Cancer of the cervix was one of the first malignancies treated successfully using radium, and the implantation of cervical cancer with radioactive sources remains a mainstay of therapy for that malignancy. This was referred to as brachytherapy (brachy- meaning short), the radioactive source being located within or next to the tumor. In parallel with improved treatment using external-beam therapy was the deployment of radium placed into needles or seeds and inserted directly into malignant tissue. 3 Thus, the concept of fractionation was developed and has been an essential part of clinical radiation ever since. In the 1920s, the French investigators Henri Coutard, MD, and Claude Regaud, MD, demonstrated that dividing the total dose into many smaller treatments delivered over several weeks could produce a cure without severe damage to normal tissue. The initial therapeutic radiation treatments that took place in the early 1900s used large single exposures that could eradicate a lesion but resulted in tissue necrosis. How did all this development occur in a little over 100 years?Ī disproportionate amount of the early development of the field took place in Europe. More than 3 million radiation therapy survivors are alive in America today, and the number will grow to 4 million by the end of this decade. Today, estimates are that more than 5,300 radiation oncologists are practicing in the United States, staffing about 2,300 facility sites. With external x-rays from a Roentgen apparatus and more powerful radiation emitted from radium, the field of therapeutic radiology was launched at the dawn of the 20th century. This substance was also quickly discovered to have biological effects, and physicians began using radium to treat cutaneous cancers with dramatically positive effects. This led to the discovery of a new element that she named radium in 1898. Polish-French physicist Marie Curie then set about to isolate the source of this radiation since the measured radioactivity of pitchblende far exceeded what could be produced by uranium alone. The second event was the discovery of naturally occurring radiation emitted by grains of uranium-containing salt (pitchblende) by French engineer Henri Becquerel. 2 A wave of clinical experimentation soon followed. In early 1896, a Chicago physician named Emile Grubbe claimed to have treated the chest wall of a woman with recurrent breast cancer. Skin erythema resulting from x-ray exposure was commonly seen. It did not take long for investigators to recognize the biological effects of radiation. Numerous labs were already working with cathode ray tubes and were easily able to replicate these x-ray experiments. What made this discovery particularly unique was the simplicity of the experimental apparatus. Roentgen’s wife was placed over the plate, the bones within the flesh could be observed in the image. The x-rays could not only expose a photographic plate, but when the hand of Dr. 1 These then-mysterious electromagnetic waves were emitted by passing an electric current from a cathode to an anode inside a vacuum tube. The first was the announcement in late 1895 of the discovery of x-rays by German physicist Wilhelm Conrad Roentgen. Two seminal events established the basis for the field known today as radiation oncology. In part 2, we will consider the many technological advances that have played a part in the field’s development and our evolving understanding of the biological concepts involved in the discipline. In part 1 of this two-part report, we trace the beginnings of radiation oncology in the United States and how it grew into the field we know today. Radiation therapy has long been one of the three pillars of cancer therapy-surgery, chemotherapy, and radiotherapy-only recently joined by what is widely considered a fourth pillar, immunotherapy.
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