Chapter 10: Lung Cancer and Uncommon Lymphomas

Dr. Cox describes the research he undertook when left the position of Vice President for Patient Care and returned to his full-time faculty position, beginning with his new role as “the lymphoma person.” He explains the lymphoma trials that combined radiation and chemotherapy and that resulted in a successful response as well as a genetic translocation that will give rise to a genetic marker. He notes studies of radiation and chemotherapy in uncommon lymphomas. Dr. Cox next explains how he was involved in teasing out the natural history of unusual lymphomas to understand them as distinct cancers. He uses testicular lymphoma as an example, describing how this cancer is treated with both radiation and chemotherapy. Patients with this cancer were rarely cured before this approach was developed: with this treatment, the cancer is eliminated in 50% of cases. Dr. Cox conducted this work between 1992 and 2000. Dr. Cox then explains that he always saw cancer as more than one disease: he explains what it means to understand this at the molecular and cytogenetic level, eventually resulting in diagnoses being rendered by biochemical, molecular or genetic findings. He notes that his work at MD Anderson was tightly linked to his work with the RTOG. He continues, explaining that he returned to work with lung cancer in the late nineties. He mentions that lung cancer still has the highest death rate among all cancers, though mortality from lymphoma is increasing and Dr. Cox explains this is largely attributed to environmental chemicals. He explains the “modest progress” that he and the lung group at MD Anderson have made combining drugs, radiation, and surgery. Dr. Cox explains his work using prophylactic cranial irradiation to decrease the risk of brain metastasis from small cell carcinoma and notes that studies were also done to determine if this irradiation increased the risk for neuropsychological complications.https://openworks.mdanderson.org/mchv_interviewchapters/1789/thumbnail.jp