Treating Cancer with Targeted Alpha Therapy – by Dr. Julian Rosenman

I’m going to talk to you today about using
the byproducts of fluoride reactors for medical care, and in particular because I am an oncologist
and treat cancer patients, for the use in cancer. Although we might sneak a couple of
non-cancer things in there. So, I am at the University of North Carolina
and radiation oncology also in computer science and today, I’m representing E-Generation. At the time that X-radiation was discovered
there was a competitor, which was radioactive material coming from natural sources and we’re
going to see this competition all through this talk; between the stuff that we build,
which is the X-ray machines and stuff that we buy, which is radioactivity. What was found in the 19th century, were that
there are alpha particles, beta particles and gamma particles and they had these properties.
After a little while, it was found that alpha particles are in fact just helium stripped
of a couple of electrons and the beta particles which were just electrons and gamma rays,
turned out to be the same as X-rays, which are described by the Maxwell’s equations. I remember as a boy thinking, “Why aren’t
there other kinds of radiation? Why aren’t protons ejected or positrons ejected? Why
these?” and I asked my physics teacher who said, “Shut up.” So, It turns out there are materials like
that. Very delicate calculations show that alpha particles are the most likely thing
to be ejected in decay and we’re going to talk mostly about them. At the end of the 19th century, there were
some strange reports started to circulate. People pointed X-ray machines at patients
with cancers. They were getting things like this. This is a lip cancer and it would go
away. This is a very nasty cancer under the tongue
called floor of the mouth cancer. Unfortunately, still pretty common. If you point an X-ray
at it long enough, it will go away. It’s interesting that these medical reports
came out within six months after Röntgen published his first paper on how to make X-ray
machines. Everybody went off and built them in their home laboratory. How this was discovered I have no idea, [jokingly]
except I think, kind of doctors in those days sort of, they had something new, they pointed
it at you and see what happens. By the 1930s, what are called orthovoltage
machines and I have $5.00 for anybody who would tell me why tell were called orthovoltage.
Nobody seems to know. Machines in the 250 keV range and they were used routinely for
cancer treatment. Not very successfully, but they were for palliation. Occasionally, you
cured a patient by accident. But. The competitor, which was originally
radium later on cesium, inserted into the uterine cervix of patients with cervix cancer
was highly curable, and so cervical cancer became the first curable cancer without surgery. In analyzing this, it was discovered that
the cervix cancer treatments were getting a lot more radiation than were the external
beam patients. And so, it was decided to try to see if you could increase the energy of
X-rays, which needs to be done if you want to give higher doses, for a number of reasons. In the 1960s, the Van de Graaff machine came
into being and produced million electron volts and treated patients successfully. But nature
struck back with radioactive cobalt which was, at one point, (2-7) and one point ( 3-3)
Mev. Its decay process of cobalt and the nickel.
It’s a nice way of illustrating it for physicians. [sarcastically] You guys don’t need this.
OK and um? Yeah, somebody finally got it. All right.
They don’t actually look like this, the decay products. The radioactive cobalt became… That was taken actually in Canada, where they
built the first machines. They even put it on a postage stamp over here. I am old enough so that I trained on treating
patients with radioactive cobalt, and we did cure a lot of cancer with it. There’s no question
about that. But In time, that gave rise to the betatron
which would crank energies up to 35 million electron volts. I’d like to also point out
decibel level to a hundred decibels at least. My own thought was that the cancer cure came
from the noise of the machine rather than X-rays because it shook the patient to death. Today, modern linear accelerator that is used
to treat cancer patients runs between six and 15 MeV. It turns out if you go over 15
MeV, you start making radioactive oxygen and air. You get neutron contamination. That’s
probably not a good idea. They’re versatile, quiet, and reliable. A few million dollars
would buy you one of these things. Those are now standard treatment. Why this push for higher energy? Well, it
has to do with the depth-dose curves. This is 250 keV. In order to get a hundred to the
tumor, you got to crank about 200 into the surface of the patient. Their skin falls off
after a while. Medically, this is not a good thing. Yeah. The patients get upset. If you Cobalt-60 though not only do you; it
only takes maybe a 150 percent at the skin level. In fact, cobalt skips the first few
milliliters and that has to do with electron equilibrium. Which, in fact, when this noted
medically, the physicist said, “Impossible.” The physicians kept saying, “But they’re not
getting skin reactions.” The physicist went back and realized that
loss of electronic equilibrium in the first few millimeters meant the skin dose was low.
It really made it possible to give high doses into the patient. As you crank up the energy, clearly you get
more and more energy into the tumor and less and less on the surface, so this is better
and better. You get more sparing on the skin too. Here’s some nice pictures. This is cancer
of the larynx. You see this kind of thing all the time in smokers. You treat them with
radiation. It’s gone. Here’s a small lung cancer that’s seen on
CT scan right here. It’s treated with a technique called radiosurgery. After about a year, it
all disappears except for a little scar tissue. Here’s an advanced lung cancer which was the
thing I specialize in so much where there were big amounts of tumor right on the mediastinum.
You treat it with radiation and sometimes you get a response like that, and the patient
will be cured. This is terrible breast cancer. I saw a lot
of these in the early days and treated with radiation. It cured the disease. Another particle that was used was the beta
particle or electrons. Electrons have a terrifically nice thing that they just fall off like a
waterfall. They don’t go very deep. Very little skin sparing though. Somebody with a very extensive skin cancer
like this, you treat it with an electron beam and you cure them. You don’t want to use an
X-ray here because if you point X-ray through here, it will go through the brain. That’s
not a good thing. Can we do better than X-rays? The answer is
yes. Here is protons. If you take protons, because of the Bragg peak, they will tend
to pump up and then the dose crashes. They don’t get much pass the Bragg peak. You have
to widen the Bragg peak out a little bit because that’s very tight, and the tumors have some
macroscopic dimensions. The price you pay there is you got an entrance dose. Protons are great. They are also horribly
expensive. They’re extremely clumsy. I actually work with these things. It’s very difficult. There’s a big rush now to build proton facilities.
There are about 15 of them in the United States now. There’s one here is in Virginia. They’re
private enterprises because they get very, very good reimbursement on these. Here’s one of the earlier use of protons.
This is melanoma in the eye. You treat it with a proton beam. You do that so that you
can spare the rest of the eye. The person had about 80 percent of the vision. Whereas
the standard treatment, would be taken out surgically. Then, you have no vision, right? Protons aren’t better than X-rays. Biologically,
they’re the same. There are a lot of tumors that are still very resistant to X-rays. Neutrons,
on the other hand, are a different deal. Neutrons are killers. I mean, they are what are called high-LET
radiation. They don’t fall off the way X-rays do. Gently, but they fall of more like protons.
They’re very, very active. No mammalian cell can really survive a neutron dose, so there’s
no such thing as tumor resistance to neutrons. Here’s an example of a patient of mine that
had big huge tumor like that of a cell type that was known to be very, very resistant
to X-rays. I sent him to Seattle where they had a neutron facility. He came back like
that and a very good response, but you can do better. The trouble with neutrons is they’re very
difficult to control. These are uncharged particles. It’s hard to collimate them. It’s
hard to deal with them. Supposing you have high-LET radiation with
charged particles? Let’s say, carbon-12, let me go back here. Then you can get a dose distribution
curve like this, where you have no entrance dose and no exit dose. It’s almost like a surgical knife. You can
go in there with a carbon beam of high-LET particles, and you’ll kill everything in that
section. Here’s a schematic of one of them. I had a
little device in here just to kind of show you what the problem was in case you don’t
understand what I’m talking about. Here’s a blow up of the picture. These things
are hundreds of millions of dollars. I suspect when you build the facilities and
you add the team of nuclear engineers; [jokingly] you guys will not work for minimum wage anymore.
It turns out these things are horribly expensive. As far as I know, there’s only one or two
in the world. Because they’re so large, they’re very difficult to work in the medical environment. Let’s go back to nature. We’ve been dealing
with this buy and build thing where we build the machines, and nature retaliates and says,
“I have something better.” Could we go back to nature and maybe get it for free? Are there,
in fact, alpha radiation sources in nature? As you know, I counted recently, but somebody
correct me if I’m wrong, I counted a 150. All right. Boron neutron capture has been
done. It’s where you flood the patient with boron. You put neutrons in there. You can
kill the tumor very nicely. It was catastrophic because you can’t keep the boron out of other
areas, and the patients died hideous deaths. This was tried multiple times and given up.
There might be a better way. Antibodies to the tumor. Antibodies carrying
nuclear weapons to the tumor. Why does this work? Alpha particles are deadly because so
much energy entering the cell destroys it. I did a little calculation here. A stick of
dynamite has an energy density of about a thousand joules per cubic meter. A single
alpha particle has a density about the same because it ranges so short that it will destroy
an entire cell. So, if it only takes one alpha particle to kill a cell. You’re in business. People consider this for leukemia. The standard
way to treat leukemia these days, if you have aggressive leukemia, is to give a whole lot
of drugs to kill all the bone marrow, and then new bone marrow transplant. This is not pleasant. I can tell you that
from personal experience because I went through this, three and a half years ago. These are
not good things to put into people. An alternative is antibodies attached to nuclear
weapons that will destroy the patient’s bone marrow but not much of anything else if the
antibodies are primed only to do the bone marrow, and then transplant them. There are a lot of research going on this
area. Just one just published a few days ago by Actinium Pharmaceuticals that uses Actinium-225,
which is, in fact, I think the wrong isotope. The properties the alpha particles have to
have availability, a half-life that’s medically usable. It turns out Bismuth-213, Actinium-225
are among some of the best. They’re only available in LFTRs. Now here’s the decay scheme of Uranium-233,
Actinium-225 and Bismuth-213 are prominent in the decay scheme. That is about the only
way you really can obtain this stuff. One of the things about the LFTRs is we may
be able to make materials that are good for leukemia, that are good for other kinds of
cancers. Maybe someday that will be the way we treat metastatic cancer disease, by having
antibodies of high specificity carrying little nuclear weapons to destroy the tumors. Skipping very quickly to diagnostic nuclear
medicine. There is Technetium-99m which is the backbone of the work horse of nuclear
medicine. This is the kind of thing you do. Here’s a patient that we thought was cured.
Then, a few months later, that’s what his bone scan looks like. Very unfortunate for
the patient. The reason this works is that bones have the
cells called osteoblast in them. They take up calcium like crazy if there’s inflammation,
which there is once the cancer is in the bone. They also take up Technetium because they
don’t know the difference. They also, by the way, take up radium as well. There is a drug
an alpha emitter, Xofigo, which is out in the market and is FDA approved. There’s a critical shortage of Technetium.
It is made overseas. It is made in aging reactors that require enriched uranium, which we can
no longer export after some date. I don’t know the exact date is. We can’t export that. It turns out, this fits into your talk, that
one of the byproducts of the LFTR is this stuff here Molybdenum-99 and Technetium-99
and is just a byproduct and contaminant. Fish that stuff out and you will solve the problem. Bill Thesling and I did a calculation back
of the envelope. We thought that one or two LFTRs, just a couple of gigawatt reactors
will supply all the Technetium that the United States needs. We would no longer be in this
severe crises mode by 2018 or 19. They think there’s not going to be any of Technetium
back at all. So, we rest our case. [laughter] , [applause] You gave Leukemia is an example of one of
the conditions that would be treatable by some of these advanced ideas, but I’m just
wondering if myeloproliferative disease would be included in that? The answer is yes. Mother told you that there
was cancer and not cancer. It turns out mother was not quite telling you the truth. It turns
out that there is a progression from normal cells to frank malignancies. What he says myeloproliferative disease with
a very sophisticated term is, in fact, one of these intermediate diseases that are very,
very bad for the patient and end up transfusion dependent. Eventually, most of them degenerate
into leukemia. In my case, that did not happen. Myelodysplastic diseases are sometimes, when
the patients get transfusion dependent, they do have to have marrow transplant. It’s the
only known way to cure them. To get a marrow transplant means you got to get the old marrow
out there. Because if you just take somebody else’s marrow and put it in there, your own
bone marrow will fight it tooth and nail and destroy it, so you got to clear it out. The only way we know of clearing that out
today is to use of these highly toxic drugs. I had six of them because I failed the first
time, and I kind of failed the second time and it was really the third time before we
actually got it cleared up enough so that I can get a transplant. The transplants are the thing that actually
mop it up, but that clearing out process. Now, the reason I think Actinium-225 is wrong
is I think you need a shorter acting isotope. Because if we’re going to clear this out,
you don’t want that stuff hanging around, so that when you put in the donor bone marrow,
it has to deal with it. Bismuth-213 seems to me to be perfect it’s
a round about an eight hour half-life or something. About a week, the patient is going to go without
marrow and the hospitals can cope with that and then transplant it. The Bismuth wouldn’t
go anywhere else, so the patient wouldn’t have two years of recover from the chemotherapy. May I make the business case for you, Julian?
With an eight hour half-life, is there any point in trying to get that from a solid fueled
reactor? You actually get it from Actinium, so I wouldn’t
do it. Yeah and If I might add, think about how many
millions of dollars per kilo something that hangs around for only eight hours and is only
present in trace amounts like less than one peco curi in a whole load like of the uranium
in the Congo. Think about how many millions of dollars per kilo that will add up to. If
that’s not a business case, I don’t know what is. Well, one of the things I was intrigued about
is if you look at the list of things that are made by a LFTR, they include platinum
so that’s another waste metal, right? All right. Both entertaining and informative.
Thank you very much, Julian.

5 comments

  1. so if Bismuth-213 only has a half life of 8 hours. that would be virtually impossible to transport it long distances yes?

  2. By far one of the greatest benefits of LFTR's is ease of collecting "waste" products from a liquid fuel medium.

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