Biomedical Engineering Reference
In-Depth Information
Table 1.
Cancer timeline.
Date
Event
3000 BC
First recorded description
400 BC
Hippocrates describes six cancer types
1880
Successful radical mastectomy
1896
Oophorectomy for breast cancer
1898
Discovery of radium
1899
Discovery of X rays
1946
First publication on successful chemotherapy for cancer
1953
Double helical structure of DNA elucidated
1955
Successful use of combination chemotherapy
1999
First molecularly targeted therapy approved for use
2000
Human genome mapped
be conserved by minimising the destruction caused by surgery. Radiotherapy was
often used instead, and for some sites, effective adjuvant therapy with drugs was
used.
Radiotherapy has come a long way since the first patient with a nasal tumour was
treated in 1899 (only 1 year after the discovery of radium by Marie Curie). Although
radiobiology developed as a research discipline, its contributions to clinical practice
have been minimal. The rationale behind modern fractionated radiotherapy comes
as much out of empirical trial and error as it comes out of experimental results.
For certain areas of the body, radiotherapy is remarkably successful. Increased
sophistication in equipment coupled with dramatic strides in imaging, have led to
great precision in planning and execution of treatment. Critical normal tissues are
thus spared, and the dose to the tumour is increased (Table 1).
The sinking of the US battleship John B Harvey in Bari harbour by the Germans
in 1942 led to the development of effective chemotherapy. The warship was carrying
canisters of mustard gas for use in chemical warfare. When survivors developed leu-
copenia, Goodman and others in the US experimented with halogenated alkylamines
in patients with high white cell counts: lymphomas, leukaemias and Hodgkin's dis-
ease. Since the first publication in 1946, the field has blossomed to the point where
there are now over 200 drugs available in our global pharmacopoeia. But as in radio-
therapy, our clinical practice is mainly based on empiricism (Symonds, 2001). Most
of the currently used drugs are derived serendipitously from plants or fungi (taxol,
vincristine, doxorubicin), rather than from rational drug design. Although these
drugs were successfully used in combination for lymphoma, leukaemia, choriocar-
cinoma, testicular cancer and several childhood cancers, the results in metastatic
common solid tumours have been disappointing, as they have been shown to have
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