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Oncology Times:
doi: 10.1097/01.COT.0000311440.21128.df
Department: Turrisi Takes on the Movies

TURRISI TAKES ON THE MOVIES

Turrisi, Andrew T. III, MD

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Directed by Ethan and Joel Coen, written by Joel and Ethan Coen, adapted from the novel by Cormac McCarthy. Starring Javier Bardem (Anton Chigurh); Josh Brolin (Llewellyn Moss); Tommy Lee Jones (Sherriff Ed Tom Bell); Kelly MacDonald (Carla Jean Moss); and Woody Harrelson (Carson Wells).

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‘NO COUNTRY FOR OLD MEN’

As the camera snaps the sequences of a flawless dawn illuminating a Lone Star desert and hills, the laconic Texas drawl of Tommy Lee Jones intones a sheriff's lament: “I sent a teenager to the electric chair for killing his 14-year-old girl friend. The papers suggested that it was a crime of passion, but he told me he was fixing to kill someone for as long as he could remember. He said that he would kill another if he had been let out. He said he would be going to Hell, and reckoned he would be there in about 15 minutes.”

You know that the title line, borrowed from William Butler Yeats's Sailing to Byzantium, was about to draw you into an unholy story directed and written by the Coen brothers, based on the Cormac McCarthy novel by the same name:

“That is no country for old men. The young

In one another's arms, birds in the trees—

Those dying generations—at their song,

The salmon-falls, the mackerel-crowded seas,

Fish, flesh or fowl, commend all summer long

Whatever is begotten, born, and dies.

Caught in that sensual music all neglect

Monuments of unageing intellect.”

In the movie, set in the late '70s or early '80s, Llewellyn Moss (Josh Brolin) takes deadly aim at a buck in a herd, pulls the trigger, and they scatter. His prey is wounded and he follows the blood-trail, when a staggering wounded, bleeding dog directs him off his mission to the site of utter mayhem: a drug deal gone bad.

He descends from a ridge to find a carnage of dead men and dogs, the rear of a pick-up truck covered with a tarp with bricks of drugs still there. The trucks have what seem like howitzer blasts and glazed or shattered windows.

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He pulls the door open to see a dying Mexican croaking for “agua”—water—and he asks him about the last man standing, the ultima hombre. He tracks the last man to a shaded tree, and eyes him through binoculars discerning his motionless, pointed boots and concludes that he too is dead. Resting next to him is a boxy black legal case bulging with wrapped $100 bills totaling $2 million—gold not exactly from Byzantium.

That night, he is strangely drawn back to the site of the ruined trucks and calamity of dead bodies to bring water to the dying Mexican, and he finds himself the subject of a murderous attack, and his journey begins, to try to keep the money, as he is relentless pursued.

We meet Anton Chigurh (Javier Bardem) as he is cuffed and placed in the back of a police car. The witless deputy leaves him cuffed, but not placed in a cell, as he makes a call. We witness the ruthless brutality, and first blood drawn from the psychopathic, amoral killer as he begins his mission.

Sheriff Bell (Tommy Lee Jones) enters in pursuit of Chigurh, and is well aware that Moss has bitten off much more than he can chew by trying to keep the drug money. Moss returns to his home to dispatch his wife Carla Jean (Kelly Macdonald), and the Coen brothers take over with an inexorable chase with blood-a-plenty to follow.

We witness Chigurh's encounters with his weapon of choice, an air-driven cylinder used in slaughtering livestock that blasts a hole through locks and skulls alike, as well as scenes where he swiftly dispatches a motorist into the artifice of eternity and flips a coin with a gas station attendant who gets the strong vibrations of ominous intent from Chigurh, who avoids death by picking “heads.”

Bardem looks like a zombie, with a helmet of jet-black locks, a deranged Prince Valiant, an angel of death and grim reaper disguised in a bowl cut. He portrays heartless, focused, relentless intensity with the lack of any passion, like the foreboding story of the teenage murder. Like Keats, he sends a generation dying:

“O sages standing in God's holy fire

As in the gold mosaic of a wall,

Come from the holy fire, perne in a gyre

And be the singing maters of my soul.

Consume my heart away; sick with desire

And fastened to a dying animal

It know not what it is; and gather me

Into the artifice of eternity.”

(Italics are mine; I had to look up the meaning of “perne” and “gyre”—a spindle and a spinning wheel, which Yeats was familiar with from his days in Sligo, Ireland. It is not an accident that he symbolically compares the timelessness of ancient Greece, its beauty and art, with the troubles in Ireland and the senseless death, despite its beauty and the artistic Irish spirit.)

The movie is lyrical and paced, relentless and inevitable. It languishes at times, and bathes you in gore. The pursuit of gold is not just in Byzantium, whose riches were plundered by Saracen and Crusader alike, but our own relentless pursuit for riches, for ourselves, our institutions, our “monuments of unageing intellect” at times take on the focus and heartlessness of Chigurh (which ironically is pronounced like “sugar”).

Bardem performs incredibly, and the movie is nominated for four Golden Globe awards, but its highly disturbing and graphic violence and bloodshed need to be known before you settle in for the chiller to ice your winter.

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RT More Effective than Surgery at Preventing Second Laryngeal Cancers

A study presented at the ASTRO Annual Meeting by researchers from Loyola University Medical Center found that radiation therapy was more effective than surgery in preventing second larynx cancers in patients initially treated for an early larynx cancer.

The study, which lead researcher Gopal Sachdeva, MD, and his colleagues called the largest and only of its kind, included 3,898 patients identified from the NCI's Statistics, Epidemiology, and End Results data base between 1988 and 2003 with histologically proven T1N0M0 Squamous Cell Carcinoma of the Glottic Larynx who underwent Primary Surgery or Primary Radiotherapy.

The long-term cure rates were equivalent with both options, and there was no increased risk of second cancers among patients who received radiation compared with the surgical control group, reported Dr. Sachdeva, a resident in radiation oncology. “More importantly, surgical management of these patients resulted in a long-term statistically significant increased risk of developing a second laryngeal cancer, which radiation appears to protect against.”

He attributed this to the concept of “field cancerization”—“Whatever the etiological factor, cigarette smoking or alcohol, genetic changes can occur in different areas of the aerodigestive tract resulting in precancerous and cancerous changes, and in the case of larynx cancer, radiation treats a larger area, essentially the entire voice box. Surgery however usually just addresses the site of the tumor,” he explained in a news release.

“Thus, radiation likely eliminates microscopic areas of precancerous changes in the field that if left untreated can progress to new second cancers,” which he terms “field sterilization. Because of equivalent long-term survival, when deciding on a therapeutic modality for patients with early glottic cancer this finding as well as functional outcomes deserve greater consideration,” Dr. Sachdeva concluded

© 2008 Lippincott Williams & Wilkins, Inc.

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