January 2000

Hit Me With Your Last Shot

By Michael J. Katin, MD

Now that midnight has passed and the end of the world as we know it has not occurred, to the best of our knowledge, it would be appropriate to reminisce about the events of the past year and plan on building on positive developments for the future. Instead, this topic will be jettisoned now that, once again, we have been shown our place by the news media.

First it should be denied one more time that this month's column should reflect a transition from the old millennium to the new, although it is becoming futile to insist on waiting one more year to mark this since the overwhelming bulk of mankind insists that this has already occurred. In concession to this, I am willing to also embrace the concept that toads cause warts, that we are living in a democracy rather than a republic, and that Jefferson wrote the Constitution, all equally accurate.

I think back on the great technical and procedural advances that have been made in the field of Radiation Oncology, and the options for improvement in the next few years. I then realize that the Rodney Dangerfield of specialties will always be taking cheap shots and never reach the level of respect accorded to chelation therapy. This was rudely brought into focus by the Associated Press report of December 31 that a 200-pound tumor was removed by surgeons at the University of Chicago.

One might assume that my complaint is that, as usual, surgeons get credit for all kinds of dramatic procedures, whether it be cadaver hand transplants, hemicorporectomies, or intrauterine fetal repairs, whereas we lack the kind of dramatic instant life-and-death images that they can generate. At least 3D conformal plans make interesting graphics for public relations, but it's not possible to easily illustrate IMRT in an understandable way for the public. No, that's not it. My concern is that the article discussed that this unfortunate woman had been growing neurofibromas and this particular mass had reached a size of 200 pounds. The tumor was removed with a lengthy, complicated set of procedures and reportedly is now working in a convenience store in Michigan. And why had this tumor grown to this size? It was because of irradiation administered last January, according to the Associated Press. Logical, since the same process was responsible for Mothra and was documented in humans in "Attack of the 50-Foot Woman."

Congratulations to the Associated Press for getting in the final low blow of the 1900's. Unfortunately, there are no referees to penalize them. Although we've become accustomed to dealing with accusations that don't stand up to scientific scrutiny, it would be a waste of time and energy to write to the newspapers about this. Even if there were a retraction, it would probably be stuck on page 17E three weeks from now. We'll have to suck it up again, but these constant hits make it more difficult for us to promote the use of radiation therapy in cancer treatment, let alone its use in non-malignant conditions such as for reduction of restenosis and treatment of macular degeneration.

Unless using radiation therapy to make things grow can be perceived as a beneficial effect. I'll speak with my urology colleagues about a joint study.

email: mkatin@radiotherapy.com