Advances in the radiotherapy of gynecologic malignancies.

Abstract

The use of radiation in the treatment of gynecologic malignancies dates back to the early years of the century. The particular anatomy of the vagina and uterus allowed early investigators to readily use primitive radiation sources in the therapy of cervical cancer. Margaret Abigail Cleaves, a New York electrotherapist, is credited with being one of the first to use radium to treat cervical cancer. In 1903, she described how she applied a sealed glass tube containing radium to an advanced cervix cancer [1]. Impressed by the result, she then developed a specially shaped x-ray tube with a long neck that could be used for transvaginal irradiation of the cervix [2]. The first intrauterine radium applicator was made by Wickham and Desgrais in Paris around 1908, and in 1909 Forsell in Stockholm reported on the treatment of 32 cervix cancer patients with silver tubes containing radium, coining the term brachytherapy for his treatment [3]. Over the next several decades, an understanding of anatomy and dose delivery allowed the development of standardized treatment systems at Stockholm, Paris, and Manchester. With advances in external beam equipment, it became possible to combine brachytherapy with external beam radiotherapy to optimize treatment. Technical advances in treatment planning and dose delivery equipment continue to be made at a rapid rate, the clinical benefits of which are being realized.