Medical Forum / Diseases and Disorders / Prostate Cancer / May 2005
question on radiation
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judamd@aol.com - 26 May 2005 19:45 GMT I'm a post-op guy with low PSAs and I hopefully will never need radiation but I have a question regarding radiation. Years ago I studied much physics and as I recall, all forms of radiation essentially pass through material (flesh included)in a straight line slamming into atoms and molecules along the way, ionizing same and thereby altering the molecular structure sufficiently to kill cells, etc.. Obviously the "focused" radiation is nothing more than aiming multiple beams from a variety of directions so that the density of damage is minimal to healthy tissue on the way in with most of the damage done at the focal point where all the beams converge and hopefully where the cancer is located. In my studies, beta rays (electrons emitted by the nucleus) had a "range" which was a distance in various materials (human flesh included) at which virtually all the beta energy was released with little given up on the way in. This range was determined by the material penetrated and the initial energy of the betas from the parent source. The ranges in tissues varied but were on the order of a couple of inches. My question is, "Why don't radiologists use betas to kill the cancer, using a source with an appropriate range for human flesh so that almost all the energy is deposited at the site, not released along the entire path damaging healthy stuff along the way?" Dave Perry
Alan Meyer - 26 May 2005 21:57 GMT > ... My question is, "Why don't > radiologists use betas to kill the cancer, using a source with an > appropriate range for human flesh so that almost all the energy is > deposited at the site, not released along the entire path damaging > healthy stuff along the way?" > Dave Perry As I understand it, there are radiation treatments that do use non-photon particles. "Proton beam" and "very-high energy electron therapy" do that. There is some argument, and some evidence, that these therapies have just the benefits you suggest they might.
Why aren't more doctors using them?
I'm not sure of the answer to that, but I'm guessing there are a number of factors. Perhaps:
1. They're relatively new and doctors are conservative. If high energy xrays are known to work, a lot of doctors may not want to try something else until more proof has accumulated. Since cancer can recur years later, doctors often want to see evidence that patients treated with the new therapies are in good shape 5, 10, or 15 years down the road as well as immediately after treatment.
2. Radiation oncologists don't yet have a lot of experience with the new techniques. Like all of us, doctors like to stick with what they know.
3. Equipment is very expensive. When a clinic already has a million or two's worth of xray equipment, they may not be eager to go buy a few million's worth of something else - at least not until the old stuff breaks down or is shown to be inferior.
But there are places where you can get these kinds of newer treatments. Keith Lundy on this newsgroup had proton beam therapy and is satisfied with his treatment. There may have been some others here too.
Alan
judamd@aol.com - 26 May 2005 22:25 GMT Alan, certainly all you say is true. When I said "years ago" I meant circa 1960 and this "range" stuff was very old news then. In fact I suspect there is little really new information on the effects of radiation in many decades, just newer technologies on how to apply it. An interesting anecdote along these lines claims Dr. John Lawrence, brother of Ernest O. Lawrence of Berkeley/Livermore lab fame zapped his mother in one of his brother's particle accelerators in the dead of night well outside the realm of approved medical care. This was done just after WWII. She had a brain tumor which would have killed her if left untreated. She went on to outlive son Ernest, probably John too. My point is that while technologies get ever better, knowledge about effects of radiation is really quite old and well predates radiation treatments of any kind. So, why did radiation treatments start off down the paths of x-rays, protons, and the like and not betas? Dave Perry
Peter Headland - 26 May 2005 22:43 GMT The Loma Linda proton beam machine is a huge installation that draws massive amounts of power from the electricity grid. Radiation and x-rays are much, much easier and cheaper to do. I think that is why they became popular despite the theoretical advantages of other approaches. It may also be that the magnet technology, etc., or simply an adequate electricity supply did not exist 40 years ago to build such "compact" installations as Loma Linda. Just because we know the theory, doesn't mean we can always implement it in any practical way.
 Signature Peter Headland
Peter Headland - 26 May 2005 22:54 GMT Interesting reading at this link: http://www.llu.edu/proton/history/index.html
Apparently the idea of using protons therapeutically was proposed in 1946 and first tried 8 years later. But, as I surmised, it hasn't been practical to implement it until much more recently.
 Signature Peter Headland
PeteBos - 26 May 2005 22:42 GMT > I'm a post-op guy with low PSAs and I hopefully will never need > radiation but I have a question regarding radiation. Years ago I [quoted text clipped - 18 lines] > healthy stuff along the way?" > Dave Perry During my investigation phase I spoke to a radiation oncologist who explianed it this way. External beam radiation requires a series of treatments over several days. Therefore, the target accuracy must be repeatble to a high degree. This repeatable accuracy is not possible since the prostate gland is connected to other tissues and has some degree of freedom to move around. Chances of hitting the exact same spot for each treatment are not good. Chances of hitting something else with the beam are possible. For example, you could damage the rectal wall, bladder, or the urethra. This is one of the primary reasons I decided against it. For radiation treatment, this doctor recommends only seeding.
Pete
Gordy - 27 May 2005 00:02 GMT Which is why Dr. Wong and Siemens came up with an external beam machine which includes a CAT scan mechanism so they can do a CAT scan before each treatment to determine exactly where the prostate is and the patient doesn't have to move between being "scanned" and being "nuked".
-Gordy
Stephen Jordan - 27 May 2005 02:17 GMT On May 26, PeteBos responded to Dave Perry:
> During my investigation phase I spoke to a radiation oncologist who > explianed it this way. External beam radiation requires a series of [quoted text clipped - 7 lines] > decided against it. For radiation treatment, this doctor recommends > only seeding. How about use of beta-mode acquisition and targeting (BAT)?
This ultrasound method was used every day of my IMRT tx to establish that day's location of my prostate.
So far, so good.
Regards,
Steve J
c palmer - 26 May 2005 22:47 GMT hi dave - since this was one of my fields of skill in the military, maybe i can put it in easy to understand terms. so here goes.
radiation energy is absorbed by water. this is one of the tools that they test the farmer's grain with, to know of the moisture content and how much to pay him.
this is also why you can't see through clouds because the cloud absorbs the energy level and the droplets of moisture act like a prism and will alter or deflect the radar's beam and spread it out for a weaken return echo.
but a long time ago, they found out something interesting. that is when RF energy is passed through a body, due to the frequency that it operates in - the x-band which is 9500 megacycle - the rapid shifting of the energy caused the molecules inside the body to vibrate and generate heat - much like rubbing your hands together.
amana was one of the first manufactures to make use of this characteristic and build the first microwave oven. and that is the theory behind microwave ovens today. the energy of the microwave causes the molecules in the product to vibrate so fast that they generate the heat and cook themselves. it doesn't make any difference whether it is popcorn or a steak.
now, using this principle for wide spread beam radiation, they want to get the body to generate the heat needed to kill the pca cells without killing the host. because of this type of theory, it is important to understand that radiation kills the good cells as well as the bad cells.
the use of the proton beam radiation is a bigger particle. and because of that reason, they now have better control on the deep of penetration in the human body
conventional radiation is giong to pass through the body and drop some of it's energy shaking up the molecules, whereas, proton beam will spend all of it's energy and stop inside the body. the end result. more power where you need it and a better kill.
hope this all makes sense.
~ curtis
knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc
judamd@aol.com - 26 May 2005 23:34 GMT Curtis, your last remark about proton beams is exactly my point regarding beta rays except that I was unaware that proton beams behaved that way too.
((conventional radiation is giong to pass through the body and drop some of it's energy shaking up the molecules, whereas, proton beam will spend all of it's energy and stop inside the body. the end result. more power where you need it and a better kill.))
All ionizing radiation (capable of stripping one or more electrons off an atom) whether it be alpha, beta, gamma, or x-ray will kill cells although alphas being so large can't penetrate anything. Lower frequency electromagnetic radiation (radar/microwave) can cause molecules to oscillate (resonate if you prefer) thereby heating up the specimen and cooking it if the frequencies are correct. This will work on a piece of chicken in the microwave or a human standing in front of a radar transmitter. I am still unclear why betas were never used since they are readily available from natural sources (Strontium 90, Carbon 14, the list is very long) and being charged, they can be focused with magnetic fields, and they dump the majority or their energy right where you want them. Also, since they are much less massive than protons, the magnetic fields required to focus them need be a tiny fraction of that required to focus protons so there is no huge energy drain although I doubt that was ever the reason to hold off on proton beams. The large proton accelerator at Berkeley would pulse every six seconds and consume about 10% of the energy of the entire city of Berkeley when it did. Hence, the lab had its own generators, no need to pay the electric bill. I doubt any proton beam medical device would consume more than a small fraction of what that accelerator required since the energies required are on the order of perhaps millions of electron volts whereas the accelerator was 6.4 billion electron volts. Dave Perry
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