Progress in Cancer Radiation
This timeline of advances in cancer radiation was developed by the American Society of Clinical Oncology (ASCO),
which represents nearly 30,000 physicians who treat people with cancer and research new cures. An interactive
version, which includes timelines of advances against a range of common cancers, is available online at
www.CancerProgress.Net.
Overview
Today’s advanced radiation therapy technologies allow treatment to be tailored to a patient’s precise tumor type,
size, and location to minimize the risk of damage to healthy tissue, improve survival, and minimize potentially
serious side-effects, such as lung scarring and heart damage.
While radiologists once drew up treatment plans with a wax pencil on X-ray films, they now construct intricate,
computerized treatment plans based on 3-D images of the tumor. This shift was made possible by advances in
imaging technology, from CT scans in the 1970s to more recent advances like MRI and combined CT and PET
scanning. Such advances have allowed doctors to use complex machines to vary both the shape and intensity of
radiation beams.
Meanwhile, one of the earliest radiation techniques, brachytherapy, has been refined for modern use. Involving
small radioactive sources temporarily or permanently implanted directly into tumors via remote-operated
equipment, the strategy offers effective treatment for prostate, cervical and other tumors.
Timeline
1903 First use of radiation to treat cancer
Five years after Marie Curie’s discovery of radium, doctors report the first successful of use of this
radioactive element to treat cancer, in two Russian patients with skin cancer. In the following decades,
radiation becomes widely used to treat many different cancers, including cervical, prostate, breast and
other tumors. In these first decades, doctors use an approach known as brachytherapy, in which small
pieces of radioactive material are implanted inside or next to tumors, delivering radiation to cancer
cells at close range. Brachytherapy remains an essential part of cancer treatment today, but has been
refined to more precisely target tumor cells while leaving healthy tissue unharmed.
1900-1950s Lymphoma
Radiation cures some patients with Hodgkin lymphoma
Early in the 20th century, doctors find that use of radiation therapy can cure some patients with
Hodgkin lymphoma, one of two major classes of lymphomas. When studies show that radiating larger
parts of the body improves cure rates, physicians begin increasing the size of the radiation fields
during therapy. In later decades, however, the long-term effects of radiation to the chest (including
cardiovascular disease and second cancers) are recognized, and efforts are taken to reduce radiation
exposure to healthy tissue.
Progress in Cancer Radiation
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Early 1970s Increased use of radioactive “seeds” to target prostate and other cancers
Studies suggest that an approach called brachytherapy extends the lives of patients with prostate
cancer, compared to surgical removal of the prostate and surrounding tissue. In this approach, tiny
radioactive sources or “seeds” are implanted directly into the prostate gland, delivering a high dose of
radiation directly to the tumor while leaving healthy tissue beyond the prostate relatively unaffected.
Brachytherapy has been used since the early 1900s, but became less common after the widespread
adoption of external beam radiation. With refined techniques and conclusive data on its effectiveness,
the approach once again becomes a central part of treatment for prostate, cervical and other cancers.
1975-1980 Brain Cancer
Radiation established as standard treatment for glioblastoma
Radiation therapy becomes a mainstay of treatment for glioblastoma, a highly aggressive form of
glioma, based on data showing it extends median survival from 3 months to about 9 months. This is
the first time a treatment is proven effective against any brain cancer. Today, radiotherapy is used
alone or with chemotherapy, both before and after surgery, and in patients with inoperable tumors.
1977 Breast Cancer
Many women can opt for breast-conserving surgery
Studies show that a procedure called lumpectomy – involving the removal of only the tumor, and not
the entire breast – followed by radiation therapy is as effective as mastectomy for women with earlystage
breast cancer. The finding helps dramatically reduce the physical and cosmetic side effects of
breast cancer treatment and enables women to recover more quickly after surgery and return to their
normal lives.
1981 Pancreatic Cancer
Chemotherapy plus radiation effective for patients who cannot be treated
surgically
Adding the chemotherapy drug 5-fluorouracil to standard radiation is shown to boost one-year survival
from 10 percent to 40 percent for patients with locally advanced inoperable pancreatic cancer (disease
that has spread to nearby tissues but cannot be surgically removed). The findings show the benefits of
combining different treatment approaches for this stage of disease.
Mid-1980s Brain Cancer
Gamma Knife therapy introduced for treating brain tumors
After nearly two decades of research, doctors begin using a non-invasive technique known as Gamma
Knife to treat certain brain tumors. Also called stereotactic radiosurgery, the approach utilizes precisely
focused radiation waves to disrupt cancer cell function and replication, while leaving the brain tissue
surrounding the tumor largely untouched. Gamma Knife may also be combined with other forms of
cancer therapy, including surgery. The approach continues to be refined today.
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1985 Pancreatic Cancer
Chemotherapy plus radiation effective as adjuvant therapy
For patients with earlier stage disease, giving a combination of the chemotherapy drug 5-fluorouracil
and radiation following surgery (referred to as adjuvant therapy) is shown to improve median survival
by nearly a year compared to surgery alone.
Early 1990s Shift to 3-D radiation treatment plans increases precision, safety of therapy
Thanks to the integration of powerful computers into medicine, doctors are able to dramatically
improve radiation therapy by creating 3-D treatment plans. These plans require highly complex
calculations and vastly more computing power than earlier, two-dimensional treatment plans. Thanks
to this advance, radiation can be targeted at tumors from multiple angles, with beams of varying
power, in ways that minimize the damage to healthy, surrounding tissue.
1990-1992 Lung Cancer
Combining chemotherapy and radiation prolongs survival for non-small cell lung
cancer
Two studies show that treatment programs involving both radiation and chemotherapy are more
effective than either approach alone for patients with “stage III” non-small cell lung cancer (including
patients with larger tumors that may or may not have limited spread within the lungs and in nearby
lymph nodes). This two-pronged treatment approach soon becomes the standard of care for this
disease.
1993 Lung Cancer
Simultaneous radiation and chemotherapy boosts survival for small cell lung
cancer
Researchers demonstrate that starting radiation therapy together with chemotherapy dramatically
improves the effectiveness of treatment for patients with early-stage small cell lung cancer, compared
to starting radiation later in the course of treatment. This new approach is found to significantly delay
cancer progression and improve survival.
Late 1990s New radiotherapy technique enables precise targeting of tumors near sensitive
tissue
Doctors begin using intensity modulated radiation therapy (IMRT), a highly advanced radiation
technique, to precisely target tumors that lie close to vital organs and other sensitive tissue that must
be protected from radiation. IMRT uses sophisticated software and complex new machinery to vary
both the shape and intensity of radiation. One of the clearest benefits has been in the treatment of
head and neck cancers; IMRT allows doctors to minimize radiation exposure to the spinal cord, optic
nerve and salivary glands, reducing side effects without compromising tumor control.
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1999 Cervical Cancer
NCI recommends chemotherapy-radiation combination for invasive cervical cancer
The National Cancer Institute issues an alert recommending that physicians consider adding
chemotherapy to radiation therapy for women being treated for invasive cervical cancer (cancer that
has spread within the cervix or pelvis). This updated approach is based on several randomized trials
showing that women lived longer when treated with both radiation and chemotherapy, compared to
those treated with the prior standard of radiation or surgery alone.
1999 Lung Cancer
Cranial radiation reduces risk of small cell lung cancer spreading to the brain
Radiation to the head is proven to significantly cut the risk that small cell lung cancer will spread to the
brain, and thus improves survival. This result is initially shown in patients with earlier stage small cell
lung cancer, and is later also proven effective in patients with advanced disease, who have an even
higher risk of developing brain metastases.
1999 Lung Cancer
Simultaneous chemotherapy and radiation proven most effective for stage III nonsmall
cell lung cancer
Researchers find that giving chemotherapy and radiation during the same treatment period, an
approach known as concurrent chemoradiation, results in better survival for patients with stage III
non-small cell lung cancer (disease with limited spread in the lungs and surrounding tissue) than the
standard practice of waiting to give radiation therapy until after chemotherapy was completed. This
finding echoes similar findings reported for small cell lung cancer in earlier years.
1999 Lung Cancer
Giving radiation to the chest twice-daily increases survival for small cell lung
cancer
A study finds that twice-daily radiation to the chest, together with chemotherapy, prolongs survival
compared with once-daily radiation and chemotherapy in patients with small cell lung cancer that has
not spread. Investigators showed that 26 percent of patients in the twice-daily group survived at least
five years, compared with 16 percent in the once-daily group.
2004 Colorectal Cancer
Chemotherapy and radiation before surgery reduce side effects for rectal cancer
patients
Results from a large clinical study show that giving chemotherapy and radiation therapy before, rather
than after, rectal cancer surgery reduces the risk of local recurrence (cancer recurrence in the pelvis,
near the original tumor). Survival was similar in both approaches, but because the pre-surgery
treatment regimen was more tolerable, it is now the standard approach for treatment of rectal cancer.
Progress in Cancer Radiation
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2005 Prostate Cancer
High-dose radiation helps men avoid cancer recurrence
Studies find that men with localized prostate cancer who receive radiation treatment at a higher dose
than was traditionally provided are less likely to have their cancer recur than men who receive
conventional radiation. The high-dose approach is made possible by technological advances that allow
doctors to precisely target more radiation to the tumor, while sparing healthy tissue.
2006 Brain Cancer
Genetic mutations affect survival for oligodendroglioma
Two studies find that patients with oligodendroglioma tumors (a form of glioma) that lack certain
parts of chromosomes 1 and 19 are more sensitive to treatment and have better survival than patients
whose tumors are not missing this genetic material. Both studies also evaluated the benefit of adding
chemotherapy to standard radiation, finding that this approach caused significant side effects and did
not improve survival in the overall population.
2007 Breast Cancer
Shorter course of radiation therapy is as effective as less frequent radiation
therapy for early-stage breast cancer
Findings from the START Trial suggest that “hypofractionated” radiation therapy, which involves fewer
but larger doses of radiation delivered over a shorter period of time, is as effective as conventional
radiation for reducing the risk of cancer recurrence among women with early-stage breast cancer, and
does not cause greater damage to healthy breast tissue. Since traditional radiation therapy for breast
cancer can take five to six weeks to complete, this shorter course (as little as three weeks) is a more
convenient option for some patients and makes it easier to complete all cycles of treatment.
2009, 2010 Prostate Cancer
Radiation after surgery or hormone therapy improves survival
Findings from a long-running clinical trial show that radiation therapy after surgery (known as
adjuvant radiation) reduces the risk that prostate cancer will spread and increases survival time by
nearly 30 percent in men with early-stage disease. A separate study finds that adding external beam
radiation treatment to standard hormone therapy in prostate cancer that has spread to the
surrounding areas can reduce the risk of death by more than 40 percent.
http://www.cancerprogress.net/downloads/timelines/progress_in_cancer_radiation_timeline.pdf