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The Other Radiation Therapy
International Journal of
Radiation Oncology biology
physics
www.redjournal.org
HISTORY
The Other Radiation Therapy Jesse N. Aronowitz, MD Department of Radiation Oncology, University of Massachusetts Medical School, Worcester, Massachusetts Danish physician Niels Ryberg Finsen (1860-1904) explored the use of light in the treatment of dermatological disorders in the 1890s. Sunlight, especially the short wavelength portion of the spectrum, had previously been found to be “inimical to the development of bacteria” (1), and Finsen demonstrated that focused violet and ultraviolet (UV) rays could eradicate lesions of lupus vulgaris (cutaneous tuberculosis) (2). This chronic, progressive infection of the young was also called “wolf cancer,” because it disfigured the face of its victim. Finsen’s light was also applied in the management of other skin diseases, including cancer, with limited success. He was awarded the 1903 Nobel Prize in Physiology or Medicine “in recognition of his work on the treatment of diseases, and in particular the treatment of lupus vulgaris by means of concentrated light rays” (3). Finsen had introduced a new therapeutic modality, phototherapy. Large quartz lenses were initially used to focus solar rays on the lesions (unlike glass, quartz does not absorb UV light). As sunlight was unreliable in northern Europe, the UV-rich rays of the carbon-arc lamp were soon substituted (4) (Fig. 1). Water circulated between the planoconvex lenses in the barrel of the apparatus to absorb heat-bearing infra-red light while allowing passage of the therapeutic actinic rays (5). A course of therapy consisted of daily 1-hour sessions, extending over months. Finsen treated his first case of lupus vulgaris in November 1895; coincidentally, the same month that Ro¨ntgen discovered X rays. Ro¨ntgen’s rays were soon applied in a similar manner and found to be as effective but less “expensive and tedious” than application of UV light (6); x-ray irradiation soon replaced phototherapy in the management of skin cancer.
Reprint requests to: Dr Jesse N. Aronowitz, MD, Department of Radiation Oncology, University of Massachusetts Medical School, 55 Lake
Int J Radiation Oncol Biol Phys, Vol. 93, No. 2, pp. 227e228, 2015 0360-3016/$ - see front matter Ó 2015 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.ijrobp.2015.04.041
Fig. 1. The Finsen-Reyn lamp, consisting of the arc light source, focusing ‘rock crystal’ lenses, and cooling water flow. Hemoglobin was found to obstruct the passage of UV light through tissue, so lens ‘A’ was pressed firmly against the skin to render it relatively bloodless. The arc lamp required a large current, so up to four patients were treated concurrently from the same light source, as an economy measure. Finsen, however, had firmly established the concept of fractionated treatment with invisible light. This image appeared in the 1907 text, Ro¨ntgen Rays and Electro-therapeutics, by Mihran Krikor Kassabian (18701910) (7). Kassabian, an Armenian immigrant to Philadelphia, was a pioneer in radiology and radiation therapy.
Ave N, Worcester, MA. Tel: (774) 442-5551; E-mail: jesse.aronowitz@ umassmemorial.org Conflict of interest: none.
228
Aronowitz
He contracted squamous cell carcinoma of his hands as a result of his enthusiastic use of unprotected fluoroscopy, and succumbed to metastatic disease (8).
References 1. Downes A, Blunt TP. Researches on the effect of light upon bacteria and other organisms. Proc R Soc Lond 1877;26:488-500. 2. Finsen NR. The treatment of lupus vulgaris by concentrated chemical rays. In: Phototherapy. London: Edward Arnold; 1901. p. 63-79.
International Journal of Radiation Oncology Biology Physics 3. Physiology or Medicine 1903dPresentation speech. Nobel Prize Organization. Available at: http://www.nobelprize.org/nobel_prizes/ medicine/laureates/1903/press.html; 2014. Accessed April 26 2015. 4. Bie V. Remarks on Finsen’s phototherapy. Br Med J 1899;2:825830. 5. Graham GH. The new Finsen-Reyn lamp. Lancet 1903;1903:449-450. 6. Montgomery FH. The present status of phototherapy. J Cutan Dis 1903;21:529-544. 7. Kassabian MK. Ro¨ntgen Rays and Electro-Therapeutics. Philadelphia: JB Lippincott; 1907. p. 515. 8. Brown P. American martyrs to science through the Roentgen rays. Springfield, IL: Charles C. Thomas; 1936. p. 86-99.
Radiation Oncology biology
physics
www.redjournal.org
HISTORY
The Other Radiation Therapy Jesse N. Aronowitz, MD Department of Radiation Oncology, University of Massachusetts Medical School, Worcester, Massachusetts Danish physician Niels Ryberg Finsen (1860-1904) explored the use of light in the treatment of dermatological disorders in the 1890s. Sunlight, especially the short wavelength portion of the spectrum, had previously been found to be “inimical to the development of bacteria” (1), and Finsen demonstrated that focused violet and ultraviolet (UV) rays could eradicate lesions of lupus vulgaris (cutaneous tuberculosis) (2). This chronic, progressive infection of the young was also called “wolf cancer,” because it disfigured the face of its victim. Finsen’s light was also applied in the management of other skin diseases, including cancer, with limited success. He was awarded the 1903 Nobel Prize in Physiology or Medicine “in recognition of his work on the treatment of diseases, and in particular the treatment of lupus vulgaris by means of concentrated light rays” (3). Finsen had introduced a new therapeutic modality, phototherapy. Large quartz lenses were initially used to focus solar rays on the lesions (unlike glass, quartz does not absorb UV light). As sunlight was unreliable in northern Europe, the UV-rich rays of the carbon-arc lamp were soon substituted (4) (Fig. 1). Water circulated between the planoconvex lenses in the barrel of the apparatus to absorb heat-bearing infra-red light while allowing passage of the therapeutic actinic rays (5). A course of therapy consisted of daily 1-hour sessions, extending over months. Finsen treated his first case of lupus vulgaris in November 1895; coincidentally, the same month that Ro¨ntgen discovered X rays. Ro¨ntgen’s rays were soon applied in a similar manner and found to be as effective but less “expensive and tedious” than application of UV light (6); x-ray irradiation soon replaced phototherapy in the management of skin cancer.
Reprint requests to: Dr Jesse N. Aronowitz, MD, Department of Radiation Oncology, University of Massachusetts Medical School, 55 Lake
Int J Radiation Oncol Biol Phys, Vol. 93, No. 2, pp. 227e228, 2015 0360-3016/$ - see front matter Ó 2015 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.ijrobp.2015.04.041
Fig. 1. The Finsen-Reyn lamp, consisting of the arc light source, focusing ‘rock crystal’ lenses, and cooling water flow. Hemoglobin was found to obstruct the passage of UV light through tissue, so lens ‘A’ was pressed firmly against the skin to render it relatively bloodless. The arc lamp required a large current, so up to four patients were treated concurrently from the same light source, as an economy measure. Finsen, however, had firmly established the concept of fractionated treatment with invisible light. This image appeared in the 1907 text, Ro¨ntgen Rays and Electro-therapeutics, by Mihran Krikor Kassabian (18701910) (7). Kassabian, an Armenian immigrant to Philadelphia, was a pioneer in radiology and radiation therapy.
Ave N, Worcester, MA. Tel: (774) 442-5551; E-mail: jesse.aronowitz@ umassmemorial.org Conflict of interest: none.
228
Aronowitz
He contracted squamous cell carcinoma of his hands as a result of his enthusiastic use of unprotected fluoroscopy, and succumbed to metastatic disease (8).
References 1. Downes A, Blunt TP. Researches on the effect of light upon bacteria and other organisms. Proc R Soc Lond 1877;26:488-500. 2. Finsen NR. The treatment of lupus vulgaris by concentrated chemical rays. In: Phototherapy. London: Edward Arnold; 1901. p. 63-79.
International Journal of Radiation Oncology Biology Physics 3. Physiology or Medicine 1903dPresentation speech. Nobel Prize Organization. Available at: http://www.nobelprize.org/nobel_prizes/ medicine/laureates/1903/press.html; 2014. Accessed April 26 2015. 4. Bie V. Remarks on Finsen’s phototherapy. Br Med J 1899;2:825830. 5. Graham GH. The new Finsen-Reyn lamp. Lancet 1903;1903:449-450. 6. Montgomery FH. The present status of phototherapy. J Cutan Dis 1903;21:529-544. 7. Kassabian MK. Ro¨ntgen Rays and Electro-Therapeutics. Philadelphia: JB Lippincott; 1907. p. 515. 8. Brown P. American martyrs to science through the Roentgen rays. Springfield, IL: Charles C. Thomas; 1936. p. 86-99.