120 years — from Roentgen’s discovery to stereotactic radiosurgery

Abstract

This paper presents some details concerning the first few years after discovery of X-rays by Roentgen. Progress in radiotherapy during 120 years is discussed and illustrated by diagrams of milestones in the physics, technology and methods of radiation therapy. Discussion is focused on two topics: “physics versus biology” and “empirical radiotherapy versus clinical trials”. Evolution of radiotherapy has been based on the so-called “Paterson school” for the first 50 years which moved since 1968 into the “Fletcher school”. Rationale of this school was based on experimental and clinical radiobiology studies carried out in the 1950s–1970s, recognised almost all mechanisms of tumour and normal tissue response to radiation. For over 80 years, retrospective clinical studies and empirical experience have built up the fundamentals of modern radiotherapy and have served to design clinical trials. However, many “evidence based trials” provide some uncertainties and offer only average results as guidelines to treat individual patients. Trials are critically discussed based on the results of the selected studies with suggestions for careful interpretation based on logic and practical common sense. Studies of molecular biology and genetics clearly show that each tumour has own individual “fingerprint”, which moves all oncology including radiotherapy to individual personalised therapy. This is an important challenge for near future.