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The financial crisis that began with the deterioration of U.S. subprime mortgages spread like wildfire setting off a global recession. Though the affects of the subprime problem should have been minimal to the Japanese economy, due to the rapid weakening of the dollar and a strong yen, even major companies found it necessary to lay off employees. Under these situations, the only action that has taken place is a decision to distribute a cash handout as living support. Many people are disappointed with the inability of the government to map out a strategy to remedy the economic situation or even hold any kind of prompt discussion regarding it.
The purpose of this article is not to argue about politics or the economy. However, as the reader takes a close look at the lives of the two scientists introduced herein, who have greatly influenced cancer research and radiation therapy, it will become evident that persons of foresight are necessary not only in the world of medicine but also in the world of politics.
In November 2008, a lecture and celebration was held at the Cancer Institute of Japanese Foundation for Cancer Research (JFCR) to commemorate Dr. Yoichiro Umegaki receiving the Japan Cancer Association (JCA) Nagayo Award. The Nagayo Award was established in memory of Dr. Mataro Nagayo, the founder of the JCA and a forerunner of cancer research, and is awarded to those who made superior achievements in the fields of cancer research and social medicine1). The scientists being introduced here are Dr. Mataro Nagayo and Dr. Yoichiro Umegaki, two scientists brought together through this award.
Let me introduce Dr. Mataro Nagayo at first. Interest in cancer was on the rise in Europe, exactly 100 years ago, and there was a call for Japan to join an international effort to further cancer research. In response to that call, the JFCR was established as a cancer research institute in 19082). Dr. Nagayo, who had been a professor and later administrator of the Department of Pathology at the University of Tokyo’s Graduate School of Medicine and finally becoming president of the University of Tokyo, was involved with the JFCR from the very beginning. As the president of the JFCR, he insisted on the need for a cancer hospital and research facility. He put forth every effort to raise money for this cause and finally in 1934 the first cancer research institute and hospital in Japan was opened. On top of that, the Mitsui Group donated one million yen and the JFCR purchased 5,000 mg of radium. One million yen at that time would be the equivalent of a sum between one billion and ten billion yen today. The generosity of the financial community of that period is quite surprising.
The average life span in the latter part of the Meiji Era was 44.3 for males and 44.7 for females3) and cancer had not been recognized as a major problem as of yet. Dr. Nagayo, however, foresaw that one third of all deaths would eventually be caused by malignant tumors and he speedily went to work laying the foundations of cancer research. Furthermore, he implemented radiation therapy using radium as a means of treating cancer. One can do nothing but admire his insight and foresight. Through these efforts the Cancer Institute Hospital became world renowned as a leading facility using radium treatment. From the moment Japan’s radiation therapy began, it was considered the best treatment environment worldwide.
It is certain that participants who heard Dr. Yoichiro Umegaki’s commemorative lecture were deeply impressed with his insight and foresight.
The lecture was entitled “research for radiological diagnosis and treatment of cancer, and realization of heavy charged particle therapy – radium, FDG and from 2 kV X-ray to 400 MeV heavy charged particle” and he spoke in a matter of fact way about the progress of his research.
Dr. Umegaki began his research work at University of Tokyo using the 2 kV ultra soft X-ray for X-ray microscopy and stereography of bone trabecula. In 1951, he moved to the JFCR and began cancer therapy as a clinician. Through his experience with radon seed treatment at the Cancer Institute Hospital, he came to recognize the worth of convergent beam radiation therapy and the importance of the accuracy of target-lesion setup. He transferred to the Department of Radiology at School of Medicine, Chiba University in 1954 and submitted a patent application for adjustable collimation technique (conformal radiotherapy). Later though Dr. Umegaki renounced this patent himself. From that time forward, many researchers pressed forward using this information in a practical manner. It became one of the stepping stones that led to the development of Intensity Modulated Radiation Therapy (IMRT).
The breadth of Dr. Umegaki’s research becomes obvious through a look at the reasons that were given for his being awarded the Nagayo Award – “cancer diagnosis with PET”, “computer controlled radiation therapy” and “particle, especially heavy charged particle for cancer therapy”. For example, to quote Dr. Umegaki with regards to diagnosis of cancer with PET, he said, “The primary requirement in radiation therapy is to accurately diagnose the presence of carcinoma and the extent of lesion. Without this, not only the cancer will not be cured but the patient will often have to struggle with the side effects and sequela. The second requirement is to confirm by image that all of the cancer cells have been annihilated by the radiation. Through this you are able to confirm that you have done the optimal radiation therapy.” Since these insights, great results have been achieved through research into the development of ultra-high speed CT, the cyclotron positron isotope production and PET diagnosis at National Institute of Radiological Science (NIRS).
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Snapshot in the celebration on Dr.Umegaki’s Nagayo Award.
(Dr. Umegaki is 5th from right in the front row. Courtesy of Dr. Akira Ito) |
Dr. Umegaki exerted a lot of time and energy into research regarding the implementation of computers in radiotherapy. Through the development of the analog computer controlled tiltable gantry cobalt teletherapy unit and the digital computer radiotherapy planning systems, he chaired “the 7th International Conference on the Use of Computers in Radiation Therapy (ICCR)”. Furthermore, through this international conference he was truly effective in establishing the Japanese Association for Radiotherapy Systems, the predecessor of the Japanese Society for Therapeutic Radiology and Oncology (JASTRO).
On the other hand, Dr. Umegaki said the following about fast neutron treatment at the time: “It is my understanding that the fast neutron is the most dangerous radiation source because it is inappropriate for computer controlled treatment, the RBE is too high and the dose distribution is not good for normal tissue behind lesion.” On top of that, during discussions about the radiation sources of the next generation of cancer treatment, he insisted that “pi-meson as secondary particle, cannot get enough output for therapy and is useless yet. The real McCoy is heavy charged particle; it is the best choice for computer controlled treatment.” His insistence was realized and because of that Japan has become a world leader in the fields of proton and heavy charged particle therapy.
Foresight is the ability to make excellent judgments based on wide-ranging knowledge and correct insistence focused on the essence of an issue. Though never to be considered in the same league as Dr. Umegaki, the author could not help looking back upon his own study life for a while after the lecture.
Reference
1) Japan Cancer Association, http://www.jca.gr.jp/
2) Japanese Foundation for Cancer Research, http://www.jfcr.or.jp/
3) Ministry of Health, Labor and Welfare, http://www.mhlw.go.jp/
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