August 2011

On the Wedge of Tomorrow

By Michael J. Katin, MD

August, 2011, represents the first month since May, 1961, that the United States is not capable of placing a person into space. The shuttle program has been officially ended, with each shuttle finding a new home on display and not available for our use by Bruce Willis when an 800-meter-long asteroid comes hurtling toward Antarctica in 2012. It’s ironic that nobody in the government has any respect for private industry being able to accomplish anything, but for some reason assumes that American space vehicles of the future are going to be generated by naturalized Americans like Elon Musk, co-founder of PayPal, and never-to-be Americans like Sir Richard Branson. In the meantime, our current and traditional allies , the Russians , will gladly assist when payloads need to be delivered, especially now that they have discovered the joys of capitalism .

Actually, the decision has been made to move beyond mundane tasks, such as rescuing marooned astronauts and mining precious materials from the moon, to go far, far beyond to send humans to asteroids, Mars , and Vulcan. This is truly a noble goal and probably not achievable anytime in the next several decades due to the need for development of technologies that do not yet exist, due to cost, and, incidentally, due to the fact that humans would not be guaranteed to survive such a trip. Those of us who need to watch readings on film badges when working with radiation therapy equipment and isotopes know that being exposed to whole-body irradiation for months, plus acute dosing . from solar particle events, is not a good thing .

The battle is continuing to be waged over the continuing use of fossil fuels as opposed to renewable “green” energy sources. It is admirable to come up with techniques that do not destroy the environment and that cannot be depleted. Unfortunately, these alternative sources can cause a great deal of disruption or their own and cannot come even close to providing the needs of our civilization, even if major breakthroughs in technology occur.

What does any of this have to do with radiation oncology? It’s not a stretch to say that these examples of jumping to the next level prematurely may be similar to the efforts to give the public (and lawmakers) the impression that current therapeutic techniques in our field are rapidly becoming obsolete. It would seem to be a matter of weeks before all linear accelerators are shut down (or to have reimbursement severely reduced—same result ), since designer drug therapy will be the treatment of choice. There has certainly been amazing progress in this field, but it is by no means ready to replace current therapy in the vast majority of people with cancer. As if that were not enough of a threat, it is assumed that all radiation therapy in the future will be carried out with proton and carbon-ion therapy. In the 1970’s, it seemed obvious that neutron beam therapy would replace high-energy x-rays and cobalt therapy, principally because of the decreased reliance on oxygen enhancement from high-LET particles in treating tumors that could be relatively hypoxic. Nearly 40 years later, there are few neutron facilities in the world, since treatment results were complicated by damage resulting from a higher RBE on normal tissue receiving even relatively low doses. It is certainly possible that proton and carbon-ion therapy will have advantages but it is somewhat premature to make a commitment to this right now.

This is not, however, to discourage attempts to move science, and humankind in general, into the future. If all these efforts prove correct, we will no doubt be looking forward to a brighter and more stable tomorrow.