Hope For New LIfe

The pituitary gland, a pea-sized object cannily concealed in the middle of the skull, was once believed to be the soul's abiding place. In the 20th century, surgeons have worried less about the soul, but the pituitary's front part was found to produce no fewer than six master hormones,* which control slave hormones in other glands. Clearly, it would be fatal if a surgeon took out so vital a gland. At most, he might operate on a cancerous pituitary, but then he was scrupulously careful to leave some of the gland intact.

Last week Dr. Olof Pearson told a packed audience of medical researchers in Atlantic City that in three years a Manhattan medical-surgical team had removed the pituitary from no fewer than 79 victims of advanced cancer. Most patients (though definitely not cured) enjoyed a new lease of active and relatively pain-free life.

The Unidentified Hormone. The revolution in medicine's attitude to the pituitary is one of many important results of the isolation of cortisone. Some cancers, it was known, did not grow so fast, or perhaps not at all, if they were deprived of sex hormones. The ovaries or testicles secreted these hormones in response to commands from the master pituitary. Theoretically, removing the sex and adrenal glands (which also secrete sex hormones) should have solved the problem. But it proved not to be so simple. Some part of the body--perhaps the pituitary --was making an unidentified hormone that was as damaging as the sex hormones in permitting cancer growth. Only after it became possible to give hormones like cortisone as replacements could doctors consider taking out the entire pituitary.

Swedish Drs. Rolf Luft and Herbert Olivecrona devised a daring operation, through the side of the skull, to get at the pituitary and get it out. They hoped this operation would be a substitute for the removal of ovaries or testicles and adrenal glands. Cuban Drs. Jose Schutte and Jorge Picaza tried hypophysectomy (medical jargon for cutting out the hypophysis or pituitary) in a woman who had been riddled with breast cancer, and gained an extraordinary reprieve for her (TIME. Feb. 1. 1954).

The Straight Line. One thing that bothered Neurosurgeon Bronson Ray of New York Hospital-Cornell Medical Center was the sideways approach through the skull, which makes operating difficult. He tried getting at the well-protected pituitary through the nasal sinuses, but this led to too many complications. Finally he hit upon a seemingly simple adaptation, cutting his trapdoor into the skull bone not at the temple, but at the forehead hairline. Then he lifted up the brain and could work in a straight line toward the pituitary. The catch was that with all his instruments he had to work through a tight tangle of crisscrossed nerves, notably those on which sight and smell depend. But cutting only one, thus sacrificing nothing more than the sense of smell on the right side. Surgeon Ray was able to get the long handle of his tiny surgical spoon into the pituitary's hiding place and scoop it out. Then he stuffed a piece of sponge into the cavity, led a thin glass tube to it, and poured in a caustic solution that burned out any last fragments of pituitary.

Surgeon Ray has perfected the operation for a series of patients selected by Dr. Pearson, attending physician at Memorial Center for Cancer and Allied Diseases. The procedure, no longer rated dangerous, takes only 1 1/2 hours. Many patients are up and about the next day; within a week they report a loss of pain or even discomfort. Some who had been resigned to an early death have begun virtually new lives after hypophysectomy controlled the recurrence or spread of colonizing cancers. Maintenance medication is simple: regular tablets of cortisone and thyroid hormone suffice for most; one in four also needs pitressin (to control water balance), which is taken like snuff.

Some men with cancer of the breast or prostate have been helped, but by far the greatest number of patients have been women suffering from recurrences of cancer of the breast. Of 37 whose progress can be evaluated, 20 showed marked improvement and 15 are still living (one almost two years after the operation). Among the 17 cases listed as failures were many whose disease was too far advanced to leave reasonable hope of betterment.

Eventually, Memorial's experts believe, the operation will be useful in no less than 80% of cases of breast cancer, which is the nation's commonest, with 50,000 cases a year.

* Growth (somatotropic) hormone, ACTH (adrenocorticotropic), thyroid-stimulating (thyrotropic) hormone and, in women, three that regulate the reproductive cycle: follicle-stimulating (FSH), luteinizing (LH) and prolactin.

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