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The following tape recorded program is a presentation of the National Association of educational broadcasters. You'll be interested to know that the Italian Navigator has just landed in the New World. That was the voice of author Compton as he first reported the birth of atomic energy. The birth of a new world. This series has been called the New World. Its aim is to outline some of the great benefits that atomic energy is bringing to mankind. The programs are produced by the University of Alabama.
Program six atomic energy and medicine. Hospitals throughout the United States are already using radio isotopes as standard procedures. As a matter of course these radio isotopes are produced for the hospitals by the atomic reactors and our national laboratories. But in a few special hospitals new procedures and new treatments are being worked out with radioisotopes after a long and painstaking research. This program is about the application of one of these new treatments about the possible use of the radioisotope of a rare metal called Yttrium. And one of our medical research centers the hospital of the Institute of nuclear studies in Oak Ridge Tennessee for doctors meet together in their conference room. They're trying to decide whether to treat a particular patient with this new drug or with a radioactive gold a substance they have used for some time. First Dr. Andrews the chief clinician of the hospital explains why the
meeting has been called. Well I thought we might get together and talk over this problem of trying to use it to 90 in the actual treatment of a patient who has an accumulation of fluid in the abdomen. We've done some previous work as you know with animals and even some trace or work in humans that work with very small doses but we've never tried to treat a patient with this isotope and I don't think we should do it without giving pretty careful thought. Then there's the pathologist Dr. Ralph Knisely. Dr. Granville kayaker chief scientist. And here is the chairman of the medical division of the Oak Ridge Institute of nuclear studies Dr. Marshall Brewster. He is also a fellow of the American Association for the Advancement of Science. Dr. Besser this is radioactive Yttrium. Yttrium is a fairly rare metal. It has no history of use in medicine. It is not a normal constituent of the body and therefore it is a somewhat
dangerous thing to use. I think it should be realised that we are using only a very minute amount of it. But nevertheless any new radioactive compound we should be sure of the toxicity and the effects of this new material on the human body before we make any decision on the use of a new drug for the treatment of any kind of a disease I think we ought to know a little bit about the patient that we're going to treat. This patient is a 43 year old woman who was sent here by one of the medical schools cooperating with us and she was in quite good help until five or six months ago when she began to develop swelling in her lower abdomen and some vague discomfort in that region. A little over three months ago she had an operation and at that time it was found that she had a very extensive malignant neoplasm apparently starting in the ovary and having spread to the
small intestine in the stomach and the liver. The surgeon was able to remove the largest part of the tumor with the ovary but he couldn't do anything about the many small areas of tumor on the lining of the abdominal cavity. Following the operation the patient seemed to be in pretty good general condition. But she began to collect fluid and had to have repeated removal of the Dhamma fluid. By and by inserting a needle in the cavity and he did negative or any X-ray therapy yes they gave her x ray therapy just about as soon as they could after the operation. And she had a rather extensive course of 250 K.B. deep X-ray therapy to a large abdominal field. What is the present status of this nation. How is it is she was in good condition now she's in a quite good general condition she's annoyed by this fluid accumulation of the necessity for repeated remove all of it. But her general nutrition is quite good and she's feeling fairly well.
She has already had a considerable amount of X-ray therapy. I'm wondering if we can afford to give any other kind of radiation. You mean the part we might consider getting her cobalt 60 treatment or some form of therapy at this at this point or were you thinking of the radiation from the injured Kevin Terry. I'm thinking of the idea that we would get from the entire camp Terry I suppose there's an advantage in giving isotopes directly into a cavity such as we are contemplating in this case. When it's given by a mouse there is a considerable amount of radiation distributed through the stomach into the intestines when it's given by me. There was certainly a radiation throughout the entire bloodstream. However when it can be given directly into the cavity and we can be fairly sure that most of the radiation is going exactly where we would like to see it go. Of course the use of the 198 is almost an accepted
isotope used for this intra cavity Terry treatment and this particular radioisotope in cotton form was studied very largely in this country by Dr. Paul Hahn of the Harry medical college in Nashville Tennessee and the particular type of use we are considering today. The intra kava tarry injection of radioisotopes was developed by Dr Muller agent ecologist in Zurich Switzerland. Well we of course have found that these people seem to tolerate the additional radiation from intra cafeteria I still prefer it even when they've had about a maximal amount of external radiation therapy. I'm not sure just why this is true. Perhaps the best interest to have a cherry isotope treatment. It is limited in its effect to the superficial surfaces. For this reason. Further treatment is tolerated. Well this is one of the reasons why we might want to try it 90
instead of the old. The older gold 198 is radioactive gold. I mean the radioactive gold does have a kind of X-ray gamma radiation which will influence the rest of the body yttrium will not have any of the gamma radiation and it being a pure Baby matter. It would allow us to give radiation to the center of the body without a reading the rest of the bone marrow. Marshall about how far are these beta passed with radioisotope. Well if the IC is deposited on me in our wallets of the abdomen we would expect that the radiation will be entirely deposited within a matter of a few millimeters. B If we gave cold. Radioactive as the method of treating the inside of the abdomen then we would not only get a penetration of the immediate surroundings in the place
where the gold deposits itself but we'd also get be a considerable amount of gamma radiation distributed throughout the entire body. Well. The Tracer studies are the test doses on the human cases. As I remember and his data are quite closely parallel to intra category studies in the animal mind on the animal we have studied the material at various dose levels and the dose is the level of the dose is an extremely influential factory and localising the material to the capital. We really come to build up sort of a routine for the new isotopes haven't we start out with very extensive animal studies and with the animals we can use large numbers and have various conditions rather well control. And from that we go to very small doses in the human being and if the small doses in
the human being to confirm the general pattern that we've already studied in the animal already observed in the animal we can go ahead with larger doses in the human being and gradually increase the doses until we get to a point either where we think we're doing some good for the patient where we're developing a form of treatment. Or else to a point where we find that the isotope is beginning to produce harmful effects and we are not able to try it any further. However nothing that is done in the animal really proves the point as to what is going to happen in the human. Especially with a relatively dangerous new material such as we're now using and immediately the question comes up as to why not continue to use the other standard forms of therapy that we have used. Well you mean that you say are you considering going 198 or radioactive colloidal as a standard form of treatment no. There are lots of economic reasons for not using gold 198. For
example gold 198 with the intense gamma radiation cannot be shipped economically very far from Oak Ridge yet for production it's really quite a practical isotope and relatively inexpensive to produce might be radioactive it can also be produced in the nuclear reactor with almost the same length of radiation at almost the same expense and the shipping costs for a pure beta emitter unlike. You cram 90 would be much less than the shipping expense of a gamma emitter and little that it doesn't need so much shielding you're just an out of the ball package and you don't have to have all this letter on it. This needs a very very small amount of land around the shipping container. Well I don't think we're really thinking so much of the expense so we really are concentrating more on trying to develop a form of treatment that we will be better than what we have even if it's only slightly better each little bit of progress is worthwhile and some valuable information out of come out of the use of interim 90 he has no by way of
comparison with to go on which I believe has such a comparison has not been provided in any of the others that we've studied here. That is I'm thinking all of the argument about how much the effectiveness of the gold in your treatment is due to the beta radiation are due to the gamma or X-ray type of radiation and. That has not been proved as yet has it. No this is really can't give us any absolute answers. We have to try these things out biologically before we can reach any conclusions that will be accepted. Certainly it is true that if it will do the same kind of treatment that gold 198 does then it would be a far more useful kind of an isotope outside of Oak Ridge. There that even conceivably might have advantages over gold as it has in its treatment effects and its effects upon the tumor in the patient. I'm considering using this particular isotope you mentioned earlier that the surgeon
got the large tumor in my ass at the primary site and I thought that there was tumors spread all around over the surface of the cavity. I think tumor masses are we thinking here in other words how deep does this. Mater radiation have to go here in order to cover the field that you want to treat. I think most of these nodules were rather small perhaps the size of a peanut a centimeter or less and diameter. And the surgeon was kind enough to send us a sample of the tumor and we've studied it and either the microscope and we've arrived at the same diagnosis as the people who first saw the patient. There's no question about the diagnosis on this by now this is the usual form of. Papillary tumor of the ovary that spreads to the pair of surfaces and and remains in its sight rather than spreading to bones or to the chest cavity.
How much do we expect to accomplish with Nash. Need to control the point would be one thing for the conference. I think that's really what we've been able to observe in other patients and it's still questionable whether this form of treatment does anything very significant to the deeper areas of tumors. There hasn't been much evidence that this is an effective way of treatment for sizable not ules of tumor is there any further benefit that we could expect from other standard forms of therapy on this particular patient. Well there doesn't seem to be very much to offer this patient if we don't go ahead with some type of intra cafeteria isotope treatment. I don't believe it would be practical to have another operation in an effort to remove these many small nodules because there are simply too many of them. They're too extensive to make removal practical. There are too many vital structures involved. I suppose we might
consider some more penetrating form of external radiation if we assume that the two hundred fifty killable therapy was too superficial into fact. But I don't believe that we could now give very heavy doses of radiation to a super village X-ray or with tele therapy. We could use the cobalt 60 machine for giving a very high energy Jamar radiation. But Marty what do you think this would really help this for now and in view of the fact that the 250 kilo X-ray deep therapy machine did not seem to stop the formation of fluid. I don't think the cobalt 60 would work in this case. Well have we really satisfied ourselves that we won't harm the patient with this new. And I think there is and I think this it's it's certainly. Quite batter and I expect and say that you know the type of external therapy because you can't administer that can you without administering
radiation effects to a lot of tissue other than the tissue of the tumour tissue itself. But from what we've already said about this is a pure bite I met her certainly practically all of the radiation dosage that the price of patients going to get is certain to be confined to the cavity and superficial surface this would not be through a view of the cobalt 60 radiation of the cesium where we would be radiating everything within the abdomen. Well then I think the only question in this particular patient is what benefits can we hope for. While I think about the most we can hope for really is that we may be able to relieve this patient of the annoying fluid accumulation. And with this there may be some secondary benefits in view for example improve nutrition. I don't believe we can really do anything to attack the fundamental malignant tumor that she has and I don't believe the treatment even at best would prolong her life very much but I believe it might make her considerably more comfortable.
Well we have visitors that keep asking and if even these favorable results are are so limited Why spend our time why why do it to these patients. Why and Why try to treat them. We know of course much of the progress in the treatment of cancer in recent years has been just of this tight slight improvements in forms of therapy slight improvements in surgery and slight improvements in radiation. And while we all of course would like to see some sweeping you go up and that would dwarf all these minute advances in the absence of such a development we certainly think it's worthwhile to keep on trying to improve our forms of treatment non-pop 20 different hospitals in this country that are now using radioactive cold fronts the same type of treatment and the general feeling among the positions that are using radioactive gold is not. Give us as much benefit as you
indicate in about 30 percent of the cases and so I'm serious I think you have a say as half of their patients when they saw you in the north. Sometimes it depends on the selection of patients. Well Marshall how much are we going to give this first patient. How how shall we arrive at the dose that might really give us a benefit and stop this fluid accumulation. How much how much is that old radioactive thing. How much is the correct dose and any radioactive drug it's almost impossible question ask until you've tried it. However we do have some indications of how much we probably should start out with at this point. If we take just the physical characteristics if for example we dump this material into a large milk bottle and measure the amount of radiation that was given off inside the milk bottle. We could say that radioactive yttrium would give up twice as much radiation effect as radioactive gold does.
We've treated lots of patients with about 50 militaries of gold and when we say one they give more than 50 and sometimes we were able to produce an apparent result with those that small but other times we go up to a hundred fifty thousand if we're giving 100 50 militaries radioactive phoned it would seem that on the basis purely of the physical considerations that we could give at least 75 Macquarie's a victim Well I would be willing to try more than 20 the first time and then if we can watch the patient's blood picture and look for symptoms of radiation sickness you know with good 198 they do sometimes get nausea vomiting and other symptoms that we think are due to radiation. However if we give such a low dose on what we think maybe a low dose then there is a likelihood of feeling from under treating the patient. Well that's a good good way to fail and I think and we can always add more but one thing about isotopes is that once they're in they can be removed very practically. We think we can evaluate the effects at least in so far as potential harmful effects
well quite rapidly probably within one or two weeks we'll know whether we've given the patient enough to produce harmful effects. And if there are no evidences. Excessive effect then we can go ahead rather soon and give an additional dose. Actually this patient is quite willing to go ahead with a new type of treatment she understands the deal about the nature of her disease and has a rather resigned and philosophical attitude about her future outlook. She hopes of course that we'll be able to help her considerably. But even if we don't she also hopes that she'll be able to contribute some information by allowing us to study her problem. Some information that may be helpful is someone else with this type of any case. Every new drug has to have a first patient. In general we've been very fortunate in that we have been able to anticipate the effect he effects quite accurately and have not had any untoward development from the trial of these
new isotopes. I think this is the general situation throughout the country that most hospitals who are trying to use brand new isotopes which have never been used before in human patients have gone to considerable expense with animal work and have very slowly built up their doses from low to high doses. So that they do are not finding effects which which might otherwise have come without any control on the radio isotope usage. So I think the user radioisotopes clinically has been handled very conservatively and as compared with other new drugs. I believe much more care and thought and much more caution has been shown in using radioisotopes and anti haven't been impressed by the amount of cooperation and willingness of these patients and their relatives to participate in such a program. I think that has been rather striking of course we see a very selective group of patients
and they are referred here often after they have had many types of treatment and have pretty well exhausted other forms of possible treatment. But it is surprising how willing they are to participate in the types of experimental program that we have underway here and many of them know that we are not at all certain that we'll be able to help them frequently in spite of our best efforts of those and use of isotopes and the application of other standard medical treatment. We find ourselves. Completely failing in many of the patients while they are here under study in these tragic situations we very frequently almost always find the patients relatives are willing to consent to an autopsy examination. This brings up the question of one other obligation we have although our primary obligation is to the patient to make sure that the patient gets the best possible care and we
can give him we also have another obligation since we are supported by government funds to run a research program. We are supposed to find out new things and what benefit do we get from this particular patient. Well Marshall there is quite a bit of information that we get. There are really a lot of bi products and the data that we accumulate during the course of our observation and treatment of our patients. We might list some of them for the first time we have some data on where these rare elements deposit when they're put into human beings and what concentrations and with the increasing use of atomic energy. Our information may also help band problems in industrial hygiene. Not only this we have now a chance to study cancer under new conditions. Under conditions where there has been treatment
with drugs or with radiation. Of course we often get opportunities to to make more fundamental observation on these patients while they're being studied here. Sometimes we can use a so-called tracer technique where a very small dose of some isotope is given and we're able to study the way the body handles a certain material or the way a certain organ functions. For example in these patients with the acidic fluid accumulation there's a good deal of interest in knowing why this fluid collects this fluid in the abdominal cavity and what the factors are that make it form so rapidly some important work has been done elsewhere and some has been done here on this problem. And for example one of the things that has been shown is that this these fluid accumulations are not static at all but they are undergoing very rapid turnover and the fluid is forming and being removed at an amazingly rapid rate.
This is the only fluid forming. Cancer but food from other diseases. That's right and we're getting the impression as we go along these flood accumulations in cancer may not be so different from those that occur in cirrhosis of the liver and some other conditions that were always thought of as being entirely unrelated. I think we've had a sufficient discussion of this particular phase and I think we can summarize this conference in two ways. First of all is there any benefit to the patient from this kind of an experimental procedure. Summary our our conversation certainly indicates that there is a very good chance that this will give as good a therapeutic result as we can expect from any other form of internal radioisotope treatment. And since it is probably impossible for us to continue with the external radiation and
certainly there is no other form of surgical or chemotherapeutic method to use. I think we should go ahead and treat this patient with if you have 95. The other factor in deciding is a certainly secondary in our minds but has to be considered. It costs us approximately a thousand dollars to treat a patient under a research program such as this. And there must be some benefit accrued to the total fund of knowledge that we have from such a patient. Is there any advance our fundamental knowledge of how to treat a patient. That can be expected from this kind of therapy and I think in this case we can also say yes there are many factors which enter into the treatment of any disease with radioactive isotopes that are unknown at the present time. This is one more bit of knowledge that we might be able to gain and certainly
there are a great many economic advantages that can be expected from the use of isotopes such as this. If they are as good as the other isotopes which have serious economic disadvantages. And so I think we should go ahead in this particular patient with a therapeutic trial. I'm 90. That was Dr. Marshall Brewster chairman of the medical division of the Oak Ridge Institute of nuclear studies coming to the decision to use it in the treatment of a particular patient. The discussion was recorded in the conference room of the hospital of the Oak Ridge Institute of nuclear studies. The others taking part were Dr. Andrews chief clinician. Dr. Granville kayaker chief scientist and Dr. Ralph nice pathologist.
Series
New world of atomic energy
Episode
Atomic energy and medicine
Producing Organization
University of Alabama
Oak Ridge Institute
Contributing Organization
University of Maryland (College Park, Maryland)
AAPB ID
cpb-aacip/500-vt1gp94t
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Description
Episode Description
This program discusses the possible use of a new radioisotope called Yttrium 90 in treatment. Dr. Marshall Brucer, Dr. Gould Andrews, Dr. Granvil Kyker, Dr. Ralph Kniseley are featured.
Other Description
About peacetime uses of atomic energy, with experts from Oak Ridge and other atomic energy centers.
Broadcast Date
1956-02-05
Topics
Energy
Science
Subjects
Medicine--United States--History--20th century.
Media type
Sound
Duration
00:29:17
Embed Code
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Credits
Interviewee: Brucer, Marshall
Interviewee: Andrews, Gould A. (Gould Arthur), 1918-1980
Interviewee: Kyker, Granvil C.
Producer: Gouds, Moyra
Producing Organization: University of Alabama
Producing Organization: Oak Ridge Institute
AAPB Contributor Holdings
University of Maryland
Identifier: 56-7-6 (National Association of Educational Broadcasters)
Format: 1/4 inch audio tape
Duration: 00:28:57
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Citations
Chicago: “New world of atomic energy; Atomic energy and medicine,” 1956-02-05, University of Maryland, American Archive of Public Broadcasting (GBH and the Library of Congress), Boston, MA and Washington, DC, accessed October 28, 2021, http://americanarchive.org/catalog/cpb-aacip-500-vt1gp94t.
MLA: “New world of atomic energy; Atomic energy and medicine.” 1956-02-05. University of Maryland, American Archive of Public Broadcasting (GBH and the Library of Congress), Boston, MA and Washington, DC. Web. October 28, 2021. <http://americanarchive.org/catalog/cpb-aacip-500-vt1gp94t>.
APA: New world of atomic energy; Atomic energy and medicine. Boston, MA: University of Maryland, American Archive of Public Broadcasting (GBH and the Library of Congress), Boston, MA and Washington, DC. Retrieved from http://americanarchive.org/catalog/cpb-aacip-500-vt1gp94t