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OAK RIDGE INSTITUTE OF NUCLEAR STUDIES OAK RIDGE. TENNESSEE Division of Biology and Medicine I am hoping to see you late next week but meanwhile would like to add some comments in connection with our recent correspondence. The comparison of the Yugoslav and Y-12 accident groups has been of much interest. The lowest dose Yugoslav patient had a clinical course compatible with the 207 rads assigned to him and thus will be left out of further discussion. If we look at the rest, we find that all of the Yugoslavs had more biologic evidence of radiation effect than any of the Y-12 group. From the listed doses one might expect less separation between the groups and even some overlap in clinical manifestations. The biologic effects referred to include nausea, vomiting, ergthema, delayed abdominal spnptoms, inflammation of the mucous membranes and, in particular, epilation. Hematologically I am thinking of lymphocyte fall, granulocyte depression, and anemia. (Platelets in contrast were about the same in the two groups; this well could involve difference in These facts have made me feel that the most recent stated doses in rads might be too high for the Y-12 or too low for the Yugoslav group, or that the quality of the radiation might be responsible for the apparent differences. I would not wish to seem dogmatic in this view. It is of course possible that we are dealing with a dose range where slight increments enhance the biological effect greatly and that coincidental differences in radiosensitivity of some patients also account for the seeming inconsistency.. * Our plans for the neutron radiation studies do have as a very important objec- -. - -I tive the obtaining of information on relative biological effects and induced radioactivity in man. We have been following a standard research protocol to build up data on total body gamma radiation responses which could serve for comparison with later neutron studies. Most of the leukemic patients have proved to be quite sensitive to doses of 50 r gamma radiation with clear-cut hematologic responses. On the other hand, patients with non-leukemic malignancies show hardly detectible blood changes at this dose. By studying neutron radiation at the same rad dose with identical criteria for effect we should be able to obtain We plan to select the patients neutron irradiation should useful information on relative biological carefully with special consideration to not be given to any patient who has any likelihood of living long enough to suffer from a second induced malignancy.
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We have no way of knowing in advance what the exact response of the leukemic or malignant process will be. We have no reason'to believe that neutron radiation will represent an important improvement in therapy of these diseases. However, we are certain that we can give the relatively low dose neutron therapy safely and make it a part of a very adequate therapeutic program which will also utilize apprapriate standard forms of treatment given after the period of observation of the radiation effect (usually 6 weeks). This study will yield data ' of value, possibly in the field of therapy, and certainly in the area of basic radiobiology applicable to problems of radiation accidents and nuclear warfare. The other comments in your letter dealing more with administrative problems can perhaps be better discussed when we next see each other.