History and Development of Brachytherapy

modified from HH Holm US in Med & Biol. 1998;20:779-91.,Sem Surg Onc 1997;13:431-37

Dating back to 1901, shortly after the discovery of radioactivity, Pierre Curie of France first suggested the use of radioactive isotopes to treat cancer. Around the same time Alexander Graham Bell made a similar suggestion in America which began the interest in refining the science within the medical community. Two early pioneers of brachytherapy, Henri-Alexandre Danlos of the Curie Institute in France and Robert Abbe of St. Luke's Memorial Hospital in New York tested the idea of shrinking tumors through exposure to radioactive materials. These early developments provided interest into the effects of radiation.

In the 1970's several medical centers used brachytherapy to treat prostate cancer. Radioactive sources were placed using an open surgical technique using a hand-placed method whereby the the surgeon would use a finger placed in the rectum to identify the approximate location of the tumor and place the radioactive material accordingly. Long-term follow up of these early cases often provided less than satisfactory results and cancer control could not always be predicted. It is now well understood that these outcomes were the result of 1) technical inability to accurately or precisely place seeds, 2) lack of adequate means by which to estimate the volume of the prostate and develop an effective dose.

Freehand Seed Insertion

Original technique of freehand seed insertion through an open abdominal incision was abandoned because seeds could not be placed uniformly.

During the late 80's and early 90's the invention of transrectal ultrasound emerged allowing for improved the evaluation of the prostate. This advancement directly addressed the need for improved volume estimates of the prostate gland. Combined with the developments of template guidance, or precise needle placement of radioactive sources, Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) these technical improvements addressed the issues of the early years and advanced brachytherapy as a viable treatment for prostate cancer.

Article highlights:

"New equipment for transrectal ultrasonomography has been developed... Transrectal ultrasonotomography is a promising new diagnostic technique that yields abundant information not available with former methods of examination. The procedure is likely to become one of the most important diagnostic tools in the field of urology." Transrectal ultrasonotomography of the prostate Watanabe H, Igari D, Tanahashi Y, Harada K, Saitoh M. J Urol. 1975 Nov;114(5):734-9.

  • Brachytherapy first suggested 1901 Pierre Curie
  • Intra urethral radium 1914 Pasteau and Degrais
  • Trans perineal radium needle implant 1917 Barringer
  • Ultrasound transducer with needle canal 1969 Kratochwil
  • Retropubic freehand seed placement 1972 Hilaris
  • Dynamic US scanning puncture 1974 Pederson & Holm
  • Transverse Ultrasound guided needles/prostate 1981 Holm
  • Sagittal Ultrasound guided needles/prostate 1981 Saitoh
  • Herlev technique ultrasound guided seeding 1983 Holm
  • USA introduction /advances 1984 Ragde Blasko Grimm
  • Intraoperative image registered treatment planning 1999 Burdette/CMS Image Guidance /Doggett
  • Prostascint image guided brachytherapy 2004 Doggett
  • Nerve-Sparing Brachytherapy 2004 Doggett