Shortly after the extraordinary discovery of X-rays by Roentgen in 1895, radiation therapy was introduced [1]. During the early period of radiation treatment the methods were primitive; however, because of the development of unique devices, radiation therapy plays an important role in cancer treatment today. In the long history of radiation therapy, numerous treatment modalities have been proposed and tested; some are used in modern treatments, while others are not. Oxygen plays an important role in cell death by radiation [2]. Radiation biologists demonstrated that the existence of oxygen atoms during photon irradiation was essential to eradicate cells effectively. When the oxygen partial pressure is \2.5 mmHg, it is necessary to increase radiation by at least 2–3 times to achieve the same effects as in sufficiently oxygenated cells. Thomlinson and Gray [3] observed that tumor tissue 70–100 lm from capillaries showed necrosis. They concluded that tumor cells could proliferate only if they were close to a supply of oxygen. Between the actively proliferating cells and necrotic cells, there should be hypoxic but not dead cells; these cells are called chronically or diffusional hypoxic cells. Subsequently, Brown [4] determined that there were also hypoxic cells in actively growing tumors. The bloodstream in tumor vessels is temporarily blocked, because the vessels in such tumors are usually malformed; this phenomenon is called acute or perfusional hypoxia. To overcome the radio-resistance of these hypoxic cells, several methods, including hyperbaric oxygen, normobaric oxygen inhalation and administration of nitroazole hypoxic radiosensitizers, have been proposed. However, none of these methods are used in the clinic in Japan at this time. Many clinical trials to test the effect of these methods have been performed, but only a few showed positive results. Radiation therapy during respiration of hyperbaric oxygen is complicated and dangerous, because oxygen promotes rapid combustion/explosion. Overgaard [5] recently demonstrated in a meta-analysis that all of these 3 treatment modalities were significantly effective in clinical tests and that hyperbaric oxygen treatment was the most efficient among them. Ogawa et al. [6] review the newly developed and promising hyperbaric oxygen therapy in this issue. Their method is simple, safe and effective for overcoming radio-resistance of hypoxic cells. Hyperbaric oxygen therapy is also useful in the treatment of chronic radiation damage, such as osteomyelitis, cystitis, proctitis and central and peripheral nerve injuries. Unfortunately, this noninvasive therapy is not well known in Japan. Ogawa et al. [6] also demonstrate the effect and indications of the treatment in the same review. One of the first systematic and elegant treatment methods in radiation oncology was the mantle and inverted-Y field-radiation therapy for Hodgkin’s lymphoma, which was developed by Kaplan et al. [7]. Hodgkin’s lymphoma was a fatal disease in Europe and the US before the 1950s. In the early 20th century, Peters et al. developed systemic lymph node treatment for this disease and achieved good treatment results. By introducing a newly developed treatment machine, a linear accelerator (LINAC), into this field, Kaplan and colleagues created a systematic radiation technique, and this was a standard treatment for this lifethreatening disease until around 1990. After the discovery of X-rays and radioisotopes, many investigators died of radiation-induced malignancies. The K. Sasai (&) Department of Radiation Oncology, Juntendo University, Hongo 2-1-1, Bunkyo, Tokyo 113-8421, Japan e-mail: ksasai@juntendo.ac.jp
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