Chapter 17: An Impact on Japanese Radiation Oncology
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Description
In this chapter, Dr. Komaki talks about her recent trip to Japan to receive the International Honorary Award of Japanese Society of Therapeutic Radiation Oncology (JASTRO), given to recognize the role she (and her husband, Dr. James Cox [oral history interview]) played in shifting Japanese attitudes about radiation oncology. She explains that because she had been living in the U.S. but understood Japanese culture and attitudes, she could speak up against tradition, and emphasize that radiation oncologist must think of themselves as much more than technicians and become an integral part of a multi-disciplinary team. She then talks about Japan’s contributions to developing proton therapy and other technologies. She explains that surgery is still considered a primary treatment.
Identifier
KomakiR_05_20190221_C17
Publication Date
2-21-2019
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - Contributions; Overview; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; MD Anderson Culture; Working Environment; Critical Perspectives; Critical Perspectives; Activities Outside Institution; Experiences Related to Gender, Race, Ethnicity; Cultural/Social Influences; Global Issues –Cancer, Health, Medicine
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
T.A. Rosolowski, PhD:
So you were talking about going to JASTRO [Japanese Society for Therapeutic Radiation Oncology] last year, and you were talking about some of the work that you and Dr. Cox were doing, so maybe you could continue with that story. So you went to JASTRO to receive an award, and tell me, just for the record, say what that award was.
R. Komaki, MD:
Okay. This is the award specific to people who have contributed to Japanese Association of Radiation Oncology Society, JASTRO, and somebody who has influenced radiation oncologists to become a part of the oncologists, rather than technologists, or a part of the diagnostic radiologists, which is a very strong society. Thirty-two years ago, radiation oncology was part of diagnostic radiology and they have not separated from diagnostic radiology. Or the department of radiology was diagnostic radiology for many years. So Jim and myself, we told them that in the United States 50 years ago, we totally separated from diagnostic radiology, and radiation oncology is part of oncology to create a multidisciplinary approach to treat cancer patients. We have to be oncologists rather than therapists or technologists. So we had to talk to the Japanese radiation oncology leaders as well as diagnostic radiologists. Around that time some of our friends were leaders there, and we established separating the radiation oncology society from diagnostic radiology, so it will not be a section of the diagnostic radiology. So they created a separated departments in university hospitals. Maybe about 25 percent of the Diagnostic Radiology Department created a separate Radiation Oncology Departments. Last year, there was the 31st annual meeting of JASTRO. That’s why I was honored to receive International Honorary Award because of my contribution to separating radiation oncology from diagnostic radiology and education of Radiation Oncologists in Japan. I received the first Gold Medal from JASTRO 20 years ago.
T.A. Rosolowski, PhD:
That must make you feel really proud, that you’ve influenced that.
R. Komaki, MD:
Because I have been living in the United States since 1970, and I can speak my honest opinions. I think in Japan, people are very “royal.” People respect seniors in the tradition. The only one problem they have is that they cannot speak up. If they feel this is the right thing to do, if they speak up, they have to take some responsibility or they might be fired, or they might leave the place where they would like to be, so usually they don’t speak up. I live in the United States, and I practice in the United States, so I can speak up more than they can. I told them what they have to do. Every time I gave a talk --almost every year I was invited to give a talk or usually I was an invited speaker at the JASTRO. I told them radiation oncologists have to be a part of the oncology group, not the technologists, not just doing the technical aspect, which is very important, but you have to be a part of the decision making about how to treat the cancer patients. You cannot let it be dominated by surgeons. Surgeons usually take care of patients at the time of a diagnosis of cancer and in Japan. Surgeons always say to the patients --which was true in the United States many years ago and maybe some of the people they still do that—“You have cancer, and that the only one way to be cured is by surgery. If we cannot cut it off, you’re going to die due to cancer.” That’s not true anymore.
T.A. Rosolowski, PhD:
Right, yeah.
R. Komaki, MD:
We have advanced technically. We can avoid any toxicity from radiation treatment, and we can combine surgery followed by radiation, or vice-versa, or radiation with chemotherapy or immunotherapy, if we cannot resect the lesion. So when the patient gets the diagnosis of cancer, the patient case has to be documented and discussed at the multidisciplinary tumor board or clinic. It has to be open to the patient, and the surgeons cannot decide treatment by themselves, what the treatment should be. I have seen so many patients who were never told about radiation treatment, other than some palliative treatment, and that’s not right. In Japan, they have fears about the radiation effects.
T.A. Rosolowski, PhD:
Now in your recent trip, the trip you came back from just like a week and a half, two weeks ago, you said you visited—there’s thoughts of putting a proton therapy center in, in Japan?
R. Komaki, MD:
In Hiroshima.
T.A. Rosolowski, PhD:
In Hiroshima.
R. Komaki, MD:
They already have 20 proton centers. In Sapporo there were three proton centers in one city, yes. One of them, Hokkaido University, Jim and I helped Hokkaido University Radiation Oncology, to get a grant to get the proton center there.
T.A. Rosolowski, PhD:
Now did that represent a big shift? Because I know even our early sessions, you were talking about the resistance in Japan against radiation. Things sound like—to what degree have they advanced significantly?
R. Komaki, MD:
Okay. They are very afraid of radiation effects, mainly because of the scattering of the low radiation to the total body from the atomic bomb. They do not have a good concept, separating accidental radiation to the whole body, versus therapeutic, and targeted radiation treatment for cancer. So they are a very highly technically advanced country, and just like with automobiles, they are so meticulous to create very precise equipment. They have the most advanced radiation treatment equipment of any country in the world. They have proton, at least 20 different places. Also, they have carbon ion, six carbon ion facilities in Japan, which is very. What they are trying to do is they would like to give treatment for patients with cancer, really targeted treatment, without scattering of the low dose of radiation to the whole body, so patients don’t develop second malignancy or leukemia or any normal tissue side effects. They are technically very advanced, but the main problem is that by the time they get radiation treatment or proton treatment or carbon ion, very elderly or sick patients have failed after surgery. Surgeons usually operate on young patients or patients without medical problems. [ ] But because of the screening, they are finding more and more early cancer. Some of the patients, they would like to have radiation treatment rather than going through surgery, once they get to 85 years old or older, or are medically not fit, they would like to get radiation treatment. So, they are going toward cancer without cutting. This year, the JASTOR will be held in Nagoya, and the theme is “cure of cancer without cutting,” that’s the theme, and I’m glad they are going into more curative intent of the radiation treatment, or proton treatment, of those medically inoperable or early cancer. That’s the way they really have to think. I’m not against surgery, but what I really think is basically more personalized treatment for cancer. Not everybody can go through surgery. MD Anderson Cancer Center is very upfront, you know, very advanced, to do a personalized treatment for cancer. Each patient needs to be evaluated for genetic mutations, and we should discuss treatment based on genetic mutation, molecular pathology and biomarkers. The patient, when they have a diagnosis, it doesn’t matter: breast cancer, lung cancer, or lymphoma, or head and neck cancer, they really have to personalize treatment based on their genetic mutation or their background, and age and performance status. All the factors, they have to put it into consideration, what’s the best treatment for the patient.
Recommended Citation
Komaki, Ritsuko MD and Rosolowski, Tacey A. PhD, "Chapter 17: An Impact on Japanese Radiation Oncology" (2019). Interview Chapters. 1298.
https://openworks.mdanderson.org/mchv_interviewchapters/1298
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