A Brief History of Brachytherapy - Subir Nag, MD
The word BRACHYTHERAPY is derived from the Greek word "brachios" meaning short and refers to the therapeutic use of encapsulated radionuclides within or close to a tumor. Henri Becquerel discovered natural radioactivity in 1896 when he found that Uranium produced a black spot on photographic plates that had not been exposed to sunlight. Two years later, Marie and Pierre Curie working in Becquerel's laboratory extracted Polonium from a ton of Uranium ore and later in the same year, extracted Radium. In 1901, Pierre Curie suggested to Danlos at St. Louis Hospital in Paris that a small radium tube be inserted into a tumor thus heralding the birth of brachytherapy. In 1903, Alexander Graham Bell made a similar suggestion, completely independently, in a letter to the Editor of Archives Roentgen Ray. It was found in these early experiences that inserting radioactive materials into tumors revealed that radiation caused cancers to shrink.
In the early twentieth century, major brachytherapy work was done at the Curie Institute in Paris and at Memorial Hospital in New York. Dr. Robert Abbe, the chief surgeon at St. Lukes Hospital of New York, placed tubes into tumor beds after resection, and later inserted removable Radium sources thus introducing the afterloading technique as early as 1905.
Dr. William Myers at Ohio State University developed several radioisotopes, including Gold-198, Cobalt-60, Iodine-125, and Phosphorus-32 for clinical brachytherapy. These were implanted surgically by Drs. Arthur James (surgeon) and Ulrich Henschke (radiation oncologist).
The advent of high voltage teletherapy for deeper tumors and the problems associated with radiation exposure from high-energy radionuclides led to a decline in the use of brachytherapy towards the middle of last century. However, over the past three decades, there has been renewed interest in the use of brachytherapy for a number of reasons. The discovery of man-made radioisotopes and remote afterloading techniques has reduced radiation exposure hazards. Newer imaging modalities (CT scan, magnetic resonance imaging, transrectal ultrasound) and sophisticated computerized treatment planning has helped to achieve increased positional accuracy and superior, optimized dose distribution. Finally, while brachytherapy was initially used only for treatment of cancer, it has now been found to be useful in non-malignant diseases (for example, in the prevention of vascular restenosis) as well. It is clear that brachytherapy is the optimum way of delivering conformal radiotherapy tailored to the shape of the tumor while sparing surrounding normal tissues.
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