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A Brief History of Radiotherapy

Rachael Barton

Consultant Clinical

Oncologist

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Discovery of X-Rays

Wilhelm Conrad Rntgen

1845-1923

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Nobel Prize for Physics 1901

Experiment 8th Nov 1895

Generated X-Rays withcathode ray tube

Published 28th Dec 1895

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Henri Becquerel

1852-1908

Demonstrated the

spontaneous emissionof nuclear radioactivity

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Naming of radioactivity

Marie Curie

1867-1934

born and educated in Poland

studied in Paris

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Nobel Prize in chemistry

1911

Discovered radium andpolonium

Nobel Prize in physics 1903

shared with Henri Becquerel

and Pierre Curie

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Ernest Rutherford

1871-1937

Nobel prize for

chemistry 1908

Atomic theory

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Early medical uses of X-Rays

Emil Grubbe

1875-1960

Describes

experimenting with X-ray treatments while

still a medical student

(!) in 1896

Reports difficult tocorroborate

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TREATMENT OF CERTAIN FORMS OF

CANCER BY THE X-RAYSFrancis H Williams MD JAMA 1901

Williams is consideredthe father of diagnostic radiology in the USA

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It is well recognized that cancer is on the

increase, and reliable statistics made in various

countries and extending over periods of yearsprove that the rapidity of this increase is

surprisingly great. Any method of successful

treatment, even though it may be limited in its

application to certain forms of this disease, will

prove to be a great boon to humanity.

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Although I shall refer to but few of the cases I have

treated. I hope to present enough to have the

reader share my opinion, namely, that in the x-rays

we have an agent which causes superficial

external forms of cancer to heal; and this may be

done without pain to the patient.

(Cases of cured cancer of the skin and lip)

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Leopold Freund

1868-1943

Best documented

case of earlymedical use of

X-Rays

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Freund treated a large hairy naevus on the back ofa 5 year old girl based on reports of hair loss in

radiation workers

Moist desquamation induced over 21 treatments of2 hours each

Hair loss was complete and permanent

Follow up continued and patient was last seen aged

80 years with some scar formation but no evidenceof second cancers

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Other pioneersVictor Despeignes reported a rapid improvement

in a patient with advanced stomach cancer

Hermann Gocht early use of radiation for 2patients with advanced breast cancer

G. Voigt reported the use of X-Rays to treat a

man with advanced pharyngeal cancer. No

technical details given

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Early years of radiotherapy

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Early uses of radiation largely in diagnostics

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Radium

Extracted from Uranium ores

All isotopes are highly radioactive

Could be packaged into small applicators and

placed near to a cancer

Cervical cancer became curable

Could only be produced in small amounts

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Early teleradiotherapy

Used low voltage generation producing

X-rays with little penetrating power

Some success in treating superficial skin

cancers

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1920s

Gradual improvements in the energy of X-

rays produced allowed the treatment ofdeeper sited cancers

General Electric developed a 200kvmachine in 1922 allowing cure of inoperable

laryngeal cancer

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Between the warsDevelopment of:

science of radiobiology measurement of radiation

Higher energy X-raygeneration

Radium therapy techniques

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Henri Coutard

1876-1950

Physician with interestin radiation

Served in mobile X-rayunit in WWI

Research in Radium

Institute, Paris

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Animal and human experiments on theuse of radiation

Showed the importance of:

FractionationUse of filtered radiation

Induction of skin and mucous membranereaction

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By 1938

1MV X-rays generated

Manchester system described for the

intracavitary insertion of radium for the

treatment of cervical cancer

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1940s-50sDevelopment of technology:

Cobalt 60 machines in use in 1951

Drs Ginzton and Kaplan developed the first

linear accelerator in 1952

Teletherapy able to treat deeper cancers

1953 Royal College of Radiologists founded

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one, two

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1960s onwards

More powerful machines

Developments in imaging

Replacement of radium

with safer alternatives

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1970s-80s

Remote afterloading brachytherapy

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Imaging

Godfrey Hounsfield1919-2004

1972: CT scanner

Nobel prize 1979

CT scanning now routinely used for radiotherapy planning

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21

st

centuryImaging

PET-CT

MRI

EUSEBUS

RT technique

IMRT

Tomotherapy

Modern brachytherapyGated radiotherapy

Image guided RT

Safe, effective brachytherapy

Stereotactic radiotherapy

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Radiotherapy 1896-2011