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"The power of an aroused public is
unbeatable."
Dr. Helen Caldicott
Herman Joseph Muller wins the Nobel Prize in
Medicine.
The effects of radiation are thought of in terms of
effects on living cells.
A typical
CT scan equals 400 chest X-rays.
Cancer Risk from CT Scan Radiation
The
surprising dangers of CT scans and X-rays
Cell Damage Occurs When People Have CT Scans
Equal
doses of different types or energies of radiation cause different amounts of
biological damage to living cells.
The units used to measure ionizing
radiation are rather complex.
The ionizing effects of radiation are
measured by units of exposure.
The coulomb per kilogram (C/kg) is
the SI unit of ionizing radiation exposure, and measures the amount of
radiation required to create 1 coulomb of charge of each polarity in 1 kilogram
of matter.
The roentgen (R) is an older traditional unit that is almost
out of use, which represented the amount of radiation required to liberate 1
esu of charge of each polarity in 1 cubic centimeter of dry air.
1
Roentgen = 2.58×10-4 C/kg.
However, the amount of damage done to
matter (especially living tissue) by ionizing radiation is more closely related
to the amount of energy deposited rather than the charge.
This is
called the absorbed dose.
The gray (Gy), with units J/kg, is the SI unit
of absorbed dose, which represents the amount of radiation required to deposit
1 joule of energy in 1 kilogram of any kind of matter.
The rad (Roentgen
absorbed dose), is the corresponding traditional unit which is 0.01 J deposited
per kg. 100 rad = 1 Gy.
1 Gy of alpha radiation causes about 20 times as
much damage as 1 Gy of x-rays.
The equivalent dose is defined to give
an approximate measure of the biological effect of radiation.
It is
calculated by multiplying the absorbed dose by a weighting factor WR which is
different for each type of radiation (see above table).
The sievert (Sv)
is the SI unit of equivalent dose.
Although it has the same units as
grays, J/kg, it measures something different.
It is the dose of any
type of radiation in Gy that has the same biological effect on a human as 1 Gy
of x-rays or gamma radiation.
The rem (Roentgen equivalent man) is the
traditional unit of equivalent dose.
1 sievert = 100 rem.
Because the rem is a relatively large unit, typical equivalent dose is
measured in millirem (mrem), 10-3 rem, or in microsievert (µSv), 10-6 Sv.
1 mrem = 10 µSv.
For low levels of radiation, the biological
effects are so small they may not be detected in epidemiological studies.
The body repairs many types of radiation and chemical damage.
Biological effects of radiation on living cells
may result in a variety of outcomes, including:
Cells experience DNA
damage are able to detect and repair the damage.
Cells experience DNA
damage are unable to repair the damage.
Cells may go through the
process of programmed cell death, or apoptosis, thus eliminating the
potential genetic damage from the larger tissue.
Cells experiencing nonlethal DNA
mutations pass them along.
This mutation may contribute to the formation
of a cancer.
Other observations at the tissue level are more
complicated.
These include:
In some cases, a small radiation
dose reduces the impact of a subsequent, larger radiation dose.
This has
been termed an 'adaptive
response' and is related to hypothetical mechanisms of
hormesis.
Radiation hormesis is the unproven and strange theory that a
low level of ionizing radiation helps "immunize" cells against DNA damage from
other causes thus decreasing the risk of cancer.
The theory proposes
that such low levels activate the body's DNA repair mechanisms, causing higher
levels of cellular DNA repair proteins to be present in the body, improving the
body's ability to repair DNA damage.
This allopathic theory is similar
to the theory of vaccination immunization.
This assertion is
very difficult to prove
(using, for example, statistical cancer studies) because the effects of very
low ionizing radiation levels are too small to be statistically measured amid
the "noise" of normal cancer rates.
The idea of
radiation hormesis is considered unproven by regulatory bodies, which generally
use the standard "linear, no threshold" (LNT) model - the risk of cancer is directly proportional to the dose
level of ionizing radiation.
The LNT model is safer for regulatory
purposes because it assumes worst-case damage due to ionizing radiation;
therefore, if regulations are based on it, workers might be over-protected, but
they will never be under-protected.
In biology, radiation is mainly used
for sterilization and as a
mutagen.
The 'background' dose
of natural radiation is ~ 3 mSv (300 mrem) per year.
The lethal dose of
radiation for a human is around 4 - 5 Sv (400 - 500 rem).
1898 Marie and Pierre Curie distill radium from
pitchblende.
1907 James Douglas, a
scientist and mining engineer, daughter Naomi is diagnosed with
breast cancer.
Doctors operate on her five
separate times but the cancer returns.
In a final effort, Douglas takes
her to Europe to be treated with radium.
1910
Douglas devotes his life to the promotion of radium therapy for
cancer treatment.
1911 Douglas dreams
of a method to more cheaply produce radium.
He directs research lab
chemist George Van Arsdale to experiment with various processes to extract
radium from carnotite.
Carnotite is a potassium uranium vanadate
radioactive mineral with chemical formula
K2(UO2)2(VO4)2·3H2O.
The water content can vary and small amounts of calcium, barium,
magnesium, iron, and sodium are often present.
1912 Douglas gives $100,000 to
General Memorial Hospital for the endowment of
ten beds for clinical trials,
and the equipment for an X-ray plant and clinical laboratory.
1913 With a US
government grant, Douglas forms the National Radium Institute, to mine
radium from uranium ores recently discovered in Colorado.
Douglas
donates a half million dollars of radium, three grams, to Johns Hopkins
University.
1915 Douglas, working
with Dr. James Ewing, establishes a radium department and lay the foundation in
the United States for radiation therapy.
1917
Douglas gives his entire share of the National Radium
Institute to Memorial Hospital along with the stipulation that the
hospital should return to its original mandate of serving as a cancer hospital.
The second is that radiation would be
studied and used to treat cancer.
1918
Grace Fryer starts work as a dial painter at the United States
Radium Corporation (USRC) in Orange, New Jersey.
Dial painting was "the elite job for the poor working girls".
It pays three times the average factory job, and those lucky enough to
land a position ranked in the top 5% of female workers nationally, giving the
women financial freedom in a
time of burgeoning female empowerment.
Radium's
luminosity is part of its allure,
and the dial painters soon became known as the "ghost girls" - because by the
time they finished their shifts, they themselves glow in the dark.
Radium is beneficial to health, just as
arsenic was in the Victorian
era.
People drank radium water as
a tonic, like they
drink monster drinks
now; one could buy cosmetics, butter, milk,
and toothpaste laced with radium.
Newspapers reported its use
would "add years to our lives!"
1946 Herman Joseph Muller, American, concludes
low dose exposure, and
therefore even natural background radiation, is
mutagenic.
There is
no harmless dose range for heritable effects or cancer induction.
1947 Colonel EE Kirkpatrick of the US Atomic
Energy Commission issues a secret document (Document 07075001, January 8,
1947) stating the agency will administer intravenous doses of radioactive
substances to humans.
Observers inject 4.7
micrograms of plutonium into American soldiers at the
Oak Ridge
facility.
Plutonium Trojan Horse in the Body
Observers give a
total of 200 doses of iodine-131, a radioactive tracer that concentrates almost
immediately in the thyroid gland, to 85 healthy Eskimos and 17 Athapascan
Indians living in Alaska.
Laboratory workers at the University of
Minnesota and University of
Chicago inject human guinea pigs with phosphorus-32.
University of
Rochester radiologist Colonel Stafford Warren injects
plutonium into human at the
teaching hospital,
Strong Memorial.
University of Rochester researchers
inject four male and two female human guinea pigs with uranium-234 and
uranium-235 in dosages ranging from 6.4 to 70.7 micrograms per one kilogram of
body weight in order to study how much uranium they could tolerate before their
kidneys fail.
Six male
employees of a Chicago metallurgical
laboratory are given water contaminated with plutonium-239 to drink so that
observers can learn how
plutonium is absorbed into
the digestive tract.
Human guinea pigs are given one to four injections
of arsenic-76 at the University of Chicago
Department of Medicine.
The Atomic Energy Commission
(AEC) sponsors iodine studies at the University of Iowa.
In the
first study, researchers give pregnant women 100 to 200 microcuries of
iodine-131 and then study the women's aborted embryos
in order to learn at what
stage and to what extent radioactive iodine crosses the placental barrier.
In the second study, researchers give 12 male and 13 female newborns
under 36 hours old and weighing between 5.5 and 8.5 lb iodine-131 either orally
or via intramuscular injection, later measuring the concentration of iodine in
the newborns' thyroid
glands.
Observers feed 28 healthy infants at the University of
Nebraska College of Medicine iodine-131 through a gastric tube and then
test concentration of iodine in the infants'
thyroid glands.
At the University of Tennessee, researchers inject healthy
two-to three-day-old newborns with approximately 60 rads of iodine-131.
Observers at Harper Hospital in Detroit give oral doses of
iodine-131 to 65 premature and full-term infants weighing between 2.1 and 5.5
lb.
Eleven patients at Massachusetts General
Hospital in Boston are injected with
uranium.
Observers inject a genetic compound
called radioactive thymidine into the testicles of more than 100 Oregon
State Penitentiary inmates to learn whether sperm production is
affected by exposure to steroid
hormones.
October 1950 Windscale Pile No. 1
becomes operational.
June 1951 Windscale Pile No.
2 becomes operational.
October 10, 1957
In Sellafield, Cumbria the worst nuclear accident in Britain takes
place.
At the time of the incident, no one was evacuated from the
surrounding area, but milk from about 500 square kilometres (190 sq mi) of the
nearby countryside was diluted and destroyed for about a month due.
The
UK government played down the events at the time, and reports on the fire were
subject to heavy censorship, as Prime Minister Harold Macmillan feared the
incident would harm British-American nuclear relations.
The event was
not an isolated incident; there had been a series of radioactive discharges
from the piles in the years leading up to the accident.
In the spring
of 1957, only months before the fire, there was a leak of radioactive material
in which strontium-90 isotopes were released into the environment.
The
radioactive isotope iodine-131, which may lead to cancer of the thyroid, was of
particular concern at the time.
Small but significant amounts of the
highly dangerous radioactive isotope polonium-210 were also released.
Windscale Britains Biggest
Nuclear Disaster
1958 The
Atomic Energy Commission (AEC) drops
radioactive materials
over Point Hope, Alaska, home to the Inupiats, in a field test known under the
codename "Project Chariot."
1986
Six documented accidents occur when a high-current electron beam
generated in X-ray mode is delivered directly to patients.
Two software faults
are to blame.
One, when the operator incorrectly selected X-ray
mode before quickly changing to electron mode, which allowed the electron beam
to be set for X-ray mode without the X-ray target being in place.
A
second fault allowed the electron beam to activate during field-light mode,
during which no beam scanner was active or target was in place.
Killed By A Machine: The Therac-25
"Breast cancer is the most
common indication for chemotherapy among women in the United States, and
chemotherapy drugs are the leading cause of
serious drug-related adverse
reactions among women with
breast
cancer."
Michael J. Hassett, A. James O'Malley, Juliana R. Pakes,
Joseph P. Newhouse, and Craig C. Earle
1942 Two
pharmacologists from the Yale School of
Medicine, Louis S. Goodman and Alfred Gilman, are
recruited by the DoD to create a
less volatile mustard gas.
They exchanged a nitrogen molecule for
sulfur creating a more
stable compound in nitrogen mustard.
1943 A German air raid in Bari, Italy leads to the
exposure of more than a thousand people to a secret cargo of mustard gas bombs
on the SS John Harvey.
Autopsies of the victims suggest
that profound lymphoid and
myeloid suppression occurred after
exposure.
Dr. Stewart Francis Alexander theorizes that since mustard
gas all but ceased the division of certain types of somatic cells whose nature
was to divide fast, it could also potentially be put to use in helping to
suppress the division of certain types of cancerous cells.
The British
and US governments cover up the presence of mustard gas.
"Oncologists
take for granted response to therapy prolongs
survival, an opinion based
on fallacy and not supported by
clinical trials." -
Ulrich Abel
carmustine, cisplatin, cytarabine
Carmustine is a mustard
gas-related compound;
Carmustine, also called BCNU
(1,3[bis]-2-chloroethyl-nitrosourea),
decomposes
spontaneously into a chloroethyl hydroxide that can alkylate the DNA and
into an isocyanide molecule, which
may produce carbamylation of proteins. Cytotoxicity is caused by DNA
cross-links.
Cisplatin is a platinum-based compound;
Cisplatin, mode of action has been linked to its ability to crosslink
with the purine bases on the DNA; interfering with DNA repair mechanisms,
causing DNA damage, and subsequently
inducing apoptosis in cancer cells.
Cytarabine is an
antimetabolite antineoplastic agent that inhibits the synthesis of DNA with
immunosuppressant properties.
Cytarabine is metabolized
intracellularly into its active triphosphate form (cytosine arabinoside
triphosphate). Cytosine arabinoside interferes with the synthesis of DNA. Its
mode of action is due to its rapid
conversion into cytosine arabinoside triphosphate, which damages DNA when
the cell cycle holds in the S phase (synthesis of DNA). Rapidly dividing cells,
which require DNA replication
for mitosis, are therefore most affected. Cytosine arabinoside also inhibits
both DNA and RNA polymerases
and nucleotide reductase enzymes needed for DNA
synthesis.
Cancer
Treatment-Induced Neurotoxicity
Hodgkin
Lymphoma Treatment Regimens
Cancer therapy
selection, dosing, administration, and the management of related adverse
reactions can be a complex process that should be handled by an experienced health care
team. Clinicians must choose and verify treatment options based on the
individual patient; drug dose modifications and supportive care interventions
should be administered accordingly. The cancer treatment
regimens below may include both U.S. Food and Drug Administration-approved and
unapproved indications/regimens. These regimens are provided only to
supplement the latest treatment strategies. These Guidelines are a work in
progress that may be refined as often as new significant data become available.
The NCCN Guidelines® are a consensus statement of its authors regarding
their views of currently accepted approaches to treatment. Any clinician
seeking to apply or consult any NCCN Guidelines® is expected to use
independent medical judgment in the context of individual clinical
circumstances to determine any patient's care or treatment. The NCCN makes no
warranties of any kind whatsoever regarding their content, use, or application
and disclaims any responsibility for their application or use in any
way.
Ocular
side effects of systemically administered chemotherapy
Tables
of Possible Side Effects for Commonly-Used Oncology Drugs
"The overall contribution of curative and
adjuvant cytotoxic chemotherapy
to 5-year survival in adults was estimated to be 2.1% in the USA . It is clear
that cytotoxic chemotherapy only makes a
minor contribution to cancer survival." - Graeme Morgan, Robyn Ward, and
Michael Barton
2006
Chemotherapy impairs the
brain, killing crucial neural cells and
causing key parts of the
brain to shrink.
New findings add to a growing body of evidence
suggesting that the mental fuzziness,
memory loss and cognitive
impairment often reported by cancer
patients but often dismissed by oncologists - is a serious
problem.
Key areas of the brain including the
prefrontal, parahippocampus and
cingulate gyri shrink during and after chemotherapy for several months.
MRI scans show cause of chemobrain
"Chemotherapy
patients experience short
term problems with memory .
About 15% suffer permenant medically
induced cognitive impairment.
The symptoms are consistent:
a mental fogginess that
may include problems with memory, word retrieval, concentration, processing
numbers, following instructions,
multitasking and setting
priorities." - Jane E. Brody
"Those of us on the front lines have known
this for a long time, now we have neuropathological evidence that
what we are seeing involves
an anatomic change." - Dr. Stewart Fleishman*, director of cancer
supportive services at Beth Israel Medical Center and St. Luke's-Roosevelt
Hospital Center
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