From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.diseases.cancer,alt.support.cancer,misc.health.alternative,
	sci.life-extension
Subject: Re: The Life Extension Foundation's Protocol for Radiation Therapy
Date: 27 Dec 1998 07:05:57 GMT

In <3684A922.173774EC@infinitefaculty.org> Brian Manning Delaney
<bmdelaney@infinitefaculty.org> writes:

>Of course (as I said before). Again, the question is not why you
>aren't listing EVERY conventional -- or even alternative --
>therapy dealing with clinically verified mitigation of radiation
>damage in a useful way.
>
>To repeat the main (this should be the easiest to answer -- I'll
>drop the others):
>
>1) When you make claims like this: "During radiation therapy, the
>use of high doses of antioxidants will protect healthy cells from
>free radical-induced radiation damage," why do you think the
>anti-oxidants won't also protect the cancerous cells?
>
>That is to say, why do you recommend anti-oxidants for use during
>cancer radiation therapy?
>
>Clinical studies aren't the only way to support a particular
>treatment protocol, of course. We have to make decisions based on
>incomplete knowledge. (We do nothing but that, one could argue!)
>So I would at least like to know whether there's some kind of
>theoretical rationale for your recommendation.
>
>Thank you,
>Brian


Comment:

    Brian, so far as I can tell after spending a little time looking,
there isn't all that much in the literature on use of vitamins in
radiation therapy for cancer.  If it's there, it's under subject
headings I haven't thought of.  I *think* I remember reading that there
was recently a study (which I'm still trying to find) which found that
giving patients multivitamins before undergoing chemotherapy at least
didn't HURT their survival (a big question in oncology for some time--
are you feeding the tumor?).   But that wasn't radiotherapy.  I know of
no randomized clinical (ie, human) trial in English which find to any
good statistical level of probability that such a thing helps.

    Worse, I could find no more than a couple of animal studies in a
quick search.  That suggests a real poverty of info, here.  The one on
vitamin C and K3 is the most impressive, but is done in rodents, is
small, and needs repeating.  The one on vitamin E is impressive mainly
in suggesting that E protects against radiation enteritis, a major
cause of morbidity in trying to get at tumors like pancreatic tumors
where you just can't get the normal bowel out of the way, and you know
it's in for a beating.  Here again you have to wonder if absorbed
vitamin E is going to help the tumor, but in this case the
concentration of E at the gut inner mucosa where the radiation damage
to the gut takes place, is so much larger than it would be in a tumor
elsewhere after being absorbed, that the idea of differential
protection here is very reasonable.  Probably reasonable to recommend,
with the caveat that it's a rodent study, and the clinical application
is based on "cookbook guess" biology, which is never very safe.


Anticancer Res 1996 Jan-Feb;16(1):499-503


Potentiation of radiotherapy by nontoxic pretreatment with combined
vitamins C and K3 in mice bearing solid transplantable tumor.

Taper HS, Keyeux A, Roberfroid M

Departement des Sciences Pharmaceutiques, Universite Catholique de
Louvain, Brussels, Belgium.

BACKGROUND: The effect of intraperitoneal and oral pretreatment with
combined vitamins C and K3 on the single dose radiotherapy of a
transplantable solid mouse tumor have been investigated. MATERIALS AND
METHODS: Groups of mice bearing intramuscularly transplanted liver
tumors, were orally and parenterally pretreated with combined vitamins C
and K3 and locally irradiated with single doses of 20, 30, or 40 Gy of
X-rays. After this treatment tumor dimensions were measured twice weekly
and the approximate tumor volume in groups of pretreated vitamins and
irradiated mice was compared to the groups of mice only irradiated and to
the absolute control groups without any therapy. RESULTS: This nontoxic
pretreatment produced statistically significant potentiation of
radiotherapy induced by 20 to 40 Gy of X-rays doses in groups of 11 to 20
mice.  Combined vitamins C with K3 most probably constitute a
redox-cycling system producing hydrogen peroxide and other active oxygen
species to which cancer cells are selectively sensitive due to their
frequent deficiency in enzymatic defense system against free oxyradicals
agression. CONCLUSIONS: A possible introduction of such nontoxic and
selective potentiation procedure into classical protocols of human cancer
therapy appears to be generally accessible and without any additional
risk for patients.

PMID: 8615662, UI: 96200756



----------

Ann Surg 1995 Oct;222(4):504-8; discussion 508-10


Intestinal radioprotection by vitamin E (alpha-tocopherol).

Felemovicius I, Bonsack ME, Baptista ML, Delaney JP

Department of Surgery, University of Minnesota Medical School,
Minneapolis, USA.

OBJECTIVES: The major objective of this study was to test vitamin E as a
potential radioprotectant for the small bowel of the rat. SUMMARY
BACKGROUND DATA: Vitamin E has previously been shown to provide
radioprotection in animal models: increased survival after whole-body
irradiation, diminished absorptive malfunction, and modest diminution in
postirradiation hemolysis. The lumenal route for intestinal
radioprotection has not been tested. METHODS: Rat mid-small bowel was
surgically exteriorized and segmented by ties into compartments, each of
which was filled with a test solution 30 minutes before 1100 cGy of
x-irradiation was administered. After the rats were killed 5 days later,
the various segments were evaluated for surviving crypts, mucosal height,
and goblet cell preservation. Lumenal agents included alpha-tocopherol
phosphate and alpha-tocopherol acetate. In a separate study, dietary
supplements of alpha-tocopherol were given for 10 days before
irradiation, and the same irradiation sequence was carried out. RESULTS:
Small bowel crypt cell numbers, mucosal height, and goblet cell numbers
were significantly protected from radiation effects by dietary alpha
tocopherol pretreatment and by lumenal application of the vitamin.
CONCLUSIONS: These studies indicate that vitamin E can serve as a partial
protectant against acute irradiation enteritis, whether given as chronic
oral systemic pretreatment or as a brief topical application.

PMID: 7574930, UI: 96025121

----------

From: sbharris@ix.netcom.com (Steve Harris  sbharris@ROMAN9.netcom.com)
Newsgroups: soc.culture.indian,alt.fan.jai-maharaj,alt.support.cancer,
	misc.health.alternative,sci.med
Subject: Re: INTENSE THERAPY BEATS HEAD CANCER
Date: 25 Sep 2003 17:34:15 -0700
Message-ID: <79cf0a8.0309251634.9bdc0be@posting.google.com>

Orac <orac@mac.com> wrote in message
news:<orac-94C8FF.20334524092003@host9.newsfeeds.com>...

> In article <3f6e949c_2@news.brisbane.pipenetworks.com>,
>  "Peter Moran" <moringa@gil.com.au> wrote:
>
> > "Anth" <anon@anon.com> wrote in message
> > news:3f6d8335$0$33799$65c69314@mercury.nildram.net...
> > > If this beats head cancer then why does it need further randomised
> > > controls to validate?
> > > Ant
> >
> > The study said ---
> >
> > > > > Professor Michele Saunders of Cancer Research UK said:
> > > > "This accelerated radiotherapy protocol is already being
> > > > used in the UK and will be the subject of a randomised
> > > > controlled trial to be organised by the National Cancer
> > > > Research Institute."
> >
> > It is rare within medicine for the results of a single study to be accepted
> > as final.
>
> Indeed. It usually takes at least two or three good randomized studies
> to convince people or a larger number of less well-designed trials. This
> is particularly true when the reported effect is not large.

COMMENT:

And particularly when the result is not conducive to the comfort of
radiation medicine specialists, who didn't enter the field to work
weekends.  Do you know what effort has already gone in to "showing"
that 5 days a week radiotherapy is just as good as 6 and 7 ?? A lot!
So this "accelerated radiotherapy" result, if it holds, is a true
disaster in the field, a mighty smelly brown thingy in the punch bowl.

Things haven't been this bad since they started telling neurologists
they had to come in from Sunday golf in order to see stroke patients
for the new emergency clot-busting. "Say WHAT??" the whole profession
said.

SBH

From: sbharris@ix.netcom.com (Steve Harris  sbharris@ROMAN9.netcom.com)
Newsgroups: soc.culture.indian,alt.fan.jai-maharaj,alt.support.cancer,
	misc.health.alternative,sci.med
Subject: Re: INTENSE THERAPY BEATS HEAD CANCER
Date: 26 Sep 2003 16:20:05 -0700
Message-ID: <79cf0a8.0309261520.6519fa1b@posting.google.com>

Orac <orac@wlsfanmail.com> wrote in message
news:<orac-4E8D07.09250026092003@host9.newsfeeds.com>...
> But all joking aside, radiation oncologists have always had to deal with
> the occasional emergency that required night or weekend treatment, such
> as spinal cord compression by tumor with neurologic deficit or superior
> vena cava syndrome from obstruction of the superior vena cava with
> tumor. There is also a a fairly large developing literature on
> hyperfractionated radiation therapy, which requires even more frequent
> small doses seven days a week; so it's not as if they haven't been
> studying treatments that might disturb their weekends...


COMMENT:

My god, don't radiation oncologists get a lot of mileage out of cord
compression by tumor and superior vena cava syndrome. These are rare
enough to be good trivia quiv for student docs (what are the only true
radiation oncology emergencies..).  But ask a rad onc guy to honestly
tell you if he personally has ever had to come in on a weekend to
treat a case, and you'll get an embarrassed "no." Or "yeah.... once in
my training." They saw it because as a *fellow* or whatever, they had
to come in and do it <G>.

As for hyperfractionated dose therapy, don't tout it until you see how
it's done. Some is 7 days a week, but a good fraction of the studies
are twice a day for 5 days a week. Guess which 5?

SBH

From: sbharris@ix.netcom.com (Steve Harris  sbharris@ROMAN9.netcom.com)
Newsgroups: soc.culture.indian,alt.fan.jai-maharaj,alt.support.cancer,
	misc.health.alternative,sci.med
Subject: Re: INTENSE THERAPY BEATS HEAD CANCER
Date: 27 Sep 2003 16:45:33 -0700
Message-ID: <79cf0a8.0309271545.5be052f8@posting.google.com>

"Steph" <steph@vancouver.island> wrote in message
news:<_v4db.27751$TM4.19144@pd7tw2no>...
> > My god, don't radiation oncologists get a lot of mileage out of cord
> > compression by tumor and superior vena cava syndrome. These are rare
> > enough to be good trivia quiv for student docs (what are the only true
> > radiation oncology emergencies..).
>
> About 10% of the common cancer get spinal cord compression, or threatened
> compression at some time..


Irrelevent, since the "threatened" are by far the largest fraction of
this group, and treating them doesn't consitute weekend emergency
care.


>
> > But ask a rad onc guy to honestly
> > tell you if he personally has ever had to come in on a weekend to
> > treat a case, and you'll get an embarrassed "no." Or "yeah.... once in
> > my training." They saw it because as a *fellow* or whatever, they had
> > to come in and do it <G>.
> >
>
> Happens to me 5-6 times per year


Really?  10% of your patients and it gets you only 5 times a year?
Once in every 10 weeks? Your own two factoids don't even agree, if I
was to take them a face value. Which of course I don't, for reasons
explained above.

Let's see you back the fact of 5 to 6 rad-onc emergencies a year, with
your department chairman or program's phone number. I will check it,
you know. Right now-- Oh, anonymous rad onc wonk, I think you're
BS'ing us. Prove me wrong.


> > As for hyperfractionated dose therapy, don't tout it until you see how
> > it's done. Some is 7 days a week, but a good fraction of the studies
> > are twice a day for 5 days a week. Guess which 5?
> >
> > SBH
>
> I think you have an attitude, based on very few facts..


Un-huh. How many accelerated regimin patients do you do yourself?
Please describe. As for facts, I have medline, same as you. Why don't
you look up 10 hyperfractionation studies at random, and get back to
us? The literature is full of hyperfractionation studies which are not
accelerated. Or are 6 days a week and not 7. Here's the first example
I pulled off medline. Hell, they can't even do people on weekends for
a formal phase III study.

Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):7-16.

Comment in:
    Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):1-2.
    Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):3-6.
    Int J Radiat Oncol Biol Phys. 2001 Apr 1;49(5):1517-8.
    Int J Radiat Oncol Biol Phys. 2001 Oct 1;51(2):563.

A Radiation Therapy Oncology Group (RTOG) phase III randomized study to
compare hyperfractionation and two variants of accelerated fractionation
to standard fractionation radiotherapy for head and neck squamous cell
carcinomas:  first report of RTOG 9003.

Fu KK, Pajak TF, Trotti A, Jones CU, Spencer SA, Phillips TL, Garden AS,
Ridge JA, Cooper JS, Ang KK.

Department of Radiation Oncology, University of California San Francisco,
94143-0226, USA. fu@radonc17.ucsf.edu

PURPOSE: The optimal fractionation schedule for radiotherapy of head and
neck cancer has been controversial. The objective of this randomized
trial was to test the efficacy of hyperfractionation and two types of
accelerated fractionation individually against standard fractionation.
METHODS AND MATERIALS: Patients with locally advanced head and neck
cancer were randomly assigned to receive radiotherapy delivered with: 1)
standard fractionation at 2 Gy/fraction/day, 5 days/week, to 70 Gy/35
fractions/7 weeks; 2) hyperfractionation at 1. 2 Gy/fraction, twice
daily, 5 days/week to 81.6 Gy/68 fractions/7 weeks; 3) accelerated
fractionation with split at 1.6 Gy/fraction, twice daily, 5 days/week, to
67.2 Gy/42 fractions/6 weeks including a 2-week rest after 38.4 Gy; or 4)
accelerated fractionation with concomitant boost at 1.8 Gy/fraction/day,
5 days/week and 1.5 Gy/fraction/day to a boost field as a second daily
treatment for the last 12 treatment days to 72 Gy/42 fractions/6 weeks.
Of the 1113 patients entered, 1073 patients were analyzable for outcome.
The median follow-up was 23 months for all analyzable patients and 41.2
months for patients alive. RESULTS: Patients treated with
hyperfractionation and accelerated fractionation with concomitant boost
had significantly better local-regional control (p = 0.045 and p = 0.050
respectively) than those treated with standard fractionation. There was
also a trend toward improved disease-free survival (p = 0.067 and p =
0.054 respectively) although the difference in overall survival was not
significant. Patients treated with accelerated fractionation with split
had similar outcome to those treated with standard fractionation. All
three altered fractionation groups had significantly greater acute side
effects compared to standard fractionation. However, there was no
significant increase of late effects. CONCLUSIONS: Hyperfractionation and
accelerated fractionation with concomitant boost are more efficacious
than standard fractionation for locally advanced head and neck cancer.
Acute but not late effects are also increased.

Publication Types:
    Clinical Trial
    Clinical Trial, Phase III
    Multicenter Study
    Randomized Controlled Trial

PMID: 10924966 [PubMed - indexed for MEDLINE]

From: sbharris@ix.netcom.com (Steve Harris  sbharris@ROMAN9.netcom.com)
Newsgroups: soc.culture.indian,alt.fan.jai-maharaj,alt.support.cancer,
	misc.health.alternative,sci.med
Subject: Re: INTENSE THERAPY BEATS HEAD CANCER
Date: 28 Sep 2003 14:55:41 -0700
Message-ID: <79cf0a8.0309281355.1a582572@posting.google.com>

Orac <Orac@wabcmail.com> wrote in message
news:<Orac-529521.20211027092003@news4.srv.hcvlny.cv.net>...

> Personally, I think *you're* getting way out of control here and need to
> take a chill pill. I don't know what your major malfunction is or what
> your beef is with radiation oncologists, but your attacks are getting
> increasingly petty and you're getting increasingly nasty for no apparent
> reason.


I've given my reasons and my beefs in detail and you seem to have
difficulty understanding them. Your problem.

I'm one of the few physicians here who posts under my own name, taking
open responsiblity for what I say. And I give my reasons for my
opinions, citing literature and experience where I can. That means I'm
open to getting my nose rubbed in it. For example, had I not been able
to find any 5 day a week hyperfraction studies, I've had looked pretty
silly. But I found them being done in San Francisco (they are done all
over the world, actually), and so my point is made. It's not my fault
if you don't get it.

Who are you, oh anonmyous one?

Steve Harris

From: sbharris@ix.netcom.com (Steve Harris  sbharris@ROMAN9.netcom.com)
Newsgroups: alt.support.cancer,misc.health.alternative,sci.med
Subject: Re: INTENSE THERAPY BEATS HEAD CANCER
Date: 29 Sep 2003 13:56:20 -0700
Message-ID: <79cf0a8.0309291256.569f4f3b@posting.google.com>

Orac <Orac@mac.com> wrote in message
news:<Orac-6B7DDF.22574928092003@news4.srv.hcvlny.cv.net>...

> > I've given my reasons and my beefs in detail and you seem to have
> > difficulty understanding them. Your problem.
>
> It's not so much the reasons, but the intensity of the dislike and the
> nastiness I don't understand. Your stated reasons and studies perhaps
> are not the whole story, I suspect.

You're wrong. I have nothing personally against any rad onc guy. I
merely report what I see. In this case, I think the science is being
warped by personal interest, and that (if you believe that latest
studies) may well be resulting in people dying because a certain class
of doctors resists working weekends.

I'm incensed about that in the same way I'm incensed about a lot of
things wrong with medicine. For example, radiologists, who make nearly
as much as cardiac surgeons, and more than general surgeons, are
overpaid. Surgery is damned difficult. Pediatricians (in all their
subspecialties) are underpaid by comparison with adult specialties
(pediatric heart surgeons make about half of what adult heart surgeons
do-- go figure). As a sometime internist and geriatrician I can say
all these things without being self-serving. I merely point out
glaring stupidities and unfairnesses in medicine, and you can make of
my opinions what you will. Yes, the profession of medicine matters to
me. Doesn't it matter to you?  If not, I invite you to bugger off, and
leave this forum to people who care about what they are discussing.


> >For example, had I not been able
> > to find any 5 day a week hyperfraction studies, I've had looked pretty
> > silly. But I found them being done in San Francisco (they are done all
> > over the world, actually), and so my point is made. It's not my fault
> > if you don't get it.
>
> I got your point. What I don't get is why it matters so much to you,
> enough to send you scurrying off to look up studies that make your
> unflattering point about radiation oncologists.


Citing the literature, which is damning, was brought on by Steph
saying "I think you have an attitude, based on very few facts.."  That
tends to provoke citation of facts. Why don't you get this?

I haven't heard a peep from Steph since. If he comes back trying to
defend 5 day a week hyperfractionation studies, he's going to look
pretty silly. So I suspect we won't hear back from him with many
specifics, or much science.

Is radiation oncology a fine subspecialty?  Sure. Are they overpaid?
No, they don't make as much as radiologists, either. Are most rad onc
people decent and honest guys?  Sure.  Does the rad onc profession
have a giant boil on its collective butt, regarding the problem of
weekend treatment?  Yes, indeed. All these things are true at the same
time. The boil needs to be lanced, for the good of the specialty, the
patients, and medicine as a whole.


>Perhaps if I knew what specialty you were...

What good would that do?  I know of no medical specialty which has a
hereditary dislike of radiation oncologists.  If there were any, they
certainly wouldn't be mine.


SBH

From: sbharris@ix.netcom.com (Steve Harris  sbharris@ROMAN9.netcom.com)
Newsgroups: soc.culture.indian,alt.fan.jai-maharaj,alt.support.cancer,
	misc.health.alternative,sci.med
Subject: Re: INTENSE THERAPY BEATS HEAD CANCER
Date: 28 Sep 2003 15:06:14 -0700
Message-ID: <79cf0a8.0309281344.5d52b0f1@posting.google.com>

Orac <Orac@wabcmail.com> wrote in message
news:<Orac-96083D.21395826092003@news4.srv.hcvlny.cv.net>...

> Man, you seem to have a bug up your butt about radiation oncologists.
> You seem to be downright hostile here. I actually did some of my lab
> research in a very prestigious radiation oncology department; so I know
> a few radiation oncologists.


So what?  So do I. I know very well they rarely (read: almost never)
work weekends. They are rather like dermatologists and most kinds of
pathologists. Personally this doesn't bother me, except when it
appears to be warping scientific perspective. Which (looking at the
literature) I see that it has.

There is no reason for the large number of trials of hyperfractionated
radiation that look at 5 and 6 day weeks. If it's worth giving
radiation more than once a day, it's certainly worth giving on
weekends. Giving radiation only during banker's hours isn't being done
for the benefit of the *patients*. They've got cancer, and would just
as soon be done on a few weekends (five of them for the average
course). In fact, not a few patients need to drive into a large city
if they are getting radiated by any kind of expensive or rare machine
(conformal, cyberknife, protons and other hadrons-- you name it), and
THOSE patients and their caregivers would be VERY happy to not deal
with as many days of weekday traffic. Even those coming in from far
out of town and temporarily staying close to the radiation center may
have an accelerated course which might be shortened from 7 weeks to 5
if treatment was every day, thus saving 2 weeks of hotel expenses. No,
for the patients it's a wash, or even an inconvenience, not to get
therapy on weekends. The studies, and the standard treatment
schedules, were constructed the convenience of doctors. If it turns
out that doing that kills some fraction of people because it's not
quite as good, then it's a real ethical embarrassment. How come the
rad onc people didn't set up the studies sooner to find THAT out?


> I count the Chairman of the particular
> department where I did my research as a friend and someone who has
> helped my career greatly. Those guys worked hard, although admittedly
> they were in an academic medical center and had to do research along
> with patient care.


Yeah, so?  I think you have me mistaken for the nuts who don't think
radiation therapy for cancer is a good thing, that medical doctors are
misguided, and so on. Wrong. For the record, I believe that *radiation
oncology is a noble profession* on the whole, and that radiation
treatment (in conjunction with chemo and even alone) is quite capable
of curing many cancers. It's nearly painless, and when it works, it's
very nearly magical.

I saw a case recently of a nearly magic cure using the proton facility
at Loma Linda. But you know what? It was 5 days a week treatment. The
proton accelerator at Loma Linda, one of only 2 or 3 in the country
(don't know if Texas is online yet) just sits there idle on weekends.
Is that because there aren't patients who could use it then?  No. Is
weekend idling of the proton accelerator because there are great
studies showing that protons 5 days a week are just as good as protons
6 or 7 days a week?  No.  No such studies exist. Hmmm. It sits there
idle because it's convenient, and by analogy it's assumed that protons
behave like photons, and some not very well-checked older studies on a
few types of cancer (not all) show that pHoton therapy does as well 5
days a week as 7.

These same studies have been clung to by radiation oncologists for 30
years or more. They were easy to believe because it was convenient.
And they were generalized as necessary, as for example in the pRoton
radiation schedules being designed from the old pHoton studies.
Induction is easy when the result is pleasing, and no bother.

But now turn that around and you'll see induction doesn't work so well
when it's not convenient. Protons got a 5 day per week schedule
because it supposedly worked for photons-- no better reasoning than
that. But now that there are beginning to be studies which suggest
that accelerated therapy with photons is better for some head and neck
cancers, do you think that the proton people will go to
hyperfractionation or 7 days a week (including sabbath at Loma Linda)
on the very same kind of evidence?

**Not on your life.** They'll say that the evidence can't be expected
to apply to the unique proton accelerator. Suddenly, when the golf
game is threatened, now professional scepticism sets in.

I'm merely pointing out that that kind of thinking is not science. As
a scientist and physican I know that very well. So what's *your*
problem?

SBH

From: sbharris@ix.netcom.com (Steve Harris  sbharris@ROMAN9.netcom.com)
Newsgroups: alt.support.cancer,misc.health.alternative,sci.med
Subject: Re: INTENSE THERAPY BEATS HEAD CANCER
Date: 2 Oct 2003 21:50:36 -0700
Message-ID: <79cf0a8.0310022050.5ece0d23@posting.google.com>

Orac <Orac@wabcmail.com> wrote in message
news:<Orac-B8F3E1.19481929092003@news4.srv.hcvlny.cv.net>...

> Well, that's a rather harsh charge. I can fully understand that not
> going through weekends can be inconvenient and costly to patients. You
> simply have not yet convinced me that not doing radiation through
> weekends is costing lives. You may be right, but I'd say the question
> isn't settled.

Well, here's a review which essentially says it's costing lives to do
it the conventional way (and you know what that is). Feel free to read
the author's cites and argue with his conclusions. The very recent
multicenter trial results reported this month which began this thread,
add additional evidence over that reported in this review.


Eur J Cancer. 2003 Mar;39(5):560-71.

Altered fractionation and combined radio-chemotherapy approaches:
pioneering new opportunities in head and neck oncology.

Bernier J, Bentzen SM.

Department of Radio-Oncology, Oncology Institute of Southern Switzerland,
San Giovanni Hospital, CH-6504 Bellinzona, Switzerland. jbernier@iosi.ch

Squamous cell carcinoma of the head and neck (HNSCC) are increasingly
treated by multimodality approaches combining surgery, radiotherapy and
chemotherapy.  Randomised controlled trials have demonstrated major
improvements in loco-regional tumour control from altered fractionation
radiotherapy, accelerated fractionation and hyperfractionation, as
compared with conventional fractionation. This experience is summarised,
and the limit as to how far these modifications can be taken is
discussed. It is emphasised that radiation fractionation will need to be
optimised separately in multimodality strategies.  Combined chemotherapy
and radiotherapy has also been shown in phase III trials to produce an
improved survival and an improved disease control.  Chemotherapy may be
given as neoadjuvant, concurrent or adjuvant treatment and the biological
rationales for each of these, and the data supporting them, are reviewed.
Although, large meta-analyses have shown concurrent chemoradiation to be
the most effective, there is still a strong rationale for trying to
develop neoadjuvant and adjuvant schedules. New, more active drugs may be
important in this context. As therapy is becoming more intense, a careful
recording and reporting of treatment-related morbidity is a crucial
element in estimating the therapeutic gain from competing therapeutic
management strategies.  Development of non-cytostatic drugs and
individualization of therapy using molecular prognostic markers are
exciting areas of research with a great potential for improving therapy
in the next decade and these are briefly discussed.  Finally, a number of
avenues for further research are identified.

Publication Types:
    Review
    Review, Tutorial

PMID: 12628834 [PubMed - indexed for MEDLINE]



>Also, consider that you're not asking that rad onc guys
> just deal with emergencies seven days a week, but that they deal with
> routine non-urgent cases seven days a week.

COMMENT

No. What these articles are saying is the "routine" head and neck
cancer cases (at least) ARE urgent. Each and every one of them. Just
like heart attacks and pulmonary emboli and strokes and all the rest
of the stuff all the other branches of medicine deal with on weekends.
Certainly the mortality of your averaged localized head and neck
squamous cell cancer is on par with most of the genuine emergencies in
medicine, and how you treat it just as influential in whether or not
the patient survives long term or dies messily a few months down the
line.


> It seems somewhat arbitrary to me to single out radiation oncologists,
> given that pretty much all of medicine operates on a five day a week
> schedule, much like most of the non-retail and non-food service business
> world (although certainly some primary care docs now have evening and
> Saturday hours). For example, surgeons take call on weekends, but most
> of us don't see nonemergency patients on weekends, nor do most of us do
> elective surgery on weekends if we can avoid it (unfortunately, we often
> can't avoid it because all too often there just isn't any other time to
> get the case done).

COMMENT:

You'll have a hard time finding me another specialty which blows off
99% of its patients to not getting weekend treatment, when literally
for decades there has been evidence in both animal and human trials
that this might not be a good thing to do for a good fraction of that
patient population.



> The same is true of many medical specialties. One
> example in particular hit close to home when a family member was
> admitted to the hospital with unstable angina on a Friday night, and the
> cardiologist didn't do an angioplasty until Monday. Granted, his angina
> did stabilize to where he was pain-free, but even so, I was pissed,
> because it made my relative wait in the CCU two days more than necessary
> on a heparin drip.

COMMENT:

There you go. Though I have to say, not quite a comparable situation.
It's only been recently with the new stents that angioplasty itself
has been proven to affect long term mortality and morbitity at all, so
I rather doubt there's much evidence yet that people die if they don't
get it within hours, vs. a couple of days. If such data existed then
we'd be close to the situation with rad onc, with the caveat that it's
far more difficult to do angioplasty on weekends than radiation on
weekends (since the former requires full open chest capability backup,
and the latter requires nothing but a couple of rad techs).

Rad onc people not radiating on weekends is a situation a little
closer to an ICU that decides to just not do any "routine" suction or
respiratory toilet on their ventilator patients on weekends, because
the respiratory care techs all want weekends off. Or not delivering IV
antibiotics to pneumonia patients on weekends because the pharmacy
techs want Saturdays and Sunday's off. Cancer cells divide every day.
They don't take weekends off any more than microbes or mucus-making
tracheal cells do.

> > I'm incensed about that in the same way I'm incensed about a lot of
> > things wrong with medicine. For example, radiologists, who make nearly
> > as much as cardiac surgeons, and more than general surgeons, are
> > overpaid.
>
> Well, take heart, as they are not overpaid as much as they used to be,
> at least, if you're talking about the radiologists who don't do invasive
> procedures. Insurance companies seem to be decreasing reimbursements for
> reading films, as they are for many other things. In contrast, the
> radiologists who do do invasive procedures are becoming more
> surgeon-like every year, both in both hours and the tendency to be
> called in at all hours of the day and night for emergencies.


Yes. And, actually, I don't begrudge the talented cowboy catheter
jockey their pay. I see no evidence in the most recent US stats I can
find of what you say for the rest of radiologists, however. I'm
waiting, but I don't see it.


> > (pediatric heart surgeons make about half of what adult heart surgeons
> > do-- go figure).
>
> It's probably a volume issue. Although being a pediatric heart surgeon
> requires far more skill and creativity than just doing CABGs and valves
> (as adult heart surgeons do), there aren't nearly as many pediatric
> patients needing heart operations.


There aren't, but so what?  So long as you have enough ped heart cases
to keep a surgeon as busy as possible full time, then you have a
situation that admits of a fair comparison. For example, Primary
Children's Hospital in Salt Lake City. Surgeons there make something
like 250 K for a caseload that would make many an adult heart surgeon
two or even three times that. And they're repairing ridiculously
complicated congenital problems in acorn-sized hearts. It's criminal.

No, I'll tell you the basic problem: children don't have any money
<g>.  And young children getting congenital heart surgery, have
parents of the age of anybody else with small children. Most folks of
the age to have small children at home don't have much money either.

> > Is radiation oncology a fine subspecialty?  Sure. Are they overpaid?
> > No, they don't make as much as radiologists, either. Are most rad onc
> > people decent and honest guys?  Sure.  Does the rad onc profession
> > have a giant boil on its collective butt, regarding the problem of
> > weekend treatment?  Yes, indeed. All these things are true at the same
> > time. The boil needs to be lanced, for the good of the specialty, the
> > patients, and medicine as a whole.
>
> Ah, and I suppose you're just the guy to lance it. ;-)


We all do our part.



SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: misc.health.alternative,sci.med,sci.med.nutrition
Subject: Re: Homeopathic Remedy Ruta 6 selectively induces cell death in brain 
	cancer cells but proliferation in normal peripheral blood 
	lymphocytes: A novel treatment for human brain cancer
Date: 6 Sep 2005 21:10:10 -0700
Message-ID: <1126066210.104289.171000@z14g2000cwz.googlegroups.com>

Peter Moran wrote:
> The clinical data alone is *explosive* to say the least, if true, and one
> wonders why a more detailed account of them was offered, and why we have
> never heard of this before. It was published in 2003. Does no one else
> believe them?
>
> Peter Moran
>
> www.cancerwatcher.com


No, nobody believes them. I wish I had a nickel for everybody who had a
brain tumor who said "I got radiation and it didn't help, so I took x
and y and z alternative medicine, and lo... my tumor stopped growing
and started shrinking!"

The full effect of radiation takes a while. I'd be more impressed in
responses in untreatd brain tumor patients. But you always see the ones
who've had every last rad (or cGy if you're politically correct), and
are singing the praises of some snakeoil.

SBH