Every Rational Aempt The Stories Behind Barts’ Contribution to the Fight Against Cancer Edited by Professor Nicholas Lemoine and Dr Delphine Purves Every Rational Attempt: The Stories Behind The Contribution of Barts In The Fight Against Cancer Legend for the ‘Shield’ Cover Images: Top row, L-R: 1. 1788 Portrait of Percival Pott (1714-1788) by George Rommey, displayed at the Hunterian Museum. 2. The St Bartholomew’s Hospital Crest, which first became associated with the hospital in the 15th Century. 3. An aortic ring as seen through a microscope. Image captured by Dr Marianne Baker, Barts Cancer Institute. Bottom row, L-R: 4. Sir Geoffrey Keynes with students, 1947. Courtesy of St Bartholomew’s Hospital archives (X8/1502). 5. The entrance of the Queen Mary Charterhouse Square campus, home of the Barts Cancer Institute. 6. Radiotherapy to the jaw, c. 1929, Courtesy of St Bartholomew’s Hospital Archives (SBHX8/180). Dedicated to Staff and Students, Past and Present, of the Barts Cancer Institute ii Every Rational Attempt: The Stories Behind The Contribution of Barts In The Fight Against Cancer Editors: Professor Nicholas Lemoine Director Dr Delphine Purves Institute Manager Editorial Mr Richard Le Vay Assistant: Graduate Trainee 2015 iii Copyright © 2015 by Delphine Purves All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review or scholarly journal. Disclaimer: Although the authors and publisher have made every effort to ensure that the information in this book was correct at press time, the book is a work of memory. The publisher does not assume total accuracy and hereby disclaims any responsibility for any errors or omissions. First Printing: 2015 ISBN: 978-1-326-33764-3 Barts Cancer Institute, Queen Mary University of London Old Anatomy Building, Charterhouse Square London EC1M 6BQ www.bci.qmul.ac.uk iv “Every rational attempt toward relieving mankind from such an evil, will, I make no doubt, be favourably received…. for when the disease has got head, it is rapid in its progress, painful in all its attacks and most certainly destructive in its events”. Percival Pott, The Chirurgical Works of Percival Potts, FRS and Surgeon of St Bartholomew’s Hospital, Volume 3, MDCCLXXIX (1779) v Contents Page Foreword………………………...……………………….……................ 1 Cancer-Related Achievements at Barts…………………..………….. 3 Author Biographies………………………………..……....................... 4 The Medical Oncology Unit at St Bartholomew’s Hospital - Prof James Malpas, Dr Peter Wrigley & Prof Andrew Lister…………. 11 Haemato-Oncology - Prof Ama Rohatiner…...................................... 26 A Ward Sister’s View - Ms Jennifer Ellwood……............................. 34 Cancer Pharmacology - Dr Simon Joel…………………..………….. 48 Paediatric Oncology - Prof John Lilleyman……................................ 54 Male Genitourinary Cancer - Prof Tim Oliver.................................. 63 Gynaecological Oncology - Prof John Shepherd…….….................. 71 Cancer Imaging - Prof Rodney Reznek…………………................... 78 Founding of the Barts Cancer Institute – Prof Ian Hart……........... 86 Special Contribution: The History of Radiotherapy At Barts – Dr Nicholas Plowman………………………......................................... 102 Epilogue - Prof Nick Lemoine………………………………………... 125 vi Foreword "If I have seen further, it is by standing on the shoulders of giants", a much quoted phrase from one of the greatest scientists of all time, Isaac Newton (1675). Yet its sentiment remains as true today as it was then, that while great scientists are proud of their contributions to their field, they remain indebted to the scientists who preceded them, without whom they may never have been able to make that contribution. And in this monograph about the impact of Barts on cancer medicine, you will see “giants” throughout, in the authors who have written of their time here, and in those they have written about. They were at the vanguard of what is now viewed as standard clinical practice and their unique talents changed the face of cancer treatment and understanding. The 20th century, particularly the latter half, was a time when a host of new weapons were discovered and produced in the so-called fight against cancer, pushing back the front line with revolutionary therapeutics, diagnostics, imaging and radiotherapy. In reading this monograph, it is clear that this was an extraordinary time and Barts, along with a handful of other institutions worldwide, was at the forefront of those discoveries. Yet also evident from this monograph is the collegiality and camaraderie at Barts. It makes it a special place, for whom many who worked or still work here consider it a privilege to have done so. Anyone entering Barts for the first time, through the Gate and into the quadrangle, is struck by its beauty and serenity, and an almost tangible sense of its history, a story of human kindness and compassion. Begun in 1123 by the Augustinian monk, Rahere, he set up St Bartholomew’s Hospital to provide solace to the sick, poor and dispossessed of London, offering them refuge, respite and care. Here it remains, arguably the oldest hospital in the world operating on the same site, still treating and caring for the sick, having fought off attempts to close it from Henry VIII to the UK government in the 1990s! And this legacy of care is evident in this monograph in the memoires of those who have dedicated their professional lives to giving hope to cancer patients, by striving to overcome this most destructive of diseases through cutting-edge research and improvements in care – the same aims which continue to drive the current scientists now working at the Barts Cancer Institute (BCI). This monograph was commissioned to mark the end of the BCI’s tenth anniversary 1 year, as a fitting tribute to all that has gone before, from many of those who were there at that time. It is daunting to consider the successes of the last ten years in the face of the triumphs summarised in this monograph, yet as Professor Hart has so eloquently described in his chapter, the discoveries continue to come, are being translated into very real patient benefits, and the dedication and calibre of the current scientists honour those on whose shoulders they now stand. From such a height, how much further can they see? Let us hope that they have the end in their sights and it will be this generation who will finally win the fight against cancer. Dr Delphine Purves Institute Manager, Barts Cancer Institute 2 CANCER-RELATED ACHIEVEMENTS AT BARTS The idea that occupational exposure to environmental factors would cause cancer – Percival Pott, 1779 The idea that cigarettes caused cancer – Ernest Kennaway, 1947 First X-ray machine for clinical use - 1896 Radiotherapy in head and neck cancer – Neville Finzi, 1907 Local excision with radiotherapy to treat breast cancer – Geoffrey Keynes, 1922 First radiotherapy department worldwide – Neville Finzi, 1924 Use of super-voltage radiotherapy – Neville Finzi, 1936 First UK Chair in Medical Oncology - Gordon Hamilton Fairley, 1971 Sub-Specialty Recognition of Medical Oncology in the UK - Gordon Hamilton Fairley and Ronald Bodley Scott, 1975 Cancer BACUP, a national patient support group, set up - Vicky Clement- Jones, 1985 Introduction of the concept of MDT (multidisciplinary team) meetings in Haemato-oncology, Germ-Cell Tumour oncology (introducing teleconferencing in 1998) and Gynaecological Oncology, many years before their introduction nationally First retroperitoneal approach to radical excision of ovarian cancer – Christopher Hudson, 1967 MVPP to cure Advanced Hodgkin’s disease – Gordon Hamilton Fairley, 1975 The effect of schedule on the activity of etoposide for lung cancer – Maurice Slevin and Simon Joel, 1999 Department of Gynaecological Oncology established – John Shepherd, 1981 MRI in Gynaecological Oncology to characterize adnexal masses, now adapted worldwide – Rodney Reznek and John Shepherd, 2004 The concept of carboplatin as a single-agent therapy for testicular cancer - Tim Oliver, 2005 3 AUTHORS’ BIOGRAPHIES Professor James Malpas MB BSc D Phil FRCP FRCR FFPM FRCPCH Professor of Medical Oncology and Director of the ICRF Medical Oncology Unit at Barts (1979 - 1995), James Malpas qualified from Barts in 1955 before joining the RAF for his National Service. In 1969, he was appointed Dean of the Medical College and in 1987, Vice President of the College. He is a highly distinguished researcher, notably in the fields of lymphoma, myeloma and children's cancer. Professor Malpas cemented his strong links with the local area through serving as Master of the Charterhouse from 1995-2000. Dr Peter Wrigley BM BCh PhD Senior lecturer in the ICRF Medical Oncology Unit, having returned to Barts in 1966 as a Research Fellow and honorary senior registrar. He studied at University College London for his preclinical training before going to Oxford to join the Clinical Medical School at The Radcliffe Infirmary. In 1975, he took an NHS consultant job, a joint appointment between Barts and Hackney. He retired in 1995. 4 Professor Andrew Lister MD FRCP FRCR FMEDSCI Andrew Lister qualified from Cambridge and St Bartholomew’s Hospital in 1969. Having been House Physician to Sir Ronald Bodley Scott, he was a research fellow at the ICRF Medical Oncology Unit and the Sidney Farber Cancer Institute, Boston, prior to joining the Staff