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Thoughts about Benign and Not so Benign Diseases

by M. Heinrich Seegenschmiedt

The term Benign Disease could also be phrased “non-malignant disease”, but we prefer not to have a definition of this field with a negation of the term “malignancy” – a field which is already handled well by radiation oncology. Today, radiation oncology is organized in scientific societies such as the European Society of Therapeutic Radiology and Oncology (ESTRO) which is a member of the Federation of European Cancer Societies (FECS).

Radiotherapy of malignancies is typically offered in the Departments of Radiation Oncology which are often part of specialized Tumor or Comprehensive Cancer Centers (CCC). Worldwide, interdisciplinary tumor boards have developed practice guidelines for the diagnostic work-up and treatment of the oncological diseases including radiotherapy. Nevertheless, the recognized good standing of radiation oncology within oncology is one of the difficulties today for the acceptance of a broader perspective of our discipline, namely as in Radiation Medicine, and for their professionals as Radiation Therapists.

As in the field of radiation oncology, radiation medicine will require and provide an interdisciplinary approach to various benign disorders. This requires an understanding of the typical pathogenesis, diagnostic work-up, staging and clinical management of multiple non-malignant dis-orders in which radiotherapy may offer a good therapeutic potential. Thus, radiation therapists will have to fully cooperate with orthopedic or trauma surgeons, e.g. when planning prophylaxis of heterotopic ossification or painful osteoarthritis, ophthalmologists and / or endocrinologists, e.g. when treating Graves’ Orbitopathy or Pseudotumor orbitae, dermatologists or plastic surgeons, e.g. when planning to treat a keloids postoperatively, cardiologists, interventional radiologists and vascular surgeons, e.g. when applying intravascular radiotherapy to prevent restenosis of coronary or peripheral arteries.

Radiation medicine has much to offer to other disciplines, but it also has to overcome the organizational difficulties and the indifference of medical colleagues. Why should patients with painful osteo-arthritis enter a cancer center to receive adequate treatment? Why should cardiologists enter a radiation oncology department to receive adequate service for their patients? As always we have to stand up and offer our services to other disciplines by approaching them, organizing our departments differently or providing services by going into other clinical settings. We should provide teaching to other medical disciplines in order not to lose our service to them, but rather to gain support for our field of radiation medicine. We could be a much larger and more important medical discipline in clinical medicine if we were not solely in the oncologist’s corner.

Moreover, for individual patients malignant physical conditions can give rise to extremely painful conditions with loss of cosmetic appearance, quality of life or specific organ functions and many other physical conditions, under which radiation therapy would offer an adequate therapeutic alternative to medication and drugs. We should always compare the risks and benefits of

conventional treatments to find out whether or not under special conditions ionizing radiation may provide a good or even better service to patients with benign conditions.

In conclusion, the so called benign diseases may not be so benign as the term suggests, in truth, they may be characterized by those malignant conditions which are well known for cancerous conditions, i.e. loss of organ function and quality of life, which justify use of radio-therapy. Thus, we should reverse the former statement of “malignant irradiation for benign conditions” which became so fatal to the progress of radiation medicine in the early 60’s for this problem.

Book review

R.U. Peter, G. Plewig (eds.): Strahlentherapie dermatologischer Erkrankungen. Blackwell Wissensch., Berlin 1996, ISBN 3894122846, DM 98,-

<Radiotherapy of dermatologic diseases>

Radiotherapy has been an integral part in the treatment of dermatological diseases for almost a century. The dermatological indications for radiotherapy range from inflammatory diseases to malignant tumors of the skin. In spite of new treatment options like phototherapy, photopheresis, photodynamic therapy, laser therapy, kryo-therapy, and continuing progress in the surgical field, for several indications, radio-therapy remains a cost-efficient, safe, and effective treatment alternative.

The book summarizes the presentations from a symposium which took place at the Department of Dermatology at the Ludwig Maximilians University of Munich in March 1995. The first (biological) section of the book deals with radiobiology, patho-physiology, hybridization, adhesion molecules, transcription regulation, cell cycle kinetics, and fractionation. These sections are followed by legal and dosimetric aspects, and on page 97 the clinical part starts with X ray therapy of malignant epidermal tumors, precanceroses and cutaneous lymphomas. In the clinical section, almost every known indication for and technique of radiotherapy is covered, e.g. fast electrons, neutrons, combination with alpha-interferon, and melanoma.

Benign dermatological diseases are covered in two chapters: inflammatory diseases (with special reference to keloids), and fibrous diseases (e.g. M. Dupuytren). However scope of the authors is not limited to radiation therapy alone – one whole section of the book is devoted to alternative treatments like surgery, laser, cryotherapy, etc. The last book section covers diagnostic and therapeutic aspects of radiation damage.

Overall, this book gives a fairly complete overview of the state of the art in radiation therapy of dermatologic diseases. The management of benign as well as malignant diseases is described in great detail. Alternative and combined treatments are also included. There are two small drawbacks to this book: biological, physical, and legal aspects cover nearly 45% of the book, and the state of information dates back to 1995. Therefore the authors should think of a second edition.

P. Schüller, O. Micke (Münster)