November 2003

There's No Business Like ASTRO Business

By Michael J. Katin, MD

A momentous event associated with the study of radioactivity occurred in 1958 that was remembered for the 45th time this year. It was in 1958 that one of the section heads of Brookhaven National Laboratory, William Higinbotham, developed the world's first video game, setting off a chain of event resulting in the total destruction of the cultural orientation of the American population between ages 9 and 15. It is also the year in whch was held the first organized meeting of the American Club of Therapeutic Radiologists, with the election of Simeon Cantril as President, and now celebrated in Salt Lake City by the 45th annual meeting of the American Society of Therapeutic Radiology and Oncology.

Some force in the universe must have been in effect in 1958, generating as it did a plethora of very familiar organizations, including the American Society of Hematology (ASH), American Association of Physicists in Medicine (AAPM), and South Central Association of Blood Banks (SCABB).

Dr. Luther Brady has contributed an excellent memoir of the early development of our organization, and it is indicative of the relatively youth of this specialty that in the year of his Presidency, 1971, it was still possible to assemble all previous Presidents with two exceptions, and only one due to death. Dr. Cantril's own story I'm sure merits special attention, coming as he did from the early trial-and-error, no- holds-barred days of radiation medicine.

We all go to medical meetings expecting against reason to come away with revelations about new techniques, new combinations of treatments, and breakthroughs in understanding of what's happening at the molecular level when treatment is given. We generally leave with reinforcement of what we already believed, plus about 10 pounds of literature from the vendors and 10 pounds from the receptions and dinners.

This year there may have been a move toward planned obsolesence, with a clue being given since the meeting was being held in a city with no incidence of disease. I noted that there were no major hospitals to be seen on the way in from the airport, and it made since considering that the majority of people there don't use tobacco or alcohol or even caffeine. Everybody I saw, with the exception of the atendees at the meeting, was energetic and youthful. Sure enough, the first Keynote Address dealt with "The Potential for Prevention of Colorectal Cancer by Diet and Lifestyle." That's certainly an admirable goal, and could certainly reduce the number of people needing our services. The second Keynote Address seemed straightforward enough, "Augmentation of Chemotherapy and Radiotherapy by EGF Receptor Inhibition." It's definitely important to explore new modalities, but what if EGF Receptor Inhibition works really, really, well? Maybe there won't be any need for the radiotherapy part. Then if that isn't enough, the first paper in the Plenary Session addresses the role of short-course palliative irradiation. In other words, we're trying to prevent cancer, and if we can't, to use something else to treat it, and if we can't do that, give the smallest number of treatments possible.

Was it a coincidence that during that very same week, The New England Journal of Medicine reported the results of a study of decreased hospital use in the Department of Veterans Affairs, with the observation that "the changes in hospital and clinic utilization were not associated with a decline in long-term survival rates." In fact, "in five of the cohorts, one-year survival rates improved significantly, wherease in the other four cohorts , the survival rates remained unchanged."

Otherwise, the meeting went very well. The weather was great, the convention center was user-friendly, and the sponsored events at the Delta Center were well organized. It was rewarding to be able to hear the world-renowned Mormon Tabernacle Choir, and their rendition of "Who Let The Dogs Out" was unexpected and not easily forgotten. One still has to speculate how long this can go on. With the combination of eliminating the causes of cancer, finding alternative treatments, and limiting the intensity of treatment, it will be a matter of time before the membership declines to the numbers of the original American Club of Therapeutic Radiologists. I notice that the list of future meetings goes only up to 2010, in San Diego, and 2011, in Miami, as if taking a farewell cross-country tour, and presumably the organization will thereafter move off into the ocean, never to be heard from again.

In the words of a current ASTRO board member: "Would the last person out please turn off the linear accelerator."

email: mkatin@radiotherapy.com