Tuesday, April 8, 2014

Historical Contribution: HH Young, Interstitial Radiotherapy, 1917


Interstitial Radiotherapy:  The use of radium and the punch operation in desperate cases of enlarged prostate.  Young H.H.  Ann Surg. 1917;65:633-41.

The idea of brachytherapy, or inserting radioactive implants directly into tissue, was first proposed by Pierre Curie in 1901.  Intraurethral radium was used by Pasteau and Degrais in 1914 and the first prostate brachytherapy was administered transperineally in 1917 by Barringer.

In the same year, 1917, at Johns Hopkins Hospital, Hugh Hampton Young reported a series of patients treated with radium needles implanted transperineally, transrectally, and transurethrally.[1]  In the manuscript featured in this entry, Dr. Young "determined to attempt to cause atrophy of the prostate and shrinking of the intravesical lobes by simple means-radium and fulguration-and the history will show that this was remarkably successful."

He noted "a remarkaible shrinking of the hypertrophied gland, with the peculiar tissue changes ... but also without complete relief of obstruction, which generally has remained unchanged, so that radium alone is apparently not a cure for prostatic hypertrophy."  Therefore Dr. Young coupled the radiation treatments with his "punch" procedure to treat his patients.  While radiation treatment fell out of favor for the treatment of benign prostatic diseases, Young astutely predicted that
"in radium we undoubtedly have a therapeutic agent of great value in urology and with improved apparatus... many brilliant results should be obtainable."

In addition to those observations, take note of the scientific precision with which Dr. Young administered the radium, the devices he created to administer the doses safely and diligence with which he recorded clinical outcomes.

Read the entire manuscript here.

[1] Young HH, Fronz W (1917) Some new methods in the treatment of carcinoma of the lower genitourinary tract with radium. J Urol 1: 505–536

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