RSS feedChristmas has come and gone. Thank goodness the kids are getting bored with those noisy presents meant to entertain and amuse. However, little did we know that some of these goodies can damage a child’s hearing. A recent study commissioned by Deafness Research UK has found that 14 of 15 popular toys, if held close to the ears by children, will harm their hearing. The recommended top noise limit for toys is 85 decibels. When held close to the ear, 14 of the toys, including Fireman Sam’s Action Jupiter, Tomy’s Spin n Spound remote-controlled car, Pixar Cars Lightning McQueen, had average noise levels between 84 and 115 decibels. Toy guns are the worst offenders, emitting 130 – 143 decibels. Noise of 140 decibels or above can cause immediate hearing damage. The only toy with a noise level below the safety threshold was a VTECH cell phone for babies. Huh, cell phone for babies? Guess some do want to start their kids young on being a real techie!
There are ‘toys’ in the field of medicine as well! Recent examples in the field of radiology include a 64-slice CT scanner for scanning coronary arteries for calcium scoring and to perform virtual colonoscopy. In the field of treating hepatocellular carcinoma (HCC) or primary liver cancer, a recent therapeutic ‘toy’ for palliating HCC is radio-frequency ablation (RFA). The crux of the treatment is to ‘cook’ the tumour with a special needle inserted under X-ray guidance or during open surgery. Up to 5 years ago, in Europe, percutaneous ethanol injection (PEI) was the ablation treatment of choice for inoperable HCC. Then RFA became the new kid on the block and displaced PEI because it could be done faster and it was thought that RFA was more ‘scientifically appealing’. Initial reports suggested that RFA led to higher rates of complete response, lower rates of recurrence and gave better prolongation of survival compared to PEI. However, with the passage of time, more recent studies have not confirmed these initial findings about the excellent efficacy of RFA.
A recent Italian multi-centre study looked at the efficacy and safety of RFA in 401 patients with HCC (Aliment Pharmacol Ther 2006; 24: 1495 – 1502). In 77% of patients there was only one lesion but this was not suitable for curative surgery. In 18% of patients, there were 2 – 3 lesions and the remaining 5% of patients had multiple lesions. The mean size of the tumour was 3cm. Following the initial RFA, in 61% of patients, additional treatment in the form of repeat RFA, PEI, transarterial chemoembolization (TACE), surgery or medical treatment was necessary, either immediately or during follow-up, because of partial response or disease recurrence. Major complications occurred in 5% of cases during or after treatment. These included portal vein thrombosis, seeding of tumour along the RFA needle tract, abscess in the liver, bleeding and perforation of the colon, to name a few. The complete response rate, as assessed by CT scanning, at one month was 67%, which is much less than the earlier reports of 90 – 98% response rates. The overall survival of this group of patients was 40% at 3 years, a very respectable figure indeed.
With the passage of time, more studies and more data on increasing numbers of patients treated with RFA has helped the medical community to refine their recommendations on the use of these ‘new toys’ in treating patients. After a recent Consensus Conference on HCC held in Barcelona, involving the European Association for the Study of Liver Disease, the American Gastroenterological Association and the Japanese Cancer Society, the take-away message was that, in practice, RFA may well be only indicated for HCC nodules ranging from 2 – 3 cm in size only. This does not mean that RFA is not a good treatment for HCC. It merely means that we have to be selective in its use and we must use it in patients with the right disease characteristics.
It is fortunate that the medical community is endowed with many ‘toys’, be it gadgets or new medicine. There is always the initial flurry at the start when each new tool is hailed as the ‘holy grail’ for treating a condition by the enthusiasts. With time and more information, the picture becomes clearer and all doctors become more informed of the scope of use for that particular ‘toy’. In the fight against cancer, we need all the ‘toys’ we can to give the patients more hope. However, we must use the ‘toy’ or ‘tool’ with care and caution so that we do not cause harm or give unrealistic hopes to the patients. As the saying goes “A fool with a tool is still a fool!”
Today heralds the beginning of another year. As the year passes, the medical community will gain more information and knowledge about various tools and how to use them better. I wish all my readers a Joyous and Healthy New Year!
