1940s radiotherapy

Radiotherapist and the cancer patient

In 1947 the BIR Presidential Address was given by D W Smithers from the Royal Cancer Hospital on the topic of the radiotherapist and the cancer patient (Smithers BJR 1947; 20(235): 261-268). He reviewed the current state of radiotherapy in the post-war world era and emphasised the placing of the patient’s interest at the centre of the work of the radiotherapist. Sir Stanford Cade gave the Skinner Lecture of the Faculty of Radiologists in 1948 and discussed the natural history of malignant disease (Cade BJR 1949; 22(258): 331-341). By the late 1940s malignant disease was the single most important cause of death. Cade states that “the increase in cancer of the lung is quite remarkable, both in total numbers and in the fact that it affects men only.”

Organ cancer incidence in relation to gender

 

 

 This was written before the association of lung cancer with cigarette smoking was appreciated and sadly lung cancer is now commonly seen in women.

Source: Cade BJR 1949; 22(258): 331-341

 

 

 

 

Ralston Paterson

The Cancer Act was passed in 1939 and its application was to have profound effects, which were reviewed by the radiotherapist Ralston Paterson from Manchester in (Paterson BJR 1942; 15(178): 297-301).  Paterson gave the Skinner Lecture to the Faculty of Radiology in 1941 (Paterson BJR 1941; 14(163): 219-234) on the subject of cancer of the bladder. The lecture is valuable and is beautifully illustrated.

Cytogram of bladder after injection of barium emulsion

Source: Paterson BJR 1941; 14(163): 219-234

He emphasised the need for radical treatment even in apparently early cases and discussed the increasing value of radiotherapy. Of particular interest is his emphasis on the need for the highest technical standards in treatment and of a  thorough training of junior radiotherapists. Paterson was President of the Faculty of Radiologists in 1943 and in his address “A Helping Hand” (Paterson BJR 1943; 16(191): 351-353) he considers the organisation of radiotherapy in the post-war environment.

Margaret Tod from the Holt Radium Institute in Manchester looked at the optimum radiation dose needed for radiation treatment for cancer of the cervix (Tod BJR 1941; 14(157): 23-29) in January 1941.

The need for biopsy prior to therapy was considered by Ff Roberts in April 1941 (Roberts BJR 1941; 14(160): 144-145) and his conclusion was that biopsy was often not needed. This is not the current practice.

B W Windeyer from the Middlesex Hospital gave the Skinner Lecture for 1943 and discussed malignant tumours of the upper jaw (Windeyer BJR 1943; 16(192); 362-366 and Windeyer BJR 1944; 17(193): 18-24).

 

 Image showing extension of cancer to base of skull

Image showing extension of cancer to base of skull. Source: Windeyer BJR 1944; 17(193): 18-24

 

Frank Ellis

Frank Ellis remained active in wartime writing on the estimation of volume doses in deep X-ray therapy in June (Ellis BJR 1942; 15 (174): 174-177) and July (Ellis BJR 1942; 15 (175): 194-201) 1942. Frank Ellis was interested in the importance of the total energy by tissues in radiotherapy. In these papers he correlated biological effects with the administered doses. He returned to the volume dose in radiotherapy in August 1945 (Ellis BJR 1945; 18(212): 240-246). In December 1942 he considered the tolerance dose in radiotherapy (Ellis BJR 1942; 15(180): 348-550). As Ellis said, “The question of deciding what is the best dose to use in X-ray therapy is as unsettled as some of the international problems with which we are faced today, but, by reasonable consideration, accurate observation and recording of reactions and results, and the free cooperation without recourse to violence which should be possible amongst radiotherapists, it should not be difficult to settle the radiological problems, even if words like insuperable are used on the international one.” 


In March 1944 Frank Ellis and Harold Miller described their use of wedge filters in Sheffield (Ellis and Miller BJR 1944; 17(195): 90-94). They used wedge filters to avoid irradiating normal tissues more than necessary.

Photo of wooden wedge, brass wedge and jig for beam direction

Source: Ellis and Miller BJR 1944; 17(195): 90-94

Frank Ellis contributed to a discussion on dose rate in November 1944 (Ellis BJR 1944; 17(203): 335-338). Ellis asked the questions: Is there a difference in biological effect corresponding to differences in dosage-rate? If there is a difference what, if any, are the critical values of dosage-rate above and below which the effects are different? How do the facts about the effects of variation of dosage-rate bear upon the practice of radiotherapy?


In 1948 Ellis was interested in the genetic effects of radiation (Ellis BJR 1948; 21(241): 1-4). It was apparent to Ellis that radiation caused damage to chromosomes, that these effects were cumulative and that the changes were almost entirely harmful and deleterious. These concerns of Ellis became more widespread in the 1950s and caused changes in clinical practices in both therapeutic and diagnostic uses of radiation. At that time Ellis was unclear as to how the effects that had been shown in experiments were applicable to humans.

In July 1942 N Finzi gave an interesting paper on the practical management of symptoms arising from radiotherapy dealing mainly with local reactions (Finzi BJR 1942; 15(175): 192-193).

 

Radium

In January 1941 the medical uses of radium were summarised in a report from the Medical Research Council and the British Empire Cancer Campaign (BJR 1941; 14(157): 1-10). In 1949 F G Spear from Cambridge gave the Silvanus Thompson Memorial Lecture and reviewed the work of the National Radium Commission (Spear BJR 1949; 22(263): 617-626) and gave a fascinating historical review.

J C Jones from the Middlesex Hospital reviewed the protection measurements for workers involved in the radium dial painting business in April 1945 (Jones and Day BJR 1945; 18(208): 126-131). Unfortunately many radium dial workers suffered from the effects of radium ingestion.

 Gamma ray test for radium in the body

Source: Jones and Day BJR 1945; 18(208): 126-131

 

Breast cancer

In 1940 the Skinner Lecture of the Faculty of Radiologists was delivered by E Rock Carling (Carling BJR 1940; 13(147): 73-81) and is an interesting discussion of the current clinical practice. In August 1941 Ff. Roberts from Cambridge (Roberts BJR 1941; 14(164): 269-274) wrote a thoughtful paper on the events that followed radical surgery and post-operative radiotherapy for breast cancer. A major concern was the dissemination of tumour outside the treated area. A major advanced occurred with the use of hormone treatment and in February 1944 George Binnie from Stoke-on-Trent described the regression of breast cancer treated with stilboestrol (Binnie BJR 1944; 17(194):42-45).

 

Benign disease

Radiotherapy for benign disease was commonly practiced in the 1940s. Inez ApThomas from the Holt Radium Institute described his experience with contact X-ray treatment for cavernous angiomata in children in February 1942 (ApThomas BJR 1942; 15(170): 43-47).

 Photo of X-ray treatment for cavernous angiomata in children

Source: ApThomas BJR 1942; 15(170): 43-47

This had replaced radium or radon treatment, which had become impractical since the start of the war in 1939. In October 1945 R McWhirter from Edinburgh described his technique for the treatment of ankylosing spondylitis using radiotherapy (McWhirter BJR 1945; 18(214): 302-305) and emphasised the value of early treatment. 

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