January 1998

The Shadow Knows (But We Don't)

By Michael J. Katin, MD

There used to be a joke about internal medicine boards to the effect that every year the questions stay the same but the answers change.  Of course, this could never be said about radiation oncology or medical oncology since there are certain basic tenets that are solid over time.

Unfortunately, the most basic of these is that we don't have the slightest idea about the validity of half the things we do every day. Any list that I could contribute would be markedly incomplete, and I will invite the the readers to add their ideas.

  1. Observation versus treatment for early stage carcinoma of the prostate
  2. The value of b.i.d. fractionation for head and neck cancer
  3. The usefulness of stereotactic radiosurgery in glioblastomas
  4. Any consistent proof of a value for neoadjuvant chemotherapy in squamous cell carcinomas
  5. Boron neutron capture--it's already come back more times than Richard Nixon
  6. Three-dimensional conformal therapy--we all love it but does it make any difference in the outcome in 90% of the patients we see?
  7. Autologous marrow transplants--how many people ever get cured?
  8. p53 and other markers--can we please start doing genetic therapy instead of just listing these on the breast cancer panels and scaring the patients (favorable/unfavorable)?
  9. Hereditary cancer patterns--if we're not going to use these for anything let's stop taking family histories, let alone putting out newspaper articles about BRCA1
  10. Lymphoma classifications--before Copernicus, the explanations for planetary and stellar movements were also becoming more and more complicated

This is a small fraction of the items that could be listed and I have even deliberately left out some that could be offfensive to some people's pet projects.  If you're going to be clueless, at least leave some people happy with their delusions.

email: mkatin@radiotherapy.com