Radiotherapy in Manchester
The Manchester group made huge contributions to our understanding of cancer and to its treatment using radiotherapy.
Ralston Paterson reviewed the state of radiotherapy from 1925-1959 (Paterson BJR 1973; 46(550): 768-770) in a paper that is a fascinating account by one of the great names of radiotherapy.
By the 1930s there were radiologists who worked in therapy full time without practicing diagnostic radiology and this facilitated the development of radiotherapy based on sound scientific principles. In Manchester at the Holt Radium Institute and Christie Hospital there was a close cooperation between Ralston Peterson as the doctor and the medical physicist Herbert Parker. WJ Meredith gave the Silvanus Thompson Memorial Lecture in 1967 (Meredith BJR 1968; 41(481): 2-11) entitled “What Manchester thinks...” and celebrated the contributions of that great city starting with the work of Ernest (later Lord) Rutherford (GS BJR 1937; 10(119): 822-823). The work of the Holt Radium Institute is reviewed and there is an interesting photograph of its staff in 1938.
Image source: Meredith BJR 1968; 41(481): 2-11
Ralston Paterson examined how different tumours responded to radiotherapy in an interesting paper appearing in April 1933 (Paterson BJR 1933; 6(64): 218-233) when he classified tumours according to their response to radiotherapy. At that time the knowledge of the radio sensitivity of tumours was based only on experience and was purely empirical.
In October 1934 a two-part classic paper by Ralston Paterson and Herbert Parker (Paterson BJR 1934; 7(82): 592-612) (Parker BJR 1934; 7(82): 612-632) appeared defining a dosage system for gamma ray therapy. Paterson’s clinical insights about the treatment of uterine cervical cancer were combined with the mathematical and physics knowledge of Herbert Parker to develop the treatment system. Scientific dosimetry in relation to radium therapy depends on the measurement of dose and the determination of the optimum therapeutic dose. So the questions are: ‘How much radium is required?’ and ‘How must it be arranged?’ From these questions emerged the Manchester system for treatment with radium. There were other dosage regimens described in that period but the Manchester system was the one that was used most widely. In the Manchester system the radioactive sources are arranged so as to provide a uniform treatment field. In March 1935 Paterson considered the topic of dosage in radiation therapy (Paterson BJR 1935; 8(87): 155-162) and the problem of knowing exactly what dosage was being given.
In November 1935 HM Parker and Joan Honeyburne looked at radiation distribution in deep X-ray treatment (Parker and Honeyburne BJR 1935; 8(95): 684-696). The publication reproduced a series of isodose charts. The accurate charts could be possible because of an improvement in the stability of radiotherapy equipment and in the availability of accurate and reliable dosimeters.
Image source: Parker and Honeyburne BJR 1935; 8(95): 684-696
In August 1936 Ralston Paterson, HM Parker and FW Spiers (from Leeds) (Paterson, Parker and Spiers BJR 1936; 9(104): 487-508) described a dosage system for the cylindrical distribution of radium. Then in April 1938 Ralston Paterson made a detailed study of dosage around interstitial radium implants (Paterson and Parker BJR 1938; 11(124): 252-266) with a second part by HM Parker appearing in May 1938 (Parker BJR 1938; 11(125): 313-340). The applicators for superficial radium therapy were described by Ralston Paterson in July 1938 (Paterson and MacVicar BJR 1938; 11(127): 452-470).
There was a particular interest in the treatment of cancer of the cervix in Manchester. Margaret Tod reviewed the current position in March 1936 (Tod BJR 1936; 9(99):196-204) in an interesting paper. In September 1938 Bernard Sandler investigated the dosages received in various techniques used in the treatment of cervical cancer (Sandler BJR 1938; 11(129): 623-636). It was shown that the available vaginal space had an important effect on radium distribution. A method of calculating dosage was described. In December 1938 Margaret Tod and WJ Meredith published their dosage system for the treatment of cervical cancer (Tod and Meredith BJR 1938; 11(132): 809-824) based on the Paterson and Parker papers of 1934. This classic 1938 paper described the dosage system and the application of the dosage system to therapeutic technique and is beautifully written and well illustrated.
Image source: Tod and Meredith BJR 1938; 11(132): 809-824
Following the war, in February 1945, WJ Meredith and SK Stephenson published an additional distribution rule for cylindrical “volume” radium implants (Meredith and Stephenson BJR 1945; 18(206): 45-47). Then in the March they described how radiographs could be used to assist in dosage control in interstitial treatments (Meredith and Stephenson BJR 1945; 18(207): 86-91).
In 1947 the highly influential book “Radium Dosage, The Manchester System” (E & S Livingstone) was published, edited by the physicist WJ Meredith. The book was basically a collection of the papers that had been published in the BJR since 1934 by Ralston Paterson, Herbert Parker, FW Spiers, SK Stevenson, Margaret Tod and WJ Meredith.