Radiation oncology: An emergence as a discipline in Thailand

Abstract

It has been a century since Wilhelm Konrad Roentgen discovered the x-ray in 1895. Immediately after it was discovered, the Roentgen Ray was applied for diagnostic purposes in clinical medicine. In 1896, radioactivity was discovered and radium was discovered 2 years later in 1896. Radiation oncology began in Europe in 1898. The Roentgen ray was used in diagnostic clinical work in Thailand since 1928, when the first x-ray machine was installed in Siriraj Hospital by a radiologist, Dr. Pin Muangman, who was trained at Peterbent Brigham Hospital, Harvard University. In 1935, one superficial x-ray machine, lo-15 KeV, and one deep x-ray machine, 230 KeV, were installed, and three doctors, two nurses, and one technician worked in the X-Ray Department. These three doctors were locally trained on the job by the only trained radiologist mentioned above (11, 17). A radiologist at that time mostly worked in the diagnostic side of the clinical work, especially in chest and bone diagnosis. The therapeutic applications of x-rays were mostly confined to the skin diseases. The superficial x-ray was used for eczema, which proved to be resistant to medical treatment. Warts or hyperkeratosis that were recurrent after surgical or electrocautery treatment were referred for xray treatment. Radiotherapy given by deep x-ray machines was confined to palliative or postoperative treatment after a second operation for a local recurrence of cancer cases. The untoward effects of x-rays, such as radiation sickness and painful moist desquamation of the skin, were well known to the public and other medical colleagues. In 1938, Dr. Amnuey Smerasuta was granted a scholarship to study a course of Diploma in Medical Radiology and Electrology in Cambridge and returned to work in the Department of Radiology in 1940. He introduced radium therappy into Thailand. For superficial lesions, he used radium plaques for the treatment of warts, hyperkeratosis, and small hemangiomas, especially in children. For interstitial radium therapy, he used radium needles for carcinoma of the lips, tongue, and buccal mucosa. For treatment of carcinoma of the cervix, he used radium tubes sitting in the intrauterine tandem and radium needles filled in the two boxes for treating each side of the parametrium. The radium applicator for treating the parametria was introduced into the fomices and was called the butterfly applicator. It consisted of a central holding handle and two boxes of radium needles on each side of the central handle. The distances between the two boxes were adjustable by screwing at the central holding handle (11, 17). The intracavitary radium applicator used in Thailand at that time was a modification of the Stockholm techniques. The dosimetry was recorded in mg h. Radiation therapy was gradually accepted in the treatment of Stage I and early stage II of carcinoma of the cervix for curative treatment and Stages III and IV for palliative treatment. Supplemental external radiation to the parametria was given by the deep x-ray 400 KeV. or convergent beam therapy 220 KeV (4, 15). A joint consultation clinic between gynecologists and radiologists (so-called at that time) was created to decide the staging of the diseases jointly. The Stage I carcinoma cervix cases were treated mostly by the Wertheim’s operation. Only the patients who refused surgery or those who had medical contraindications to surgery were referred to be treated by intracavitary radium. In the Department of Surgery, patients who had carcinoma of the lower lip, tongue, and buccal mucosa were referred for interstitial radium followed by radical neck dissection of the regional lymph nodes. In 1951, Dr. Roj Suwansuthi received a scholarship from the Instituted of International Education for postgraduate study in the U.S. and was trained at the Memorial Sloan-Kettering Cancer Center, New York and Peterbent Brigham Hospital, Harvard University. He was the first M.D. from Thailand to receive the diploma of the American Board of Radiology. When he came back to Thailand he was appointed the head of the radiotherapy division and did a lot to improve the standard of radiation therapy in Thailand, especially for external radiation. In 1953, teleradium was introduced into the Army Hospital and at the same time nuclear medicine was intro-