Chapter 07: Surgery vs. Radiation Therapy; Long-Term Complications with Radiation Therapy

Title

Chapter 07: Surgery vs. Radiation Therapy; Long-Term Complications with Radiation Therapy

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Description

In this chapter, Dr. Almond explains the debate between treating tumors surgically or with radiation. Physicians like Fletcher preferred treating tumors with radiation therapy first to try to preserve a patient’s quality of life and resorted to surgery if radiation therapy failed while surgeons preferred to do the surgery immediately. Dr. Almond describes how this led to complicated discussions among surgeons.

Identifier

AlmondP_01_20040404_C07

Publication Date

4-4-2004

Publisher

The Historical Resources Center, Research Medical Library, The University of Texas Cancer Center

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Overview; Overview; Definitions, Explanations, Translations; Multi-disciplinary Approaches; MD Anderson History; MD Anderson Snapshot; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Technology and R&D; MD Anderson Culture; Patients; Patients, Treatment, Survivors

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 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

James S. Olson, Ph.D.

Do you remember when they dismantled the Cyclotron?

Peter Almond, Ph.D.

No, I wasn’t here, but I . . .

Lesley W. Brunet, MA, CA

I want to [?], because you said something about as you went forward as the treatments come out, the long-term complications got too high, what period was this?

Peter Almond, Ph.D.

It’s certainly five, ten, fifteen years. So we started neutron therapy in the late sixties, I think here, with A&M, for example. So we’ve now got a very long experience. Of course, the Cyclotron went out in the late 1980s. That program was stopped maybe in the 1990s, but anyhow, it’s been over ten years. So now we’ve got those follow-ups. But we treated for a long time.

But certainly, even after two or three years on certain patients, you could tell the complications were going to be more severe. I will say this: They were no more severe than some of the complications forty years ago, X-ray treatments which at times could be very, very severe.

James S. Olson, Ph.D.

Of an untreated tumor?

Peter Almond, Ph.D.

That’s the problem. What’s the alternative? Or of surgery. Surgery can result in a lot of complications and difficulties.

What Fletcher always used to say about radiation therapy, very often the known complications, he would very often know that there would be sort of not a way out, but at least you could deal with the complication either with surgery or some other form of treatment. So for him, it was let’s try this, and if you get a complication, then we can deal with that surgically, rather than go ahead surgically and do it first. Your quality of life might be better. So I think you always have to look at that and say, “Well, let’s try this.” The complications, you know, I think the quality of life is going to be better. If you have complications, for example, he would, with the head and neck people, one of his big arguments, they’d get a larynx tumor in and the surgeons always wanted to take the larynx out. Fletcher knew he could treat it and save the voice box.

James S. Olson, Ph.D.

Then they can speak the rest of their life.

Peter Almond, Ph.D.

They can speak for the rest of their life and they could swallow for the rest of their life and all the rest of it. That’s why he used to get, in some of the cases, so upset because there were the complications of the surgery. Sure, they were cured of the cancer. Quality of life was just terrible, and he said, “You know, I can treat them. I’ll have cure rates that are 90-something percent, and for the 10 percent, we can go back and do the surgery.” Whereas the surgeons, that was way back when, wanted just to go ahead and do the operation. It was in those areas that we would really have some [unclear] discussions.

James S. Olson, Ph.D.

I’ve seen some letters, yes.

Peter Almond, Ph.D.

I’ve seen his staff in tears, literally in tears. It was interesting.

Lesley W. Brunet, MA, CA

[Inaudible] tears, screaming at them?

Peter Almond, Ph.D.

Yes, or just so upset at the animosity and the fights that would go on in the clinics. Not in front of the patients. But he wouldn’t mind stating what he thought.

James S. Olson, Ph.D.

He also seemed worried, too, very often that somehow they didn’t refer enough patients to him

for him to sustain his studies.

Peter Almond, Ph.D.

That was the other thing, and I don’t know what it’s like now, but way back then you would put in and enter into a national trial on the sort of promise that you would get so many patients to treat, and when that didn’t happen, then he would get very upset. That happened on a lot of cases and to some extent on the neutrons also because patients had to be entered into the trials. There was a national neutron trial going on and we had to submit patients and the head and neck and breast was always a problem. He used to get upset because he couldn’t get patients to do studies. That was the fight between the surgeons, and then when the chemotherapists came along, that was just you’d have was a three-way fight going on for the patients.

James S. Olson, Ph.D.

How about Felix [N.] Rutledge, in Gynecology? Did he get along better with Fletcher?

Peter Almond, Ph.D.

Oh, yes, he and Felix were very good friends, yes. He and [William S.] MacComb had an excellent . . . there were people that Fletcher got along very well with and there were people who he didn’t get along very well with and there were people that learned to get along with him even though it was difficult. Now, Felix was a very good friend of his, yes, and would work very closely with him.

Lesley W. Brunet, MA, CA

He’s still alive, isn’t he?

James S. Olson, Ph.D.

Rutledge? I don’t think so. I think he died.

Peter Almond, Ph.D.

I don’t know.

Lesley W. Brunet, MA, CA

I think I’m getting him mixed up with [Marvin M.] Romsdahl.

James S. Olson, Ph.D.

Romsdahl’s still alive.

Peter Almond, Ph.D.

Romsdahl’s still alive.

James S. Olson, Ph.D.

I see him in the library here, big, tall fellow.

We’re getting close to three o’clock for your wife there.

Peter Almond, Ph.D.

Yes. Okay.

James S. Olson, Ph.D.

Perfect. Thank you very much.

Peter Almond, Ph.D.

Give me a call if you need anything else.

James S. Olson, Ph.D.

I don’t know. I’m trying to think of something.

Peter Almond, Ph.D.

I’m in and out like you are, and I don’t have any sort of set duties. So it’s not. . . .

Lesley W. Brunet, MA, CA

You’re doing a lot of work in the history [?] lab.

Peter Almond, Ph.D.

Yes, but I’m just doing that and writing some things. I will have some teaching responsibilities in the fall, but that’s not going to take too much time.

End of Tape 2 of 2 and Interview 1

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Chapter 07: Surgery vs. Radiation Therapy; Long-Term Complications with Radiation Therapy

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