Dr. BUGHER. The third and the most recent of the research cancer hospitals to be discussed is the new Argonne Cancer Research Hospital in Chicago, dedicated last March, so that it has been in service now for only a few months. It is operated for the commission by the University of Chicago Medical School, but it functions also on behalf of all of the medical schools of the Middle West. We have asked Dr. Hasterlik, who is associated in the direction of this new venture, to give you the major outlines of the program as it is developing there.

The CHAIRMAN. We would be glad to hear from you, Doctor.

STATEMENT OF DR. ROBERT HASTERLIK, ARGONNE CANCER HOSPITAL, CHICAGO, ILL.

Dr. HASTERLIK. Thank you, Mr. Chairman and members. First, Dr. Jacobson, who is ill, asked me to express his regrets that he could not appear in person, and he asked me to present these data to you.

Essentially, our program is divided into three parts. The first is the development of high-energy apparatus for the treatment of cancer. Another portion of it is the evaluation of the efficiency of these various types of machines. And then we are doing fundamental studies on the biology of cancer and the growth factor, and included in this are studies on the effects of radiations on cells and tissues and organisms as a whole.

I was interested to hear Mr. Dolliver ask before whether these were complex machines. Yes. On the staff of our hospital, which has a total scientific staff of 50 individuals, we have 8 physicists and electrical engineers, planning, who also will be needed to keep such equipment in operation. They are very complex.

That brings up a corollary problem. Our institution is not planned as a prototype of what will be available in general to the average physician. It is a research institution. Our apparatus is of a research type. We hope to get answers on what various energy radiations will do to cells, what they will do to tumors as a whole.

Dr. Warren mentioned before that one of the important aspects of treating cancer in the human was the slight difference in sensitivity of the cancer cells in relationship to normal cells. Cancer cells are slightly more sensitive. They die a little more easily than normal tissue cells.

In the past, with the lower energy radiations, this was the means of killing tumors and killing cancer. However, it was not always possible to put a killing dose of radiation into a tumor without doing extensive destruction to the normal tissue around it. Now, how can one change these effects?

Well, one can hope to find chemicals to develop means of making tumor cells more sensitive to radiations in contrast to normal cells, or one can find mechanical means of putting a higher dose of radiation into the tumor directly and not putting it into the normal tissues around it.

As Dr. Brucer mentioned, this can be done by rotating the radiation around the patient; by placing the tumor, as it were, in the center of the circle, so that from all points the radiation passes through the tumor, and very little of the radiation passes into the normal tissues about the tumor.

Well, to carry out these studies we have essentially four machines at present, either complete or in the process of completion. At the

present time we are using a 2 million volt Van de Graaf accelerator. This can be used for rotational therapy, not by rotating the machine but by rotating the patient. This is useful also-and we hope to develop the specific use for the treatment of skin cancers, because electrons can be brought out of this machine very easily, and electrons of 2 million volts are just the proper energy for penetrating a short distance into the skin. This is just another use of such a machine.

We have almost completed an 1,800 Curie cobalt-therapy unit. This is a unique machine. It is not planned, as Dr. Brucer's machines are planned, for general availability, but is planned to carry out fundamental research on rotation therapy with the energies that are possible from radioactive cobalt.

As an expression of the importance of association of our type of research hospital with the Atomic Energy Commission, I would like to mention that the design of this machine was made possible by the availability of a very high flux of neutrons in one of this country's atomic reactors, making it possible to have this source which is equivalent in radioactivity to about 4 pounds of radium.

As Dr. Warren mentioned, before 1940 there was only 1 pound of radium present in the whole world in refined form.

Moreover, it is possible for us to produce this source in a very tiny shape. The entire source will be only a little more than 1 inch long and about one-fourth of an inch in diameter. This means we can shoot a very small pencil of very energetic radiation into the patient. Moreover, the Atomic Energy Commission has loaned us 900 pounds of uranium to use as a shield. This uranium is not useful for the other purposes of the Commission, but it is extremely valuable to us, because uranium is a very fine shielding material. If we had to use lead to protect us from this cobalt radiation we would need approximately 4,000 pounds. With uranium we can get adequate shielding with only 900. So mechanically we can have a very small unit, which is very easily rotated around the patient.

We also have in the process of development a highly experimental machine, a 50 million volt linear accelerator. This has been developed for physics research, and now we are adapting such a unit for the treatment of cancer.

I will come back to the reasons for the use of these machines in a moment.

The University of Chicago also uses a 450-million-volt synchrocyclotron. Approximately 14 percent of the operating time of this synchrocyclotron is available to our research group for studies. At the present time means are being devised for getting out a 450-millionvolt beam of protons.

A proton is another particle which has a positive charge, and it is also a particle that is very much heavier than an electron.

Now to go back to the reasons for these high-energy machines. I would like to say that this is not done to just build bigger and better machines. The reason for higher energy is that it is possible with these high energies, because of certain physical characteristics, to put a very large dose of radiation within the body and a very small dose into the surface of the body. This means that we will no longer be encumbered by the requirements of doing damage to the surface of the body in treating cancer as we have in the past with low-energy radiations.

Some preliminary studies have been done at the University of California on the biological effectiveness of protons. We hope to extend these studies. The early studies look very promising. It appears that one can put a very large dose of radiation into a deep portion of the body with high-energy protons.

Another aspect of our studies is an extension of the use of hitherto unused radioisotopes in cancer therapy. This aspect of our program is just getting under way, and it parallels the Brookhaven and the Oak Ridge programs.

One interesting use of radioisotopes that is being developed by our group-and it is only possible by the use of some of our very high flux reactors in this country-is the development of a very powerful source of lower energy radiation for the taking of X-ray radiographs. At the present time we are developing a very high specific activity thulium 170 source. This gives off rays that are much like the rays from an ordinary X-ray machine. We hope to develop a unit that is very small, does not depend on electric connections for use, and we hope that it will be possible to develop a practical radiography source. This means many people can do radiography for the detection of cancer under rather adverse conditions.

Yesterday Dr. Mider mentioned the work Dr. Leon Jacobson had been doing and the demonstration he had made that the shielding of the spleen during a radiation protects an animal to an extent from the lethal effects of radiation. This observation is of fundamental importance, not only because of the obvious aspects of protecting individuals from radiation but also because it seems that it may be possible in the future to develop and to demonstrate certain substances present in the blood stream which both protect the bone marrow from damage and will make possible the administration of larger doses of radiation to people in the treatment of cancer, and also because it seems that this not as yet isolated growth factor might in some way be related to the growth of tumors.

Dr. Jacobson's group is carrying on this very interesting approach to the study of cancer and formation of blood.

Another group at our institution is studying the effects of radiation on cells, tissues, and on total organisms. As Dr. Bugher mentioned, in this country there is a rather large group of individuals who were administered radium many years ago as a therapeutic procedure. One of our groups at our hospital is studying the effect of this radium on the bones of these individuals, and the production of tumors in these individuals.

The placing of the Argonne Cancer Research Hospital as part of the University of Chicago Clinic is, I feel, rather fortunate. We have extended some of the studies alluded to yesterday of the relationships of hormones to the growth of cancer. One of our groups at our hospital is studying the relationship of the endocrine glands, specifically the adrenal glands, to the growth of tumor cells, and they are doing this by feeding to the individual safe amounts of tritium, which is radioactive hydrogen and radioactive carbon, labeled precusors of certain hormones, and studying the synthesis of these hormones both in normal and cancerous people. This is a very fundamental study and is being used to elucidate some of the relationships between hormones and growth of cancer.

At this point I would like to mention that this study is made possible because the entire facilities of the Atomic Energy Commission are available to us. These tests, in order to do them safely, require small amounts of these radioactive substances, and we are fortunate in that we can have developed for us very fine and very sensitive detection apparatuses which in general have not been available up to the present, outside the National Laboratories of the Atomic Energy Commission.

Now, we have 58 beds in our hospital, and patients are admitted through our University of Chicago clinics, of which we are a formal part, and are also referred by the 19 medical schools of the Middle West who are affiliated with our hospitals through their relationship to the Argonne National Laboratory. We are accepting only research patients. We hope to evaluate these various radiation factors in these patients.

Another important part of our program which is just getting under way is the training of radiologists from our 19 medical schools. I might mention that others from other parts of the country can certainly come to our institution, but we are concentrating this program in the Middle West at present. This is the training of radiologists in the use of these improved techniques; rotational therapy, the use of radiocobalt therapy, and so forth. We feel it is important for us to disseminate the information on these newer techniques as widely as possible.

I think this sums up in general some of the things we hope to accomplish at our new institution.

The CHAIRMAN. Any questions, gentlemen?

Mr. ROBERTS. Just one question, Mr. Chairman.

The CHAIRMAN. Mr. Roberts.

Mr. ROBERTS. Doctor, is it true that as far as any research program is concerned it could not proceed any faster than the trained manpower and the facilities available to do the job? That would be generally true, would it not?

Dr. HASTERLIK. Yes, I would agree heartily with Dr. Bugher that this is one of the most important parts of our program; stimulating and training scientists in these specific fields.

Mr. ROBERTS. How would you feel about a strong fellowship program to train young scientists?

Dr. HASTERLIK. As a generalization I am very much in favor of it. In what area do you mean, sir? In cancer therapy or in fundamental research in cancer therapy?

Mr. ROBERTS. Well, I would say in fundamental research.

Dr. HASTERLIK. I am very heartily in favor of such a program of training scientists.

Mr. ROBERTS. I believe that is all, Mr. Chairman.

The CHAIRMAN. Any further questions, gentlemen?

I just had 1 or 2 questions to ask Dr. Brucer. What is the approximate size of the cobalt machine?

Dr. BRUCER. The small cobalt machine that we have just developed contains about 350 to 600 curies of cobalt 60. This is the type of cobalt we can readily make available. The size of the machine is about 15 inches in diameter. About that large [indicating].

The machine is supported on the same type of a commercial X-ray stand that is now available for the larger X-ray machines, the 400kilovolt type. It weighs about 1,250 pounds.

The CHAIRMAN. It has been brought to my attention, Doctor, that you have just recently returned from studying radiation in Europe. Can you tell us about your findings and how we in the United States compare with European research? I think our committee would be very much interested in having your brief statement with reference to it.

Dr. BRUCER. When I refer to this trip with my boss present, I always say we are way behind. Actually we are not completely behind. The outstanding things I noticed in going through many of the laboratories, especially in England but also in some of the other countries, is the fact that they are making very good use of the two things that they do have available. One is the mechanical engineering that goes into the manufacture of X-ray machines. he other is they do have, through the English reactors, small amounts available of very low intensity cobalt and other isotopes.

In the field of the large sources the X-ray machines, since they cannot get, except through the Canadian reactors, the very large isotope sources, are such that they have specialized on the X-ray machines. One of the things that is outstanding is the fact that they have gone into this moving field, or these extensions of rotational therapy. Actually, I think they are in this field way ahead of us.

Almost all of the research radiotherapists have either developed or are developing or are looking forward to developing some form of a rotational therapy or moving field therapy device.

In the development of the use of very low intensity sources, which they do have available, they have done some very clever things, some of which we are going to copy and some of which I think we can do better than they are doing.

The group at Heidelberg, for example, has taken very small millicurie amounts of cobalt and has made them into seeds, beads, plastic materials, disks, and wafers. None of these are of general use in the treatment of cancer, but each one has a specific use in a very specific type of cancer.

For example, one of the types of seeds that has been developed is only good for treatment of cancer of the maxillary sinus. Another type is only good for treatment of cancer of the bladder.

This is a type of thing we should be doing much more of, and is a type of thing that we will be doing much more of.

The CHAIRMAN. We will now hear from Dr. Charles Doan, dean of the college of medicine of Ohio State University.

STATEMENT OF DR. CHARLES DOAN, DEAN, COLLEGE OF MEDICINE, OHIO STATE UNIVERSITY, COLUMBUS, OHIO

Dr. DOAN. Thank you, Mr. Chairman.

Mr. CROSSER. Doctor, before you undertake your special job, I may say—and I believe I am correct in saying that you have in Ohio in your own town of Columbus a chapter of the Arthritis and Rheumatism Foundation, have you not?

Dr. DOAN. Yes, sir; that is correct.

Mr. CROSSER. So, as usual, we are leading the way in Ohio.