History of Radiation Oncology

Dr. Raul Urtasun 

The Edmonton Cancer Clinic, Radiotherapy, under the Department of Health was located on the grounds of the University Hospital in a wooden building, which opened in 1941, it was located next to what at the time was the residents in training housing.  There were two British Radiation Oncologists treating patients with a Eldorado Cobalt 60 unit, a Cesium Teletherapy unit, a Picker 270 KV, Picker 120 KV units plus radium applicators for brachytherapy.  There was no simulator for treatment planning, they used fluoroscopy x-ray, taking films at right angles (orthogonal films) marking the patient’s skin with blue ink representing the treatment fields.  Dr. Usiskin was the medical physicist at the time.  There were no residents or medical students.  The two British Radiation Oncologists left town shortly before the cancer clinic moved in 1968-69 to the present building, named at that time the Dr. W. W. Cross Cancer Institute.  Dr. Marchand Tulloh went to Hanover, New Hampshire USA.  Dr. David McGowan was at the time the only Radiation Oncologist.  However, Dr. Walter C. MacKenzie, Dean of the University of Alberta Medical School, recruited Dr. James Pearson from Edinburgh, Scotland, an internationally well known Radiation Oncologist for his work on the definitive radiation in carcinoma of the esophagus.  He moved to Edmonton at the end of 1968 with a team of British radiation oncologists, among them, Patricia Burns, George Glazebrook and later on Alan Lees.  The equipment in the new building consisted of a Theratron Cobalt 60 rotating unit, a rotating Cesium unit and an orthovoltage deep x-ray unit.  Planning of treatment continued to be done using the x-ray films taken at orthogonal angles.  The films were then taken to the radiation oncologist’s office for approval.  During that time there were three Radiation Oncologists from Great Britain in Calgary, Drs. Priscilla Barnes and her husband, as also a Radiation Oncologist and Dr. Brown.  The new building in Edmonton had one entire floor for radiation therapy in-patient beds and Dr. Chuck Harley was the ward physician.  There were no Medical Oncologists in the building.  Dr. Adam Little, an adult hematologist and Dr. Gordon Selby, a pediatric hematologist, were doing all the cancer chemotherapy in Edmonton, Dr. Little, at the University Hospital and Dr. Selby at the Royal Alexandra Hospital.  Shortly thereafter Dr. Abdul Khaliq trained at that time as one of the few medical oncologists in Canada, at the Memorial Hospital in Buffalo, New York, arrived and a few years after Dr. Pierre Band, trained in Paris and also Memorial Hospital in Buffalo, New York, became the two medical oncologists in Edmonton.  The first 6MV linear accelerator was installed in 1968-1969.  A conventional simulator was installed shortly thereafter.

 

 

The first rotational x-ray simulator, a Picker unit, was commissioned in 1972.  Two 6 MeV linear accelerators were commissioned in 1978-79 and an 18 MeV electron and 15 MeV photon linear accelerators were commissioned in 1980 together with the first rotational simulator. 

 

Early in 1970 Dr. Walter C. MacKenzie recruited Dr. Neil McDonald for the position of Director of the Dr. W.W. Cross Cancer Institute.  He at the time was Associate Dean of the Medical School at McGill University, Montreal.  Also, in 1970, Dr. James Pearson recruited Dr. Raul Urtasun from the Montreal General Hospital and McGill University via Johns Hopkins Hospital to join the British team of radiation oncologists.  During the early 70s the laboratory research using animals with transplantable tumours, treated with radiation to assess the effect of radiation in areas of tumour hypoxia was done at the Surgical Medical Research Institute located at the old Dentistry School building on campus.  This research work was done by a radiation oncologist outside of clinical hours on evenings and weekends with the help of summer students.  In this particular building there was a vivarium with a full time veterinarian.  All the radiation oncologists had faculty appointments under the Department of Radiology at the University Hospital (Dr. Jack Miller was the chairman of the department).  Years later, Dr. Walter C. MacKenzie recruited both Dr. Don Chapman, a radiobiologist and Dr. Mac Paterson, a molecular biologist, in 1972.  Dr. Chapman was recruited from the Atomic Energy of Canada in Pinawa Manitoba.  Soon after Dr. Chapman recruited two other radiobiologists Dr. Cameron Koch and Dr. James Raleigh.  This team was successful in competing for funding grants from NCI Canada and NCI USA.  Their lab was located in the basement of the institute currently occupied by the operating room.  Their focus was on the use of chemical modifiers of radiation response.  Later on Dr. Allan Franko joined the group.  Dr. Paterson’s laboratory was established on the fourth floor.  He recruited Dr. Rufus Day and Micheal Weinfeld.  All the full time laboratory researchers were on “hard money”, salary paid by the Provincial Cancer Hospital Board. 

 

Since 1975 the patient load in radiation therapy increased at the rate of 9.5% per annum, while the research activity and funding increased at 21% per annum. 

 

During the 1970s and early 80s the radiobiology group lead by Dr. Don Chapman, established a strong collaborative research work with the Gray Laboratory in the UK where Dr. Chapman did his postdoctoral work.  The radiobiology group at CCI became an internationally, well respected group for their work on radiosensitizers.  During the early 1980s, Dr. Chapman established strong collaborative work on practice radiation with the Lawrence Berkeley Laboratory in California working under Professor Tobias.  Raul Urtasun joined this group in Berkeley, California during the mid 80s on three sabbatical leaves.  During one of R. Urtasun’s sabbaticals, he was a temporary member of staff of the Department of Radiation Oncology at UCSF, courtesy of Dr. Ted Phillips.  He was collaborating with the Department of Neurosurgery (Neuro-Oncology under Dr. Victor Levin) treating malignant gliomas on research protocols with patients from UCSF San Francisco Medical Centre, treating them with high LET Neon beam at the Lawrence Berkeley synchrotron facility.  It was at that time during the 1980s that the exciting era of computer radiation planning started at that facility working with George Chan, Joe Castro, Ted Phillips and Michael Goitien and also developing a new concept on computer modeling of normal tissue complications and tumour tissue control probabilities by Dr. John T. Lyman.

 

The lab to bedside work with chemical modifiers of radiation became the focus of clinical research in Edmonton, becoming the first cancer centre in North America and second in the world to use chemical modifiers of radiation response in the clinic. 

 

Because of both the physical and geometric advantages as well as the biological advantage of heavy particle radiation, and in collaboration with the group from the Lawrence Berkeley Laboratory, the Government of Alberta funded the initial feasibility study for the design of a Medical Accelerator Research Institute in Alberta (MARIA Project).  It was aimed at producing proton and carbon ions.  The initial funding was one million in1980 Canadian dollars.  Unfortunately two years later there was an economic crisis in Alberta with falling oil prices and consequently the premier of Alberta, Mr. Lougheed, explained to the investigators at the Cross Cancer Institute, that the project was off.

 

From 1979 to 1980 the Department of Radiation Oncology had three full time research nurses supported by research grants from national agencies through individual investigators, as well as a part-time data manager.  Approximately 70 patients per year were accrued to clinical research protocols, for both RTOG and NCI(C).  It was felt at the time that three more research nurses and two data managers were needed, due to the workload of investigator driven phase I and II clinical radiobiological studies.  This did not materialize. 

 

During this period the Dr. W. W. Cross Cancer Institute was a full member of ECOG and RTOG.  It was the first Canadian institution to become a full member of RTOG.  Dr. Pierre Band, Dr. Abdul Khaliq, as well as Dr. Raul Urtasun, as a Radiation Oncologist were members of ECOG. 

 

The group of engineers and physicists working on the particle accelerator, MARIA Project, were housed in a trailer adjoining the institute’s building.  Another trailer was housing the group of research nurses doing clinical trials.  In 1982 the medical physics research program acquired the VAX computer and initiated digital imaging for computerized treatment planning and three-dimensional dosimetry.  During this time there were plans for the creation of a Clinical Research Unit (CRU)  for the Department of Radiation Oncology.

 

Socially during the 1980s, there were the famous soccer games being played on a natural grass fields, just across from the Cross Cancer Institute, (currently the underground parking lot) and the games were mainly Medical Oncology against Radiation Oncology teams.  There were also three-legged races, weekly TGIF parties in the nurses’ trailer and homemade tricycle races.

 

During this period there was an impact of radiation medicine/imaging at the Cross Cancer Institute in American scientific societies.  Dr. Brian Lentle, from Nuclear Medicine became President of RSNA, Dr. Tripaneni, a previous resident in-training in our Radiation Oncology Program became president of ASTRO, and most recently in the decade of  2000-2010 Dr. Sandy McEwan, became President of the Society of Nuclear Medicine and Dr. Matthew Parliament became President of CARO.