Priority for radium therapy of benign conditions and cancer.

In medicine, assigning priorities for original ideas and for first implementation of a new type of treatment or technology-radium afterloading, for example-is often difficult. This situation is certainly true for radium therapy, with conflicting claims coming from France, Germany, and the United States about who first implemented it. Moreover, if possible, a distinction must be made between the person who had the idea for a therapy and the person who actually implemented it. These people are not always one and the same. Difficulties in assigning priority also sometimes arise from the lack of a published claim in a medical journal, and extant photographic evidence is typically almost impossible to find some 100 years after the event. The present article tries to solve the problems of priority regarding those who were really responsible for the ideas and implementation of radium therapy, including the technique of afterloading.

Pierre curie, 1859-1906.

The year 2006 marked 100 years since the death of Pierre Curie. It is therefore appropriate that we remember his life and his work, which was cut short by his untimely death from an accident on the Pont Neuf, Paris, on April 19, 1906. He had already accomplished much during his life, both before the discovery of radium with Marie Curie, in work co-authored with his brother Jacques on piezoelectricity, and afterwards, when he published the results of several experimental studies with radium and radon. He came from a medical family, and his grandfather Pierre Curie was a famous homeopathic physician. He has, in print, unfairly been relegated to the background-his own scientific contributions having been overtaken by the fame of Marie Curie, probably because she outlived him by 28 years.

Methodology to predict long-term cancer survival from short-term data using Tobacco Cancer Risk and Absolute Cancer Cure models.

Three parametric statistical models have been fully validated for cancer of the larynx for the prediction of long-term 15, 20 and 25 year cancer-specific survival fractions when short-term follow-up data was available for just 1-2 years after the end of treatment of the last patient. In all groups of cases the treatment period was only 5 years. Three disease stage groups were studied, T1N0, T2N0 and T3N0. The models are the Standard Lognormal (SLN) first proposed by Boag (1949 J. R. Stat. Soc. Series B 11 15-53) but only ever fully validated for cancer of the cervix, Mould and Boag (1975 Br. J. Cancer 32 529-50), and two new models which have been termed Tobacco Cancer Risk (TCR) and Absolute Cancer Cure (ACC). In each, the frequency distribution of survival times of defined groups of cancer deaths is lognormally distributed: larynx only (SLN), larynx and lung (TCR) and all cancers (ACC). All models each have three unknown parameters but it was possible to estimate a value for the lognormal parameter S a priori. By reduction to two unknown parameters the model stability has been improved. The material used to validate the methodology consisted of case histories of 965 patients, all treated during the period 1944-1968 by Dr Manuel Lederman of the Royal Marsden Hospital, London, with follow-up to 1988. This provided a follow-up range of 20-44 years and enabled predicted long-term survival fractions to be compared with the actual survival fractions, calculated by the Kaplan and Meier (1958 J. Am. Stat. Assoc. 53 457-82) method. The TCR and ACC models are better than the SLN model and for a maximum short-term follow-up of 6 years, the 20 and 25 year survival fractions could be predicted. Therefore the numbers of follow-up years saved are respectively 14 years and 19 years. Clinical trial results using the TCR and ACC models can thus be analysed much earlier than currently possible. Absolute cure from cancer was also studied, using not only the prediction models which incorporate a parameter for a statistically cured fraction of patients C(SLN), C(TCR) and C(ACC), but because of the long follow-up range of 20-44 years, also by complete life analysis. The survival experience of those who did not die of their original cancer of the larynx was compared to the expected survival experience of a population with the same age, birth cohort and sex structure. To date it has been generally assumed for early stage disease that although for some 5-10 years after treatment the survival experience of this patient subgroup might be no different from that expected in the matched group, thereafter the death rate of this subgroup becomes lower than that of the matched group. This implies that surviving cancer patients cured of their disease tend to die of other conditions at a higher than normal rate as they become older, and therefore cancer is never totally cured. Our conclusion is that at least for cancer of the glottic larynx, the answer to the question: 'Can cancer totally be cured?' is 'Yes to at least 15-years post-treatment and also probably to 25 years.'

Nasopharyngeal carcinoma: treatments and outcomes in the 20th century.

Nasopharyngeal carcinoma (NPC), although rare in Europe and North America, is not uncommon in parts of Asia such as southern China and Hong Kong. Consequently, very few oncologists in the Western world have extensive experience in treating this neoplasm. Treatment using external beam therapy and/or brachytherapy evolved greatly during the 20th century and is still evolving, particularly with the use of adjunctive chemotherapy regimes. Diagnosis of NPC has also improved with the availability of CT and MRI. This worldwide review is divided into historical, transitional and modern eras, with the latter concerning 1971-2000. Currently, the most controversial aspects of NPC are recommendations for treatment of recurrent disease and the role of chemotherapy in the overall framework of treatment. Comparison of results from different centres is not possible without an understanding of the various staging systems that are, and have been, used; a comparison is given in this review. In the future, early diagnosis, adequate radiation dose to the primary with boost to bulky disease, and regular follow-up with biopsy of any suspicious residual or recurrent disease, are likely to become key issues to improve outcome. Also, apart from direct/indirect nasopharyngoscopy, the role of follow-up CT needs to be studied for early detection of residual or recurrent disease. More clinical trials on chemo-radiation are also required, in order to study optimum doses and agents.

Marie and Pierre Curie and radium: history, mystery, and discovery.

Commencing with Marie Curie's early life in Poland and the discovery of radium in the rue l'Homond "shed" in Paris in 1898, this paper includes some little known facts. It ends with some unusual uses of and claims for radium, and finally, because Medical Physics is an American journal, details are included of Marie Curie's two visits to the USA.

A conformal index (COIN) to evaluate implant quality and dose specification in brachytherapy.

PURPOSE: To propose a new index (COIN) that can be easily understood and computed to assess high dose rate (HDR) brachytherapy interstitial implant quality and dose specification and is an improvement on existing indexes. METHODS AND MATERIALS: The COIN index is based on an extension of dose-volume histograms and employs an analogous concept to that of cost-benefit analysis, which has already been applied to quality-of-life assessments for two alternative treatment protocols. The COIN index calculation methodology is shown for two cases: with and without critical structures. An analysis is given of dose distributions for two planning treatment volumes (PTV) of simple geometrical shape, applying both the rules of the Paris system and that of the "Offenbach" system. 40 patients who have received interstitial implants form the clinical material. With current HDR brachytherapy technology both for dose delivery, using remote afterloaders, and for three-dimensional (3D) treatment planning, it is now possible to relatively easily plan conformal brachytherapy treatments that would have been impossible with manual afterloading techniques and two-dimensional (2D) treatment planning. RESULTS: Examples of the use of the COIN index are presented for experimental and clinical data. CONCLUSIONS: The results show that COIN is a useful and practical index to improve the quality of treatment of interstitial brachytherapy implants. Further work will be undertaken with a larger population of implanted cancer patients and a subdivision of the results by treatment site.

The discovery of radium in 1898 by Maria Sklodowska-Curie (1867-1934) and Pierre Curie (1859-1906) with commentary on their life and times.

This review celebrates the events of 100 years ago to the month of publication of this December 1998 issue of the British Journal of Radiology, when radium was discovered by the Curies. This followed the earlier discovery in November 1895 of X-rays by Röntgen, which has already been reviewed in the British Journal of Radiology [1] and the discovery in March 1896, by Becquerel, of the phenomenon of radioactivity, which introduces this review. This is particularly relevant as Marie Curie was in 1897 a research student in Becquerel's laboratory. Marie Curie's life in Poland prior to her 1891 departure for Paris is included in this review as are other aspects of her life and work such as her work in World War I with radiological ambulances (known as "Little Curies") on the battlefields of France and Belgium, early experiments with radium and the founding of the Institut du Radium in Paris and of the Radium Institute in Warsaw. Wherever possible I have included appropriate quotations in Marie Curie's own words [2-4] and each section is related in some way to the life and work of Maria or Pierre. This review is completed with details of the re-interment of the bodies of Pierre and Marie on 20 April 1995 in The Panthéon, Paris.

Thyroid cancer among "liquidators" of the Chernobyl accident.

In 1986, immediately after the Chernobyl accident, the USSR Ministry of Health adopted a large scale programme of establishing an All-Union Distributed Registry of persons affected by radiation due to the accident. The registry was based at the Medical Radiological Research Centre of the Russian Academy of Medical Sciences (MRRC RAMS). In 1992, when the USSR was dissolved, this registry database contained information on 659,000 persons, including 284,000 Chernobyl accident emergency workers ("liquidators"). Currently, the Russian National Medical Dosimetric Registry (RNMDR) contains data on 435,276 persons, including 167,862 liquidators. This paper reviews the data for 47 verified thyroid cancers in the liquidator subgroup of the RNMDR. Analyses show that there is an excess relative risk of thyroid cancer per Gy of 5.31 (95% confidence intervals 0.04 and 10.58) and an excess absolute risk of thyroid cancer per 10(4) person-years per Gy of 1.15 (95% confidence intervals 0.08 and 2.22).

Invited review: Röntgen and the discovery of X-rays.

This review celebrates the events of 100 years ago to the month of publication of this November 1995 issue of the British Journal of Radiology, when X-rays were discovered by Röntgen (8 November 1895) and he was working in his laboratory leading up to his 28 December 1895 communication "On a new kind of ray". Biographical details of Röntgen are given, together with his work in Würzburg before the discovery and popular and scientific opinion in the immediate months after the world first learned of the existence of X-rays. Some of Röntgen's apparatus is illustrated, accompanied by typical advertisements of 1896-1897. Where appropriate I have included information related to the UK, concerning, for example, Sir Arthur Schuster and Lord Kelvin; there is also a mention of the Röntgen Society, the forerunner of today's British Institute of Radiology.

The early history of x-ray diagnosis with emphasis on the contributions of physics 1895-1915.

The contribution of physics to the development of x-ray diagnosis was vital in the early years of this century following Röntgen's discovery of x-rays in November 1895. This review records some of the highlights during the period 1895-1915. Much of the information presented has been buried in libraries for more than 50 years and the selection of illustrations and text will be largely unknown to today's readership of Physics in Medicine and Biology. It is also a celebration of what could be achieved in physics before the occurrence of the technological revolution involving not only computer applications but also the disappearance of the small independent x-ray companies into today's multinational companies. Research and development is nowadays just too expensive for much independent practical high-technology contributions without financial backing. Hence this review takes us to those bygone years of experimental physics in home laboratories, poorly equipped university physics laboratories and of the lecture-demonstrations of the period. The sections are presented in a logical order beginning with the discovery of x-rays, followed by x-ray tube technology to the advent of the hot cathode Coolidge tube, with the third and final section covering diagnostic radiology physics. It has been compiled from personal research over 35 years in libraries worldwide, drawing on textbooks, journals, popular magazines, newspapers, x-ray company catalogues and museum exhibits. I have included a certain amount of anecdotal information, because after all, much of the early commentaries were indeed anecdotal--and make very interesting reading. Finally it is commented that although this review is devoted to x-ray diagnosis, x-ray therapy should not be forgotten, and readers are referred to another review by the author on early therapeutic advances.

Invited review: the early years of radiotherapy with emphasis on X-ray and radium apparatus.

Radiotherapy apparatus, both X-ray and radium, is reviewed for the first 4 decades of this century and the developments during this period are outlined, emphasizing the more important growth points. Radiation dose measurement units and radiation protection features of equipment are also included.