Radiation Oncology; the years of maturity

As it was discussed in last month's post several doctors led the early developments of Radiation Oncology. The ones listed below led the specialty to maturity.

Frank Ellis (1905-2006) was a world leader in the field of Radiation Oncology.  He studied medicine at the University of Sheffield in England.  In 1943 he became the director of Radiation Therapy's department at Royal London Hospital.  Ellis was the President of the British Institute of Radiology and remained active until his passing at the age of 100.

Gilbert Fletcher (1911-1992) was born and educated in Paris.  He was a polymath and in addition to his medical degree, he had several others such as in Greek and Latin languages, Engineering and Physics.  He did a fellowship at Royal Cancer Hospital in London.  He was recruited to head the department of Radiology at M.D. Anderson hospital in Houston.  Dr. Fletcher practiced both diagnostic and therapeutic radiology something common in that era.  He rejected the prevailing opinion that large tumors should receive a lower radiation dose. He was instrumental in the designing of first Cobalt-60 unit and pioneered the high energy beam units such as the Betatron and the Linear accelerator. 

Herman Suit (1929-2022) was born in Waco Texas and got his MD degree from Baylor Medical School.  He got a PhD in Radiation Oncology at the University of Oxford where he studied the effect of Radiation on the cellularity of bone marrow.  Upon his return to the US he went to the National Cancer Institute to soon move to M.D. Anderson hospital in Houston.  It was at M.D. Anderson that under the tutorship of Dr. Fletcher he established the treatment of soft tissue sarcomas with radiation therapy and conservative therapy instead of amputation.  He also developed the Fletcher-Suit applicator for intra-cavitary radiation of women with cervical and/or endometrial cancer. In 1970, he became Professor at Harvard and Head of  Radiation Medicine at Massachusetts General Hospital in Boston.  Dr. Suit's lifetime achievements cannot be overstated regarding his studies of the response of tumors and normal tissues to radiation therapy.  He used his wide radiobiological and clinical knowledge to advance the safe and successful use of radiation therapy whether through fractionation, radiation doses based on tumor size or integration of radiation therapy with surgery and chemotherapy. 

Ellis, Fletcher, Suit and many others created the specialty of Radiation Oncology as we known it today.

This post is dedicated to the late Drs Edwin Liebner Chief of Radiation Therapy and Virginia Patterson Chief of Nuclear Medicine who offered me a position in the University of Illinois residency in 1971.  Also to the late Dr. Vlastimil Capek the Chairman of the Department who took me under his wing and was a second father to me.

Radiation Oncology, the early years

Radiation oncology is the medical specialty focused in the treatment of patients with cancer using ionizing radiation.  Before a treatment is initiated patients undergo imaging (CT, MRI, PET scans) to map out the location, size and shape of the tumors. Radiation oncologists then determine the appropriate dose and angles of radiation beams to maximize tumor control while minimizing damage to adjacent healthy tissues.

Radiation is delivered either with Linear Accelerators (LINACs) or with Proton Beam Therapy (PBT), brachytherapy with specialized applicators or with radioactive isotopes such as Iodine-131 for thyroid cancer. 

Diagnostic Radiology, Radiation Oncology and Nuclear Medicine were practiced for many decades as distinct divisions of departments called Radiology.  All three are now operated as separate departments and their residents upon the completion of their training take separate boards.  The individuals listed below are pioneers who advanced the field of Radiation Oncology and made it a distinct specialty.

Leopold Freund (1868-1943) a Viennese physician founded Radiation therapy 100 years ago.  He provided the first scientific proof of the biological effectiveness of ionizing radiation when he treated a 5-year-old girl with a huge nevus pigmentosus on her back with x-rays.  

Victor Despeines (1866-1937) treated a patient with stomach cancer with radiation therapy in July 1896.  He was also the first physician who published a radiation therapy paper in 1896, one year after publication of the discovery of x-rays by Wilhelm Röntgen.

Emil Grubbe(1875-1960) was likely the first American to use x-ray therapy in the treatment a 55-year-old woman suffering from inoperable recurrent breast cancer. 

Radiation Oncology is a dynamic field that plays a vital role in the multidisciplinary approach in the treatment of patients with cancer.

This post is dedicated to Reinhard Gahbauer MD who established the Radiation Oncology Division at James Cancer Hospital.  I met Dr. Gahbauer during my tenure as Radiology Chairman.  Dr. Gahbauer and his associates offered the most   advanced therapies to their patients.  His devotion to the wellbeing of his patients was recognized by all. I was fortunate that met and worked with him and for staying friends for many years after our retirement.

The Founder; Wilhelm Conrad Röntgen

Wilhelm Conrad Röntgen was born in 1845 in Germany.  When he was 3 years old, his family moved to the Netherlands.  He started his studies at the University of Utrecht and completed at Zurich's Polytechnic from which he graduated in 1869 with a PhD in mechanical engineering.

On November 8, 1895 while he was studying the passage of an electric current through a gas of extremely low pressure, the cathode ray tube, he discovered a new kind of rays, he called X-rays.  His discovery revolutionised the field of medicine and for his discovery was awarded the first Nobel Prize in Physics in 1901.  The first application in medicine was when he exposed his wife hand, on the same day, in the path of x-rays over a photographic plate and he observed after developing it, the image of his wife hand showing shadows of the bones and soft tissues of the hand and of the ring she was wearing.  This was the first "röntgenogram" ever taken. 

In spite of the numerous honours, Röntgen was a modest, amiable and polite man who preferred working alone.  He built most of the apparatuses he used with great ingenuity and experimental skill.  His discovery created the specialty of Radiology (Diagnostic and Therapeutic) a sine qua non in the practice of modern medicine.