site of 
the tumour. 1 12 days after 
treatmem with direcr cur­
rent (180 coulombs at 10 
volts), siu of the mediaJJy 
located rumour has de­
creased slightly. (c) Comput­
eri~ed tomogram through 
the rwo rumours before 
treatment. See also Figs. XVIJ: 38,40 (electrode im­
plantation s). DC treatment was performed under local anaesthe­
sia after preliminary medication with 10 mg Valium® 
and 5 m,g morphine-scopOlamine. Tbe anterolateral 
tumour receive-d 100 coulombs at 10 volts. Fig. XVII: 39 presents the relationship of current to time in 
this treatment. The discontinuities in the curve indi­
cate that the treatment was interrupted twice, each 
time because the patient complained of sudden pain. The pain is presumed to have been caused when the 
flow of current was interrupted by gas produced 
around the electrode'S. Other than the moderate dis­
comfort produced by these interruptions of current, 
the patient had no complaints. When the electrodes 
were pulled out, one small piece of the tumour elec­
trode broke off and remained in the tumour. A small 
pneumothorax was also produced hut the air resorbed 
spontaneously in two days. Fig. XVII: 36. Decrease in size of small pulmonary nodules 
(2no,vs), lateral basal segment, right lower lol:H:, patient no. 4t after large metastases in the same lobe were treated with 
direct current. Radiographs, shaHow right anterior oblique 
Fig. XV/1:37. Sarcomatous 
tissue from lung and pelvis, 
patient no. 4. (a) Cytologic 
specimen from metastatic 
tumour, medially situated in 
the right lower lobe. (b) His­
tologic section, primary pel­
vic sarcoma. The cellular 
material is comparable from 
each of the two lesions. a 
• • projection. (a) Before 1reatment. (b) Four months later. Sev­
eral of the smaU les.ions b:ave di$Appe:ared or diminished in 
size. Treatment of cancer 305 In this patient the first treated tumour rapidly de­
creased in size. Five months after treatment the tu­
mour could no longer be identified. As seen in Fig. XVII: 3Sb, no tumour remained at its previous site, as 
indicated by the remaining piece of the electrode. Radiologically , no scar tissue is evident in tbe lung at 
the sites of the electrodes. The position of the electrodes implanted for DC 
treatment of the posterior basal tumour is also shown 
in the radiographs in Fig. XVII: 40a, b. A computer ­
ized tomogram (Fig. XVII: 40c) shows the reactions in 
the lung about 30 minutes after treatment of this 
tumour. The arrow points to a small cavity in the 
tumour, the dotted line a larger cavity at the site of the 
previous position of the cathode. Haziness in the ca­
thodic area is caused by electroosmotically collected 
tissue fluid ("B" zone effect). Gas produced around 
electrodes is always more extensive around the cathode 
than the anode. This tumour was given 180 coulombs 
at 10 vohs electrod-e potential. Despite treatment with 
a dose nearly twice that given the anterolateral metas­
tasis, the medial basal tumour decreased 10 a size only 
somewhat smaller than before treatment (right tu-
mA 
20 
10 Fig.XVl/:38. Oirectcu.r­
rent treatment of anterolat­
enol basal pulmonary metas­
tasis, patient no. 4. (a) Per­
cutaneous e.lectrode for 
treatment (wire on left) with 
screw needlt, and sampling 
of ceUular material to con­
firm the pre~ucnptive diag­
nosis of metastatic sarcoma. (b) Anteroposterior , and (c) 
latenol photofluorognophs of 
electrodes in tumour and in 
nearby pulmonary paren-
chyma. mour, white arrows in Fig. XVII: 35 a, b). Neither of 
the treated lung tumours showed any sign of recur­
rence during the observation period ( 485 and 444 
days). The patient died from recurrence of her prima­
ry intrapelvic sarcoma and brain metastases. Tbe behaviour of tbe two tumours of patients no. Z 
and 4 requires some comments. In patient no. 2 a 
more rapid and prominent decrease of the slightly 
larger tumour (III) occurred after 65 coulombs than of 
the smaller tumour (II) after 100 coulombs (Table 
XVII: 2). In patient no. 4, the lateral basal tumour 
disappeared after 100 coulombs, while the size of the 
posteromedial basal tumour decreased only slightly 
after 180 coulombs. These discrepancies between 
amount of current and effect on tumour size have been 
interpreted as follows: 
The growth of a tumour can be stopped permanent­
ly when all tumour cells are destroyed. ,'\ resorption of 
devitalized tumour tissue will then take place, which 
may lead to total or partial disappearance of the tu­
mour. In case an overdose of current is given, the 
treatment will also interfere with the functions of the 
surroundin g normal tissue. For example, microthrom-
o+---------~ ------ --r--- -----,------ --~--------Fig. XV/1:39. Current-time 
chan, patient no. 4, treat­
ment of the .anterolateral 
metastasis (100 coulombs, 
10 volts). Interruptions in 
the curve indicate the two 
instances when the patient 
reported pain, which was 
presumed to be caused by 
gas around the electrodes in­
terrupting the flow of cur­
rent. 0 20 40 60 80 min 
306 Treatment of cancer Fig. KV/1:40. Oir«t cur~ 
rent treatment of medial 
basal pulmonary metastasis, 
patient no. 4, rndiographic 
images. During trtatment 
the cathode was in pulmo­
nary parenchyma posterola· 
teral to the anode in the tu· 
mour. Gas has formed 
around each electrOde. (a) Anteroposterior , (b) lat­
eral projections. (<) CompUI­
erized tomogram 30 minutes 
after treatmem. Tu.mour 
shows small gas bubble (thin 
arrow). Centre of cathode 
shows larger cavity sur· 
rounded by elecuoosmoti · 
cally accumulated oedema 
(dotted line). boses and fibrosis may develop, preventing the resorp­
tion of destroyed rumour tissue. We then obtain what 
might be called a seq~stration of destroyed tumcur tissue, 
which might be an even more reliable effect of the 
treatment than apparent disappearance of a tumour 
after treatment. The crucial problem is, however, that 
it will become difficult to decide whether a slight 
decrease of a tumour treated with direct current re­
flects a "safe sequestration" or only partial destruction 
of tumour tissue, possibly to be followed by later 
regrowth of the tumour. Another remarkab le finding also developed in pa­
tient no. 4. Several of the multiple small nodules in the 
posterior basal segment of the lower lobe (Fig. XVII: 36a) clearly diminished in size after the treat­
ments, as seen in Fig. XVII: 36b. It appears, there­
fore, that a therapeutic effect on tissue may not be 
limited to the destructive effects on tissue of protons 
close to the anode. Effects of the electric field may 
induce sufficient change of the biologic environment to interfere with the living conditions of malignant 
tissue within the organ but at a distance from the 
electrodes. This finding is also in agreement with the 
biologic effects described earlier several centimetres 
from the anodic and cathodic electrode$. Thus, dehy­
dration> extensive microthromboscs and attraction of 
leukocytes take place around the anode. Around the 
cathode alkalinity and interstitial oedema are promi­
nent. Large vessels are temporarily occluded, locally 
impairing the circulation. These biologic field effects 
as well as the induced changes of ionic composition in 
the tissue fluids and cells represent, in the view of the 
author) an interesting and fruitful aspect of treaunents 
with direct current. Patient no. 10. Chest radiographs (Fig. XVII: 41 a, 
b) revealed a tumour, 2 em in diameter, in the middle 
lobe of the right lung of a 46-year-old woman. One 
year previously an adenocarcinoma or the left breast 
bad been resected. Needle biopsy of the lung tumour 
revealed cells which appeared to be of the same type as 
T~atment of cancer 307 a 
, 
308 Treatment of cancer 50JJm 
, 
' Fig. XV/1:41. Decrease in size of a pulmonary metastasis , 
potieot no. 10, after treatment with direct current. Primary 
adenocar cinoma of breast. Radiographs , (a) pOSteroonterior 
and (b) lateral projections before treatment ( 190 coulombs at 
10 volts). The size of the !Umour gradually decreased . Radio· 
graphs, (c) posteroanterior and (tf) lateral projections I 110 
days after creatment. Fig. XV/1:42. Patient no. 10. (a) Cytologic material 
from screw needle biopsy of 
pulmonarY metastasis. (b) Corresponding histologic 
tissue section from primary 
adenoc:arcinorna of the 
breast. 70 
60 
50 Largest tumour 
diameter,mm 
16. 0 13. IJ. 2' 14· StOC, 7Smm 0 -=="-'="'-
~· 1330C,52mm 
18. 8 Fig. XVI/:43. Effects of 
DC treatment of cancers in 
the lung. Diameter of each 
cancer before DC treatment 
(largest radiographically 
measurable diameter) in re­
lation to quantity of current 
given. Numbers refer to pa· 
tients ofTable XVII: 2. C =coulombs. 40 3. 0 • n'b111c ······················Oo" 66SC.40mm .... ·····--··--17!b ______ ••••• --·· 
a· .o··--· 
17~a nla .• -·. a· 1b 
9.~~ ~~J~~ !f .............................. -3· 710C, 27mm 30 
0 .191 •• 
12~ 4~ • • s. • a' • 
2m 4' • • 8. 2' 8 •• 20 
11. • Regression U2metastat ic tumours) 
10 0 0 Progression ( Smetastat ic and 3primary tumours) 
8 lndeterminite ( 3metastatic and 2primary tumours) 
• • thereafter 0 ( 1 metastatic tumour} 
o+----- --~ ------.-------,-------.- --------
0 2 3 
the cells from her breast cancer (Fig. XVII: 42). She 
had no symptoms and was in excellent general condi­
tion. Surgical excision of her lung tumour was there­
fore recommended. The patient refused surgery, radi­
ation and cytostatic therapy but accepted a "slight 
attempt" with direct current. The tumour, 24X21 x20 mm in diameter, was given 
190 coulombs at 10 volts. Gradually the tumour dimin· 
ished to 9x 11 x8 mm, 3 years, 1 month after the 
treatment (Fig. XVII: 41 c, d). To date (3 years, 8 
months after treatment ) no metastases are visible in 
her lungs and she remains free of symptoms. The actual data on direct current treatment of the 
series of tumours are surveyed in Fig. XVII: 43, corre­
lating the largest diameter of each cancer at the time of 
treatment, the amount of current given and the esti­
mated effect on tumour diameter (indicated by sym­
bols). It is obvious that the short observation time does 
not permit any definitive ,·onclusion about permanent 
control of the treated tumours. Some conclusions, 
nevertheless, may be drawn from the results to date. The first important general comment must be that 
the majority of the patients were considered as "hope­
less", i.e., standard forms of treatment were not ap­
propriate. In spite of their often poor condition, none 
of the patients has been lost as a result of the treat-4 •100 Coulombs 
men!$. A definitive beneficial effect has been observed 
in twelve of twemy·onc treated metastatic tumours as 
well as in many neighbouring small tumours in patient 
no. 4. One metastasis decreased in size during 730 
days and then later started to increase in size (patient 
no. 7). Five metastases have progressed. Observation 
time is too short tO evaluate three of the metastases. Out of five primary cancers no one has so far shown 
regression. Three have progressed and two arc indeter­
minate because of too short observation time. Tumours of greatest diameter larger than 30 mm in 
general did not respond well to treatment , possibly 
due to too small dose of treatment. The largest tumour 
to react favourably was the 42 mm diameter sarcoma 
or patient no. 2. The peripheral site of this tumour 
probably contributed to this beneficial result. Elec­
troosmotic oedema in the more proximal cathodic 
field may have interfered with blood circulation and 
thereby enhanced the possibilities of proton diffusion 
and migration around the anode. One relatively small tumour (case no. 11) increased 
in size after treatment. It was difficult in this patient to 
keep the anode in the tumour during the treatment. It 
is therefore likely that the dose delivered to the tu­
mour was too small, as was probably also the case in 
tbe other tumours which showed progression. In spite 
Treatment of cancer 309 "' Table XVII: 2. Rm;lu ()/ trfatmtmu un'rh dirttl cun·tniiO 16 runurs (21 mtrastatic, S pn'mary) in th~ lungs of ZO patttnll 
0 
Date of tre11tmcm Coulombs 
~ Size of pulmon.-ry Position of per largest Obstn•ation .. .. Patient tumour (mm) cathode diameter time (days ~ "' g Age Prinury ,\\ • lllC'IUta.si' Vohage (Type of (em) Size of tu· Effects of " No. (years) canctr P • prim11ry canet:r (••oltsl Coulombs anode) o( tumour mour(mm• treat.m~t Comments a 
0 ... 
" I. H.S. 9 Adenocartinonu M.l 8.6 1978 Ill-IS 180 PulrtlO!Uf)' 78 I 3SO Rt~ression Coronary anc:rioscl~:rosis , atrial " 66 of ovary 2SXI7xl7 poralcllyma lXI XI fibr.U.tion and myooudial infare-" " .. R<S<Ction 1973 (Type I) lion precluded su.raical ueaunent . .. 
+4 000 ndJ 
2. B.K. 9 Fibroliposar-- M.l 16 1978 10 ISO Pulmomry 60 I 370 Rqression Aft<r uatmcot I, small pleural 
20 coma of uteruJ 3Sx37x•z poralcllynu 20X20Xl9 dlusion for two c:bys. After treat-
R<t<Ctioo 19n (Type I) mcnt II, minimal baemoptysis. M.ll 3'8 1978 10 100 Pulmomry 71 I 2'JO Rqression Eltttllcnt condition. R<sum<d her 
13x1Sxl2 poralcllyma llx II X II •uk as nut'SC' usiscant. (Type I) 
M. Ill ~ > 1'11'1 IU ~) l'lllmonary j(> lULU l<qm$IOfl 
16XI9x 18 J)<lmldi)'DU lOx 12xiO 
(Type I) 
3. K.L. 9 Squamous carci· M.l IS'S 1978 10 200 Pulmonuy 56 930 Prosmsion Mirumal po<umothotu . Suicide 
68 noma of uterine 1JX4lx36 parenchyma 49X6S><SS 3 yQI's afi~r trntmt:nt . Ac autopsy 
crrvix + pulmonar)' multiplr smaU pulmonary m~tastases . Rrsn:1ion 1974 artuy 
(Type I) 
4. S.D. 9 Intrapelvic M.l 1sn 1978 lO 100 Pulmonary S6 485 Regression Hypc::.rtcnsion. Coronary ane-rio· 
60 sa.rcoma 15X 18X 18 parenchyma ISX 14X 14 sclerosis. Diabetes mellitus. Small 
Res«tion 1964 (Type I) pneumothorax. Death, 1979, of 
M. II 2818 1978 10 180 Pulmonary 94 444 Rcgrcuion intracercbr.U haemorrhage. 16xl9xl8 parenchyma 17x 14x 14 
(Type I) 
s. G.P. 9 1\dcnoc:ardnoma M.l 118 1978 10 210 Pulmonary 140 I 260 Res.ression MininuJ pnc::umothoru. Patient received 
53 of breast 1Sxllx12 parenchyma 6X 14X6 (lndeter· progesterone:, so the effect of DC tteat· 
~esce1ion 1969 (Type I) tn.inate) mcnt is uncrrtain. 6. A.J. d Osteosarcomt M.l 20111 1978 10 130 Pulmonary 57 50 RcaressJon large pnc:um<tthora :~~:. Pit"Ce of platinum 
11 ReS<Ction 1978 23X23X23 parenchyma 22Xl2X20 electrode left in lung. Treated 
(Type I) tumour I removed surgjcaUy but specl· 
M. II (20111 1978) No (50) Prosrasion men lost. Tumour 11 noc operated. (2SxlSx2S ) treatmmt (34x34X31 ) Ocatb from multiple mc1:asta:ses aftc:::r 
(control) 60 days. 7. D.). 9 Acknocaranoma .M.I 2SIIO 1978 10 160 Pulmomry 43 730 ~ion Lars< po<WnO<boru . Picco of platinum 
71 o( 0\'lty JSxJ7xJ3 poralcllyma 22X31X30 dectrock ldl in tumour. Coromry 
R<section 1974 (Type I) arta iotderosd . I ISO ..,.,._ 
S0X70XS3 8. M.R. 9 MsaliW~ant M. I ll/11 1978 10 120 Pulmonary 80 21 I ndecerminate Pneumothof'IIX . Dc:ath from haemo"hage 
48 melanoma 15x ISX 15 parenchyma ISX ISXIS in cerebral mc:t:a.SIIt!iJ l weeks after 
rt~«ttd from (Type 2) 50% lrH.tmcnt. skin 197l d«ICO)'ed 
9. K.N. d Adrnocardnoma P. I 9 10 1978 10 ISO Pulmonary 75 JIO Progrrssion Th.id.cncd p~ura after lobectomy . 54 of luna 18x24x20 parencbyma Wronc posiuon of anod<. Oath from 
Lol>c<tomy 1978 (Type 2) multiple mttutaso . Sc:ar tissue 
adjacmt to trat«< tumour. 10. M.L. 9 AdcnGC:an:inoma ,\\, I IYl 1979 10 190 Pulmonary 75 1 110 Rt:ynsion Small pncumochorax . Pkural drain. 46 of biC'.Ut 24><21 X20 par<n<:byma 9x11x8 Small leal blttdin1 around tumour. Rcooction 1978 (Typ< I) 
II. A.S. d Small cell bron· P. I 712 1979 10 100 Pulmonary 100 I 050 rrogrt'SS.ion DiabetH mellitus. Difficulties in 
74 chogenic c:arci· lOX lOX 10 parenchyma 48X45X45 keeping anode positioned in tumour. numa (Type I) Pleural drain. Local blttding around 
tumour. Dc:nh from brain metastases. 12. A.T. d Tc:rult.Karcinomu M.l 512 1979 10 160 1\!Jmonary 64 440 Indeterminate Proph)'lactic pleural drain. Death 
41 of u.~~ti.s 22x25x2J parenchyma Pleunl from multiple metastases. R~tK%:do n 1971 (Type I) thickening 
M. II 6'J 1979 10 ISO Pulmonary 83 410 Rcgre5Sion 
15x l8x IS anery 15x 17x 15 
(TYJX I) 
IJ. N.A. d 5qiWilOUS cell M.I 7'8 1979 7 245 Aona 42 180 f>rocrcsPon Propbylxbc pkursl drain. Pain In 
76 QnltiOOU of the 53x5Jx58 (Type 2) 72x65x5J kfl shouldc<. Small pn<umothoru . O<f<ll'l>•cu• large ttntral a'•ity WJih colbp5C' 
Res«tion 197S J45 lndeterminat ·c of 1\nnour. Death from «:l"C'bral 
+ ra:li111ion 40X48X52 metastaKS. tratment 
14. K.W. d Squ1cnou1 cell M. I 2318 1979 10 510 . '\ona 68 840 Progression Progtc"ssjon after chemotherapy. Small 
70 bronchogenic 75x65x65 (Typ< I) 90x90x8S pnt:umothurux. No plcunl drain. carctnoma Na:-rotic: ccn1rc: of tumour which pro-
Rcso::cion l977 grcs.scd al.so afccr DC crcatmc:nt. Death from «~mplicacing broncho· 
o-j pncumoniaj . ~ " 15. A.H.Cf C:tn:inoid P. I 2ll0 1979 10 200 Aona 71 240 lndctcrmin.a.tc Emphysema. Prophylaccic pleural drain. "' a 72 cumour of lull.l 17><16x18 (Type l) l6x.l6"'28 Doth from abuse of alcohol. .. s 16. E.W.Cf Poott-"1 d1ffcrcn· P. I 8 10 1979 10 200 i\ona JS 655 Prognssion Chronic rapintory insu«.ciency 
0 54 uatd squamous 40x4SX57 (Type 2) 65x65x65 post poliomydotls . Bronchial blm· ... 
n «II arc:inoma inc on rtm0¥11 o( dccuode. Temponry .. of luna c:ardiK aJTC$1, ~T~pondcd to cardio- :> n pulmonary rnusatation . Larce pkural .. 
~ dfuslon. E'·cntual death from tocaJ 
"" growth o( tumour tnd widespread meta· 
Coni. s~. "" Table XVll: 2. Com. -.... Date of treatment Coulombs 
o-j Size of pulmonary PO$idon of per largest Obsewoc~t ion ., 
Patient tumour (mm) cathode diameter time (days) .. ., 
§' Age Primary M = metastasis Voltage (Type: of (<m) Si1.e of tu· EITccrs of .. No. (y<ars) cancer P = primary cancer (vohs) Coulombs anode) of tumour mour (mm) treatment Commems a 
0 ... 17. U.K. 9 Adenocarcinoma M. Ia 10110 1979 10 zoo Aorta 67 287 Progression Prophylactic pleural drain. Pleur;al n " " 56 of uterus ZOxlOx 17 (Type: Z) 35><30X33 drain during trtatment. Nephrostomy. n Resection 1971 Stenoses o( ureters after radiation " ., 
+radiation I b 2317 1980 10 270 Pulmonary 77 78 Progression treaunent. Death from multiple meta· 
tre11tmen1 35x30xH a ncr)' 40X28X32 stases. (Type: 2) 
I c 9110 1980 3.4 665 Pulmonary 166 330 Progression 
40x28x 32 parenchyma 65x50x70 
(Type J) 
M. II a 1-118 1980 10 160 Pulmonary 46 90 Progn:ssion 
3JxJ5xJ5 artery 40x35X35 
(Type: l) 
II b 11111 1980 1.5-3.5 400 Pulmonary 100 300 Progression 
40XJ5xJ5 parenc-hyma 75x75x70 
(l"ype 3) 
18. o.s. (f Squamous ce!J P. I 251') 1979 10 400 Aorta 89 l ndetcrmin.a te Arteriosc lerosis. Clinically well 
64 bronchogcn.ic 45X42X43 (Type 2) after treatment. 3 w~k$ later 
carcinoma sudden death, acute myocardial 
infarctjon. 19. s.s. Cf Ade·nocarcinoma M. Ia 1617 1980 10 200 Pulmonary 71 185 Indeterminate Diabetes meJlitus. Pleural 
58 of rectum 28X22Xll artery 28x20x25 thickening post pulmonary tubercu-
Resection 1977 (Type 3) los is. I b 21/1 1981 3.4 710 Rjghl subda-263 400 Progressio n 
28X20X25 \·ian vein 80x60x75 
(Type 4) 
II 28110 1981 10 200 Pulmonary 91 105 Regression 
2ZXI9X 18 parenchyma 18x 12x II 
(Type Z) 
20. A.N. 9 Cardnoma of M.l 3113 1981 5 I HO Left subcla;• 333 m Regression Anode displaced from tumour for an 
61 uterus stage I 40X5lX45 via.n vein J0X42X35 indeterminate period of time. gnde II (Type: 4) Actualwmour dose therefore unccnain . Skeletal metastases. Pleural thickening. of the smaJJ matcrisJ, several observations indicate thut 
different biologic ~pes of cancers may respond differ· 
ently to DC treatment. Two tumours in patient no. 17 
were treated vigorously in comparison with the rela· 
tively small dose given to patient no. 2. In the evalua· 
tion of the present material, it must be kept in mind 
that tbe technique of treatment is still far from opti· 
mized. It can be improved and also combined with 
different other techniques. An electrophoretic attrac· 
tion of cytostatic agents of suitable charge may be 
possible, as was shown in principle with Evans blue 
dye (Chapter XIV, pp. 191-192). 5. Complications 
The patients, despite often poor general condition, 
have usually tolerated direct current treatments very 
well. Fourteen of the patients have reported moderate 
pain, which was caused either by loeation of the anode 
close to the pleura or by tbe pleural drainage tube. Local anaesthesia or the pleura and chest wall succeed­
ed in managing these pains. In one patient an irritant 
cough was probably produced by electrolytic com· 
pounds at the surfaces of an electrode , e.g., chlorine at 
tbe anode. Spontaneous interruption of current by gas formed 
at the electrodes causes intense pain and muscular 
contractions. The treatment must then be interrupted 
and the gas allowed to resorb before treatment can be 
restarted. In this respect electrode Types 3 and 4 are 
favourable because they contain channels, which allow 
suction of gas and the injection of solutions, e.g., 
saline. These aspects are important in attempts to tre-dt 
large tumours (e.g., over 3 em in diameter ). Pneumothorax \\ith dyspnoea occurred in some of 
the patients first treated. Thereafter, a pleural drain 
was applied before each treatment. In one patient a 
slowly developing and asymptomatic pneumothorax 
resulted in displacement of the electrode rrom the 
tumour (patient no. 8). In one patient the anode was 
positioned incorrectly because thickened pleura made 
its position difficult to determine. Minimal hacmopty · 
sis occurred in four patienrs in connection with the 
transthoracic positioning of the electrodes. These 
slight bleediogs did not prevent tbe treatments from 
being carried out as planned. In actuality, the anode 
should be kept away from direct contact with large 
vessels. In tbe anodic region the tissue dehydrates and 
vessels thrombose. In the cathodic region a massive 
collection of interstitial , electroosmotically transferred 
fluid compresses the vessels. These bioelectric effects 
all contribute to decreasing the risks of bleeding dur· 
ing treatment. In one patient with ventilatory insufficiency after 
poliomyelitis (patient no. I6), major haemoptysis de­
veloped when the tumour electrode (one hooked, 0.2 mm thick, platinum electrode, Type 2) was pulled out 
from a rather centrally loeated primary carcinoma. Massive bleeding into the bronchus produced tran· 
sient hypoxaemia and cardiac standstill. Rapid bron· 
chial draining and artificial respiratory assistance 
quickly restored cardiopulmonary function. The 
bleeding stopped. The patient recovered and subse· 
quently returned to his work. He died of local recur· 
renee and widespread metastases I year, 10 months 
arter the treatment. This episode of local arterial 
bleeding has been the only serious complication in the 
present series of patients. How the bleeding happened 
is difficult to prove, but the following explanation may 
be offered: the hooked platinum string probably 
caught a branch of 3 bronchiaJ artery in the anodic 
tumour cavity as the electrode was pulled out. The 
electrode definitely resisted being pulled out. Its distal 
end was 2.0 em long, sharply bent as a hook in the 
tumour. This long length appeared to prevent the 
hooked end from straightening out during the retrac· 
tion. Instead, it probably tore a partly injured bronchi· 
al artery in the tumour cavity. After this episode the 
bent part of string-shaped electrodes has been limited 
to a length of 10 mm. This length permits the string 
electrode to straighten out rather easily during retrac· 
tion from a tissue. In three patients small pieces of a 0.2 mm thick 
platinum string electrode have broken off, presumably 
by respiratory movements stressing the material , and 
then been left behind in the tumour tissue or chest 
l"all. No untoward effects have subsequent ly devel· 
oped in any of these patients. E. DC treatment 
of lung tumours: 
discussion and conclusion 
Possibilities for treatment of patients with metastatic 
cancer in the lungs are often very limited (12). In 
certain cases surgical removal of a solitary metastasis, 
e.g., hypernephrom2 , h:.1s proven beneficiaL When 
metastases are multiple in a lung or bilateral, surger-y 
is often rejected. Surgery also is commonly rejected in 
patients with limited cardiopulmonary function or oth· 
er serious complicating conditions (77). Radiation therapy is not very effective in most com· 
mon primary lung cancers, e.g., squamous cell carci· 
nomas, and is generally ineffective for most metastatic 
tumours (65 ). A rapid decrease in size of a poorly 
differentia ted tumour after radiation treatment is all 
too often accompanied by regrowth of the tumour after 
a short time. Then the tumour is often more insensi· 
tive than previously to any attempts at a repeat course 
of radiation treatment. Treatment of cancer 313 Hormonal and cytostatic chemotherapy are occa­
sionally useful. Nonetheless these chemical treatments 
commonly fail. They also have undesirable side ef­
fects. Other techniques have also previously been intro­
duced in attempts to improve the possibilities of rrear­
ing lung tumours unsuitable for surgery. For example, 
the author has tried the following measures : regional 
perfusion of cytostatic compounds distal to a balloon­
occluded pulmonary artery or vein, infusion of cyto­
static compounds into intercostal and bronchomedias ­
rinal arteries proximal to a balloon-occluded thoracic 
aorta, selective perfusion of a catheterized bronchial 
artery, direct injection of cytostatic compounds into 
the bronchus leading ro the region of a tumour and 
also direct transthoracic injection of such compounds 
into tumourous tissue after local elecrrocoagulation of 
the centre of the tumour (39, 40). Other clinical at­
tempts have been made ro improve the effect of radio­
therapy by increasing the oxygen content of the tu­
mour tissue ( 46, 68). Diathermy is intended ro destroy tissue by the gen­
eration of heat. This technique can be used with 
"dry" electrodes in the lung only for treatment of 
relatively small tumours (less than I em diameter ). Regional cooling of tissue by circulating blood and 
ventilation of lung may interfere with the tr.tnsmission 
of heat. The use of liquid-perfused electrodes , as has 
been shown in this study, improves the possibilities for 
hear production and heat transmission. Wet electrodes 
permit coagulation of somewhat larger tumours than 
do dry electrodes. Electrocoagulation by liquid-per­
fused electrodes can be made rapidly and relatively 
simply with tumours less than one em in diameter. Only occasionally can larger tumours be treated suc­
cessfully with this technique (Fig. XVII: 5). The use of direct current for treating tumours offers 
different and, in some respects, improved possibilities.
631928626-Biologically-Closed-Electric-Ci-Bjorn-Nordenstrom-pdf.txt
Summarize the following text section accurately and concisely. Maintain specific details and numerical information, and use anti-repetition mechanisms:

        This is obviously important for 
avoidi. ng the leading of current through the myocardi­
um. Tb~ structures of the trJ:ated organ also are impor­
tant in direct current treatment, because they affect 
the pathways for current. For example, Fig. XVII: 22 a illustrates the cathode positioned across the 
vascular bundle central to a lung tumour and inside 
the same segment or lobe as the tumour, assuring 
favourable conductivi ty and spatial distribution of cur­
~nt. Fig. XVII: 22 b, however, shows the cathode 
positioned beyond the interlobar pleura, which 
hinden current Oow. Any air leak into the pleural 
space will further enhance the hindrance, so that the 
current must pass in a wide arc over the hilar tissues. This broad and indirect course is unnecessary. Resis­
tance to Oow will be increased and may even theoreti­
cally produce unexpected reactions, ~. g. , from nerves 
in the hilum. Pneumothorax is a likely complication of traru;thora­
cic insertions of electrodes. In order to contrOl this 
complication, one should int. roduce a pleural drainage 
rube before the electrodes •~ to be implanted. When 
the pleural tube is connected to a suitable suction 
device, collapse of the lurtg can be prevented. During 
the treatment, pressure in the pleura must be continu-ously maintained at subatmospheric levels, so that the 
lung is maintained expanded. Constant size and posi· 
tion of involved lung are necessary to prevent a pneu· 
mothorax from dislocating the electrode from the tu· 
mour. Absence of pneumothorax is also obviously nec­
essary for respirator y comfort and safety of the patient. The pleural drainage tube should be kept in place a 
day or two under constant suction after conclusion of a 
treatment with direct current. 6. Voltage and current 
In experiments on animals, up to 40 volts have been 
applied between electrodes in the lung. ln patients, usually 10 volts (range, l. S-15 volts) 
have been used. Initially, current should be applied by 
evenly elevating the voltage from 0 to the desired level, 
which in practice has been performed during one 
minute. Similarly, the current should be lowered slow· 
ly, e.
To prevent pneumothorax and maintain the lung's size and position.
What is the purpose of introducing a pleural drainage tube before direct current treatment?
It can affect the flow of current and the spatial distribution of current.
What is the significance of the distance between the electrodes in direct current treatment?
Gradually lowering the voltage and current, and waiting for the accumulated gas to resorb.
What is the recommended approach for managing pain during direct current treatment?
To avoid damaging the surrounding tissue and ensure the electrode remains in the tumour.
What is the primary concern when positioning the anode and cathode?
To maintain a constant current and voltage, and to prevent unexpected reactions.
What is the goal of the DC Treatment Processor?