Coutard was among the first to recognize that different cancer histologies and locations carried distinct probabilities for radiocurability. This occurred during a time when dosimetry was extremely crude and unreliable. His methodical nature and keen observational skills led him to customize treatment intensities based on the levels of radiotherapy-induced skin desquamation and oral mucositis. Using this strategy, he was able to cure patients with a variety of head and neck malignancies and to popularize this concept of fractionation in the international community ( 2, 13– 15). In the 1920s, Coutard applied the concept of fractionated XRT with treatment courses protracted over several weeks. Henri Coutard joined Regaud at the Radium Institute of Paris, where he operated a basement X-ray unit. The Standard Chemical Company began commercially marketing radium from Colorado mines by 1913, and this “wonder drug” subsequently found its way into many products and applications. By 1904, patients in New York were undergoing implantation of radium tubes directly into tumors, representing some of the first interstitial brachytherapy treatments. By 1902, radium had been used successfully treat a pharyngeal carcinoma in Vienna. The notion of using radioactive elements to treat cancer probably dates back to 1901, when Becquerel experienced a severe skin burn while accidentally carrying a tube of radium in his vest pocket for 14 continuous days. Shortly thereafter, Marie and Pierre Curie discovered radium and polonium their stories have been nicely chronicled ( 7– 9). Antoine-Henri Becquerel, a physics professor in Paris, was the first to recognize natural radioactivity while working with uranium salts. The field grew rapidly through the last years of the 19th century and into the first years of the 20th ( 3). Aside from famous cases such as these, however, most tumors around this time could not be cured without extensive normal tissue damage, given the low energies (and hence limited depths of penetration) of these early X-rays. The first deep-lying tumor to be eradicated by X-rays was probably a malignant sarcoma of the abdomen, treated over 1 1/2 years in New Haven by Clarence Skinner. Palliation of painful tumors was reported as early as 1900 ( 6). Thor Stenbeck and Tage Sjogen of Sweden reported successes with treating skin cancers by 1899. Émil Grubbé, a medical student in Chicago at the time, would later claim to have been the first to treat cancer patients with X-rays in 1896 ( 5). Only 7 months after Roentgen's discovery, however, a 1896 issue of the Medical Record described a patient with gastric carcinoma who had benefited from radiotherapy delivered by Victor Despeignes in France. The very earliest X-ray treatments were for benign conditions like eczema and lupus. The first therapeutic uses of X-rays in cancer quickly followed this initial discovery ( 3, 4). Bringing these laboratory discoveries and techniques to the clinic is the key challenge. There is now a tremendous body of knowledge about cancer biology and how radiation affects human tissue on the cellular level. The radiobiological discoveries over the past century have likewise been revolutionary. Perhaps the most important of these developments has been the paradigm of fractionated dose delivery, technologic advances in X-ray production and delivery, improvements in imaging and computer-based treatment planning, and evolving models that predict how cancers behave and how they should be approached therapeutically. These initial efforts stimulated a revolution of conceptual and technological innovations throughout the 20th century, forming the basis of the safe and effective therapies used today. The use of ionizing radiation for the treatment of cancer dates back to the late 19th century, remarkably soon after Roentgen described X-rays in 1895 and the use of brachytherapy after Marie and Pierre Curie discovered radium in 1898.
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