J.M. Cuttler

Abstract: Although the existence of beneficial health effects following low radiation doses has been known for a century, a controversy rages among scientists regarding this subject. This seems to be due largely to political, social and economic issues. People are not aware that anti-nuclear attitudes deprive humanity not only of an important source of energy but also a medical therapy that would provide immense benefits. Many of those who could change "what is" to "what should be" seem reluctant to act. Credibility is needed to do something about the basis for nuclear fear - a history of negative images of cancer and genetic effects. The medical community could resolve this health concern by starting to provide low-dose irradiation (LDI) therapy, which would help many cancer patients cope with their illnesses at very little risk. Slow progress is being made in Japan and Europe, but there are many barriers everywhere to the introduction of this therapy. The nuclear community should help physicians overcome these barriers. Cancer patients and their support groups, by urging hospitals to offer LDI therapy, may be the key.

Richaud et al pointed out that "low-dose fractionated total body irradiation has been used since the beginning of the century."^[1] Unfortunately it fell into disrepute in the 1930s following the incorrect association of such treatments with homeopathy and for other reasons.^[2] Chemotherapy was introduced in the 1950s and became a more popular treatment option for various forms of cancer. Nevertheless, medical research continued in many countries on low-dose irradiation (LDI) therapy, especially for non-Hodgkin’s lymphoma. Safwat carried out a review of many of the investigations and gave very positive conclusions,^[3] suggesting three mechanisms: immune enhancement, induction of apoptosis and hypersensitivity of tumor cells. His commentary described different ways the immune system could be stimulated by LDI.^[4] Many Japanese research centres have been carrying out successful research and therapy over the past 20 years,^{[5, 6]} and a patient with a rare blood cancer has been receiving repeated applications of LDI therapy at the Johns Hopkins Medical Institute.^[7] On 2000 Oct 6, following a successful pilot study in France,^[1] the European Organization for Research and Treatment of Cancer approved a proposal for a randomized clinical trial on follicular non-Hodgkin’s lymphoma.^[8]

In spite of many such positive developments, the medical community seems very reluctant to try LDI therapy for cancer patients. Why is this?

The debate among scientists over the beneficial effects of low doses of radiation has greatly intensified over the past five years. The difficulty in resolving the controversy seems to be due to the political, social and economic stake of the nuclear regulators and the radiation protection community in maintaining the status quo.^[9] But the stake of the nuclear industry and the medical profession is much larger. Unfortunately, many of those who could change "what is" to "what should be" seem reluctant to act. Credibility is needed to do something about the basis for nuclear fear - a hundred year history of negative images: cancer, propagation of genetic damage, vaporized cities, etc.^[10]

The evidence for adverse health effects following large, acute doses of radiation is clear, and no one challenges it. But the compelling evidence of beneficial health effects following small doses is being ignored by the authorities, even though a biological explanation, based on measured stimulation of the body’s natural defenses, has been provided.^[11]

One can understand the attitude of the authorities, but what about all the scientists? Should they not 1) learn more about these beneficial effects; 2) urge the medical profession at large to review the evidence, try LDI therapy and endorse this treatment if it is as attractive as it appears to be; 3) urge the authorities to change their regulatory policies?

If more radiation oncologists would only take a greater interest and start to provide low-dose irradiation (LDI) therapy (in conjunction with clinical trials), many cancer patients would be helped, at very little risk, and the controversy would soon be resolved. Unfortunately, there are many barriers to the introduction of this therapy.

What is credibility? It comes from the Greek word credos, and consists of three factors: ethos (ethics, honesty, openness), pathos (empathy, compassion) and logos (logic, reason, knowledge, expertise). The ideal composition of these factors depends on the particular issue. For nuclear radiation, the ethos and pathos factors carry much weight. The credibility of the nuclear energy community, in speaking to the public, is weak because people assume it has a vested interest in demonstrating that nuclear energy is an attractive product. Are nuclear energy people perceived to be primarily logical - lacking in ethos and pathos? If so, is it feasible to change this image?

Who then is sufficiently credible to challenge the perception that all radiation is a carcinogen? Firstly, it’s the medical community - the physicians. Although many of them employ ionizing radiation in diagnostics and therapy, everyone expects them to have a genuine concern about the health effects of radiation. They also have the medical expertise, and this is, after all, a medical issue! Secondly, it’s the patients with cancer and other life-threatening diseases. They have a life-or-death stake in the resolution of this controversy, because if the observed beneficial effects of low doses are accepted as real, then many of them could be treated with low-dose irradiation (LDI) therapy and likely derive great benefits - cancer cures or extensions of their lives in reasonable health - at very little risk or hardship. So these two groups of very credible people must be brought into the discussion to resolve this controversy and thereby provide humanity with a very important source of energy and a vital form of treatment for cancer and other diseases of the aged.

Over the past year, and especially during the past six months, communication with several Canadian radiation oncologists was initiated regarding the application of LDI therapy to cure cancer, especially for non-Hodgkin’s lymphoma. Seminars were held at the Princess Margaret Hospital in Toronto and at three regional cancer centres in Ontario; folders with many papers and articles were given out, and a dialogue was initiated with the incoming president of the Canadian Association of Radiation Oncologists.

Some oncologists expressed doubt about the reality of a net beneficial effect. Others seemed reluctant to explore this therapy because of the controversy regarding the beneficial effects of low doses. Two had already begun to collect information, but were apprehensive about the difficulty in obtaining funding for a LDI therapy program. Two others indicated that the radiation oncologists are just too busy with their existing heavy workload - there is just no one available to devote the effort needed to implement a program of LDI therapy.

How can this be? One in three people (oncologists too) will become ill with a form of cancer, and one in four will die from it. Many of them could be greatly helped by LDI therapy, at very little risk.

Why is it so difficult to start a program? LDI therapy is advantageous. Total body irradiations are much simpler to administer than local (high dose) irradiations. The 15 cGy LDI doses, to stimulate natural defenses, are a very small fraction of the typical doses used in local irradiation therapy, for destroying cancer cells. There are no significant adverse side effects after LDI, whereas the side effects of surgery, local irradiation and chemotherapy are often quite severe. LDI therapy can be used independently or in conjunction with one or more conventional cancer therapies to achieve optimal results. Its prior use for several weeks would not preclude the subsequent application of any of the conventional therapies. LDI can be repeated annually or semi-annually as a booster therapy.

The principal concern is that LDI therapy has not been accepted by the medical community, although it has been tested successfully on different types of cancer.^[7] Trials of LDI therapy, following chemotherapy, on non-Hodgkin’s lymphoma patients were carried out at Harvard University in the 1970s and later at Tohoku University, Japan, on ~150 patients,^[6] and at the Bergonie Institute, France, on 107 patients.^[12] High response rates (>80%) and long-term recurrence-free survival were achieved.

The following issues seem to present barriers to the introduction of LDI therapy:

1. The existence of beneficial health effects following exposures to low doses of radiation is a controversial subject. Therefore, LDI therapy, which is based on this phenomenon, is a controversial treatment, even for radiation oncologists who know that such low doses do not pose a significant risk to cancer patients.
2. There is a stigma associated with people who draw attention to the large amount of evidence of beneficial health effects following low doses of radiation.
3. Many physicians believe ionizing radiation in any amount is a carcinogen, and have difficulty accepting evidence which contradicts this belief.
4. Most cancer patients share the notion that all radiation is harmful. They understand and accept its therapeutic application to destroy cancer cells.
5. The media have always portrayed radiation in negative ways and would be reluctant to accept that small doses could be beneficial to health.
6. Nuclear regulatory staff and most members of the radiation protection community adhere to the views and guidelines of the International Commission on Radiological Protection, which still holds the LNT hypothesis of radiation carcinogenesis to be sacred in spite of the large amount of scientific evidence which contradicts it.
7. Cancer is not well understood; there are many confounding factors. Research is required before a non-conventional treatment is accepted for clinical use. (An EORTC trial is now underway.)
8. Many radiation oncologists are unfamiliar with the long history of extensive research that has been carried out on the beneficial health effects of low doses of radiation.
9. Results of the research on the beneficial health effects were ignored or suppressed for the political purpose of stopping A-bomb testing.
10. The effects of radiation on the immune system and the body’s other defenses are not well understood.
11. Scientists generally look for adverse health effects at high doses and do not look for (or ignore) beneficial health effects at low doses.
12. Are physicians concerned about the possibility of lawsuits for a controversial therapy whose results may not meet the expectations of some patients or their families?
13. Skepticism about the effectiveness or risks of LDI therapy may be expressed by other physicians who favour conventional therapies.
14. Skepticism may be expressed by suppliers of chemotherapy products.

Addressing the above issues, to the extent they are manifest, will be quite a challenge to the introduction of LDI therapy. Nevertheless, this therapy is very important for every person, because cancer affects everyone, either directly or indirectly. It is not in anyone’s interest to oppose a treatment which is so important to human health.

The nuclear community should urge and encourage physicians to provide this therapy for humanitarian reasons. Its successful application would put low level radiation in a very positive light and help eliminate the fear that has been exploited for more than a century to keep nuclear technology under a cloud of cancer.

LDI therapy should be brought to the attention of cancer patients and their many support groups, and their help requested to request hospitals to provide LDI therapy.

1. Richaud PM, Soubeyran P, Eghbali H, Chacon B, Marit G, Broustet A, Hoerni B. "Place of low-dose total body irradiation in the treatment of localized follicular non-Hodgkins lymphoma: results of a pilot study." Int J Radiat Oncol Biol Phys 40: pp 387-390, 1998
2. Calabrese EJ, Baldwin LA. "Radiation hormesis: origins, history, scientific foundations." BELLE Newsletter 8:2, University of Massachusetts, School of Public Health, Amherst, MA 01003, 1999 December. See also http://www.belleonline.com/home82.html
3. Safwat A. "The role of low-dose total body irradiation in treatment of non-Hodgkins lymphoma: a new look at an old method." Radiother and Oncol 56:1, pp 1-8, 2000
4. Safwat A. "The immunobiology of low-dose total-body irradiation: more questions than answers." Commentary in Radiation Research 153, pp 599-604 (2000)
5. Hattori S. "The research on the health effects of low-level radiation in Japan." Proceedings of 11^th Pacific Basin Nuclear Conference, Banff, Alberta, Canada, 1998 May 3-7
6. Sakamoto K, Myogin M, Hosoi Y, Ogawa Y, Nemoto K, Takai Y, Kakuto Y, Yamada S, Watabe M. "Fundamental and clinical studies on cancer control with total or upper half body irradiation." J. Jpn. Soc. Ther. Radiol. Oncol. 9: pp 161-175, 1997
7. Cuttler JM, Pollycove M and Welsh JS. "Application of low doses of radiation for curing cancer." Canadian Nuclear Society Bulletin, Vol. 21, No. 2, pp 45-46 (2000 Aug). See also Radiation Safety Health Inc. http://www.radscihealth.org/RSH/Docs/cuttler_et_al.htm
8. Meerwaldt JH and Richaud P. "A phase III randomized study on low-dose total body irradiation and involved field radiotherapy in patients with localized, stage I and II, low grade non-Hodgkin’s lymphoma." A proposal by EORTC Lymphoma Cooperative Group, 83, avenue Emmanuel Mounier, Bte 11, B-1200 Brussels, Belgium, 1999 Sep 13
9. Cuttler JM. "Resolving the controversy over beneficial effects of ionizing radiation." Proceedings of World Council of Nuclear Workers (WONUC) Symposium on the Effects of Low and Very Low Doses of Ionizing Radiation on Human Health, Versailles, France, 1999 Jun 17-18. 2000 Elsevier Science, ISBN: 0-444-50513-x, pp 463-471
10. Weart SR. Nuclear Fear - a history of images. Harvard University Press, Cambridge, MA,1988; ISBN: 0-674-62835-7
11. Pollycove M. "Low dose radiation immunotherapy of cancer." Proceedings of ICONE-8, 8^th International Conference on Nuclear Engineering, 2000 Apr 2-6, Baltimore, MD, USA. ICONE-8789. See also: http://www.radscihealth.org/RSH/Docs/MP98_Ottawa.html
12. Richaud P and Hoerni B. "Combination of chemotherapy and low-dose total body irradiation for low grade advanced non-Hodgkin’s lymphoma." (Abstr) ESTRO 7^th annual meeting, Den Haag, pg 60, 1992 Sep 4-8

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