2361 - From the Archives: A Primary Source-Based Case Series of Early Radium Therapy (1922)

Purpose/Objective(s): Contemporary brachytherapy practice evolved out of radium therapy. Herein, a primary source-based case series from the early implementation of radium therapy at a single institution in the early 1920s is reviewed, illustrating early treatment indications and practice patterns. This case series is intended to contextualize current brachytherapy practice through a closer look at its early clinical implementation.

Materials/Methods: Institutional archives were reviewed for primary sources. Radium therapy was first made available at our institution when 100 mg of ²²⁶Ra (t=1600 years) was obtained in October 1921. Two memoranda detailing patients treated with radium therapy written for the Dean of the medical school were discovered. One memorandum dated May 20^th, 1922, provides details regarding patients treated by the general surgery and the urology services, and another undated but contemporaneous memorandum provides details regarding patients treated by the gynecology service.

Results: Together, the two memoranda from 1922 describe 60 patients who underwent radium therapy at a single institution in the first 7 months radium therapy was offered. Of these, 39 (65%) were treated by the general surgery service, 14 (23%) were treated by the gynecology service, and the remaining 7 (12%) were treated by the urology service. Patients received anywhere from one to eight treatments, with 41 (68%) patients receiving one or two treatments. Common indications described include basal cell carcinoma or “rodent ulcer” (10 cases, 17%) and cervical tumors (9 cases, 15%). While most patients were treated for malignant disease, 21 cases (35%) were for a benign indication, including 3 keloid cases (5%) and 6 papilloma cases of various kinds (10%). Several historic benign indications for radium therapy are also mentioned, including two patients treated for uterine fibroids (3%) and one patient treated for menorrhagia of puberty (2%).

Conclusion: This study describes rare primary source documentation of brachytherapy’s early clinical adoption at a single institution over a century ago. Many foundational elements of modern brachytherapy practice including multidisciplinary collaboration and fractionation were already present in its earliest clinical implementation. The routine treatment of benign conditions in this early cohort, later virtually abandoned and now more recently selectively revisited, illustrates how radiotherapeutic indications evolve in response to emerging evidence and long-term considerations. For contemporary clinicians, these cases offer a powerful lens through which to examine current debates surrounding indication expansion and appropriate use in brachytherapy and radiotherapy more broadly.