The Emperor of All Maladies: A Biography of Cancer

by Siddhartha Mukherjee

Why did Kaplan succeed where others had failed? First, because Kaplan meticulously restricted radiotherapy to patients with early-stage disease. He went to exhaustive lengths to stage patients before unleashing radiation on them. By strictly narrowing the group of patients treated, Kaplan markedly increased the likelihood of his success. And second, he succeeded because he had picked the right disease. Hodgkin’s was, for the most part, a regional illness. “Fundamental to all attempts at curative treatment of Hodgkin’s disease,” one reviewer commented memorably in the New England Journal of Medicine in 1968, “is the assumption that in the significant fraction of cases, [the disease] is localized.” Kaplan treated the intrinsic biology of Hodgkin’s disease with utmost seriousness. If Hodgkin’s lymphoma had been more capricious in its movement through the body (and occult areas of spread more common, as in some forms of breast cancer), then Kaplan’s staging strategy, for all his excruciatingly detailed workups, would inherently have been doomed to fail. Instead of trying to tailor the disease to fit his medicine, Kaplan learned to tailor his medicine to fit the right disease.