In this section you can talk about events which have made an impact on you, or which you feel it is important to share. These may concern scientific articles, congresses, thoughts on training for young people, the handling of tumours in children by health authorities.
It is also an opportunity to compare different practices throughout the world. Please send all ideas, suggestions and comments to Edward Halperin .
The consensus is that there is no consensus about total body irradiation
The Children’s Oncology Group (COG) sent out a questionnaire to 152 institutions to ascertain how physicians and physicists were performing total body irradiation (TBI). Twelve institutions responded that they did not do TBI and of the remaining 140 institutions 69% of the physicians and 63% of the physicists replied.
56% of the institutions used an AP/PA technique, 50% lateral beams, 16% volumetric modulated arc therapy or tomotherapy, and 5% other techniques. 79% used 6 MV photons. 42% of institutions had the patients lying supine or prone, 40% decubitus, and 33% standing with support for AP/PA technique. When lateral fields were used 67% had the patient supine only and 31% sitting up or partially sitting up. The two most common dose rates were 6-10 cGy/minute and 11-15 cGy/minute. There was wide variation in the use of lung blocks, head blocks, compensators, lung dose determination, dose verification detection, and many other factors. The most common dose/fraction schemes were 12 Gy in 6 fractions, 13.2 Gy in 8 fractions, 12 Gy in 8 fractions, and some institutions used the low dose scheme of 2 Gy in 1 fraction.
With no consensus in patterns-of-practice of TBI it would seem to be nearly impossible to do any cooperative group correlation between TBI does and disease control or normal tissue toxicity. These results prompt the authors to argue for an attempt by COG to standardize practices.
Rassiah P, et al. Practice patterns of pediatric total body irradiation techniques: a children’s oncology group survey. Int J Rad Oncol Biol Phys 111:1155-1164, 2021.
The First Black Physician in the US
James McCune Smith (1813-1865), the son of an enslaved Black woman from South Carolina and a White merchant slave-owner, received his BA, MA, and MD from the University of Glasgow. He returned to New York City and practiced as a physician and apothecary. He was also an active abolitionist and authored books and articles on environmental health, history, and biography.
Although this article will have a wide readership because it appears in JAMA, for a more comprehensive biography, which does a better job of placing Smith’s life and work in historical context, I recommend “James McCune Smith: medical doctor, anti-slavery leader, and prominent intellectual” by Petros C. Karakousis in the Spring 2021 issue of The Pharos, the official journal of the medical honor society Alpha Omega Alpha (84:19-25, 2021).
Aggarwal NK. The legacy of James McCune Smith, MD - the first US black physician. JAMA 326: 2245-2246, 2021.
Do I have to have that blue dot on me permanently?
We have probably all been there and done that: We tell the child and the parents that the radiotherapy is not going to hurt. “It’s going to feel like having a chest x-ray. You won’t feel anything.” Then we break the news that there is going to be a pin prick for a permanent blue-black tattoo to show the field location and set up points.
In a study of 34 adult breast cancer patients, the investigators from Singapore show that an ultraviolet-ink tattoo visible with a ultraviolet light flashlight worked just as well as tattoo with dark ink and a regular flashlight.
If this technique were to be employed in pediatric radiotherapy, it wouldn’t avoid the use of the pin prick but, at least, it would render the tattoo invisible to the naked eye. I can imagine, however, an objection insofar as, 10 years after radiotherapy, if someone needed to use the tattoos to ascertain field location, it would be more difficult with the ultraviolet-ink tattoo.
Lim LH et al. A prospective randomized controlled trial to compare the use of conventional dark-ink tattoo to ultraviolet-ink tattoo for patients undergoing breast radiation therapy. Practical Radiation Oncology 11:463-469, 2021.
Professor Edward Halperin