In the 19th century, science underwent a true revolution in which research was modernized, great discoveries were made and great scientific figures were consolidated. This led to the birth of a new era in medicine.
In 1895, Wilhelm Röntgen discovers X-rays; in 1986, Henry Becquerel did the same with natural radioactivity and, in 1898, Marie Curie discovered radium. Three milestones in a short space of time allowed research into radiation for the treatment of cancer to begin.
The first known treatment was given in 1896 by the American doctor Emil Grubbe, who administered X-rays for one hour over 18 days to a woman with recurrent and inoperable breast cancer.
Marie Curie was the pioneer
Without this great scientist, winner of two Nobel Prizes, the subsequent development of radiotherapy as a cancer treatment would not be understood.
Marie Curie, during her doctoral thesis, began to study X-rays, following in the footsteps of Henri Becquerel. Through her work, she discovered two new elements, polonium and radium, which she classified as radioactive, and which laid the foundations for the understanding of radioactivity.
Shortly afterwards, in the early 20th century, her husband, Pierre Curie, proposed that a radioactive source could be inserted into a tumour and found that the size of the tumour was reduced. At the same time, Alexander Graham-Bell, the inventor, also had the same idea and, in honour of the discoverer, asked to call the process "curietherapy", a name that stuck for years.
It was at this time that the medical use of radioactivity, both in diagnosis and treatment, was consolidated, when hospitals all over the world began to carry out research in this direction, laying the foundations for today's radiotherapy.
Aim: Cure cancer
On a trip to New York in 1920 to raise funds for further research (the price of radium had skyrocketed as a result of World War I), Marie Curie stated that her goal was to "put an end to cancer".
In 1934, Marie Curie died of aplastic anaemia, probably contracted from the radiation she was exposed to during her lifetime. The negative effects of radiation were not known at the time, and during her research and experiments, she did not use even minimal safety measures (it was said that she carried test tubes with radioactive isotopes in her pockets). She also exposed herself unprotected to X-rays while working as a radiologist in the so-called "Les Petites Curies" (mobile units that carried X-rays to the battlefields).
Aware of these dangers, the medical uses of radiation declined until the 1950s and 1960s, when new radioactive sources emerged that reduced the risks and revolutionized the field of cancer control. The Manhattan Project, developed during World War II, made possible the production of artificial radioisotopes for radiotherapy.
In the 1950s, cobalt therapy was developed, which was only used in areas where the tumour was not very deep to reduce its size before an operation. It was a treatment with cheap, robust, and easy-to-use machines, but the cobalt needed to be replaced every five years. It is clear that his contribution was key to the advance of radiotherapy, however, doubts about the residues and the appearance of new methods, such as the linear accelerator, the great discovery in this field in the second half of the 20th century, led to its disuse from the 1980s onwards.
Added to all this was the development of technology to obtain virtual images in three dimensions that allowed the volumes of the tumours to be treated to be observed and the doses applied to be better concentrated.
The great revolution of the 21st century, in terms of radiotherapy, is that technology has made it possible to administer much more effective and less aggressive treatments. The greatest advances have been seen in tumours that were in complex locations and which we did not want to give very high doses because of the risk of toxicity to adjacent structures. Today, with the different treatment techniques and the different types of treatments, large doses can be administered without generating effects on vital structures such as the heart, parts of the brain, abdomen, stomach, small intestine, optic nerves, etc.".
One of the areas in which radiotherapy still needs to improve has to do with patient perception. They still approach it with fear, especially of radiation. People have the concept that the old cobalt machines are still being used where the planning was not three-dimensional and this has been a thing of the past for a long time.
"Radiotherapy is a safe and technologically advanced treatment"
You can't compare the radiotherapy of the beginning with that of today. There has been a great evolution in all aspects, mobilization, technology, and how to treat a tumour that is moving because the patient is breathing and the machine can now follow the tumour in movement with a very small margin. In addition, the side effects of the treatment are reduced, and being more efficient in administering the treatment means that the patient has a better quality of life.
Although there is still a long way to go, access to radiotherapy treatment continues to improve worldwide. A field in which there is still much good news to be discovered.
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