Mod 1

• Radiotherapy


  A treatment used for cancer and, less commonly, thyroid disease, blood disorders, and noncancerous growths
• Radiation therapy


  Delivering powerful waves of energy to disrupt the ability of cancer cells to grow and divide, killing cancer cells, slowing their growth, and shrinking tumors to enable surgery
• Radiotherapy is sometimes given with chemotherapy. This is called chemoradiation
• Discovery of x-ray by Wilhelm Conrad Roentgen


  1895
• Discovery of radioactivity by Antoine Henri Becquerel


  1896
• Serendipity


  Discovery by luck, intuition on the other hand is discovery as a fruit of extensive work/research
• Discovery of Radium and Polonium by Marie and Pierre Curie


  1898
• Nobel prize for Curie's and Becquerel

  1903
• Marie and Pierre Curie showed that Becquerel rays could be measured using ionizing techniques, and radiation intensity is directly proportional to the amount of uranium in a substance


  1898
• Marie Curie received the Nobel Prize in Chemistry


  1911
• Emil Grubbe, a medical student in Chicago, noted peeling of his hands on exposure to x-rays and used it to treat a woman named "Rose Lee" with recurrent carcinoma of the breast


  1896
• Claude Regaud argued the differential effect of x-rays on cancer and normal tissues could be best obtained by giving the treatment slowly


  1920-1930
• Regaud's Experiment

  Tried to sterilize sheep by irradiation of their testis, found that fractionated dose achieved sterilization without excessive damage to skin of scrotum
• Henri Coutard pioneered the use of fractionated radiotherapy in a wide variety of tumors


  1934
• Brachytherapy


  Close contact, stronger, uses radioactive seeds for prostate cancer, seeds are inserted inside the scrotum, patient with seeds implanted inside must avoid crowded area, half-life of I-131 is 8 days, 60-100 seeds are used
• Ralston Patterson was appointed as Director of the Holt Radium Institute and built a world recognised centre for the treatment of cancer by radiation


  1931
• Edith Paterson, part of Patterson's team, became a world-renowned pioneer in biological dosimetry, childhood cancers and anti-cancer drug treatment methods


  1938
• Herbert Parker developed the Manchester System for radium therapy at the Holt Radium institute


  1932
• Glenn T. Seaborg shared Nobel Prize in Chemistry with Edwin M. McMillan for discovery of transuranium elements


  1951
• Dr. Harold E. Johns


  A Canadian medical physicist who sent a request to the National Research Council (NRC) asking them to produce Cobalt-60 isotopes for use in a cobalt therapy unit
• Linear Accelerators (LINACS)


  High energy (megavoltage) treatment machines capable of producing high energy, deeply penetrating beams, allowing for the very first time treatment of tumors deep inside the body without excessive damage to the overlying skin and other normal tissues
• Dr. Henry Kaplan & physicist Edward Ginzton


  Developed the first medical linear accelerator at Stanford University, San Francisco in 1956
• Gordon Isaacs


  First patient to be treated using the medical linear accelerator, a 2 year old child with retinoblastoma. The treatment was highly successful and the patient remained free of disease with good vision for more than 40 years later
• In subsequent years, the field of Radiation Oncology experienced multiple technologic revolutions with the advent of computers and newer technological advances
• Ernest Rutherford


  Discovery of alpha and beta particles, proposal of radioactive decay & half life, received Nobel prize in Chemistry for "Disintegration theory" of elements
• Thor Stenbeck


  Cured BCC of Nose with 100 treatments over 9 months in Stockholm
• Tage Sjoegren


  Treated sq. cell epithelioma with 50 treatments over 30 months
• Elihu Thomson


  Burns from deliberate exposure of a finger to x-rays
• Edison's assistant


  Hair fell out & scalp became inflamed and ulcerated
• Mihran Kassabian


  Started work as radiographer in Cologne, held nervous patients & children with unprotected hands, controlled the degree of hardness of the x-ray tube by placing her hand behind of the screen, after 6 months strong flushing & swellings of hands, diagnosed with an x-ray cancer, some fingers amputated, then whole hand amputated, whole arm amputated, severed difficulties of breathing, extensive shadow on the left side of her thorax, large wound on her whole front- and- back side, died on October 22, 1916
• Sister Blandina


  Worked as radiographer in Cologne, died on October 22, 1916
• Emil Herman Grubbe


  Treated 50 woman with breast cancer with 18 daily 1 hour irradiation, condition was relieved but died shortly afterwards from metastases
• William Rollins


  Wrote that "X-light kills" and Codman EA wrote that "No practical danger from the x-ray"
• Early protective equipment

  • Lead glasses
  • Filters
  • Tube shielding
  • Early personal "dosemeters"
• With the advent of computers and newer technological advances, the radiotherapy planning systems underwent a drastic makeover
• 3D Conformal Radiotherapy


  A form of radiation therapy where the fields used are designed such that the radiation dose is mostly delivered to the tumor, while the surrounding tissues receive little to no radiation dose. It attempts to deliver a tumoricidal dose to the tumor while minimizing the damage to the surrounding healthy tissues. 3-dimensional information about the patient's body is supplied by the CT-simulations process.
• Intensity-Modulated Radiation Therapy (IMRT)


  An advanced form of three-dimensional conformal radiotherapy that uses sophisticated software and hardware to vary the shape and intensity of radiation delivered to different parts of the treatment area
• Image-Guided Radiation Therapy (IGRT)


  A rapidly growing technology in radiation therapy that uses new linear accelerators with both treatment and imaging machines
• Goals of Radiotherapy


  • High dose to tumor tissue-tumor control
  • Normal tissue sparing
  • Minimize long and short term toxicities
  • Better quality of life
• Typical Radiotherapy Treatment

  • Delivered 5 days per week over 6-8 weeks
  • Typical treatment takes around 5 minutes
  • Treatment is painless– like having an x-ray taken
  • No radioactive substances involved; beam goes on/off
  • Side effects usually temporary; controlled with medication/diet
  • Covered by Medicare and many other insurance companies