Rays of hope: our pioneering work on radiotherapy

1903

Our first successful use of radiotherapy

Most radiotherapy today uses x-rays, which the German physicist Wilhelm Röntgen discovered entirely by accident in 1895.

After a few weeks of experiments, he was able to use these unexplained rays, which seemed to pass through skin as easily as glass, to take a picture of the bones in his wife's left hand.

Anna Röntgen's ghostly fingers threw the world into a frenzy, but there was something the image left hidden. X-rays don't just pass through soft tissue. As doctors, researchers and entrepreneurs started using them for longer periods of time, they found nasty burns forming on their skin.

Then came the crucial connection. Looking down at their own hands - swollen and peeling from too much radiation - some researchers began to wonder if x-rays could burn away cancerous tissue, too.

It was an inspired idea. We would later learn that cancer cells are unusually vulnerable to the DNA damage caused by x-ray radiation. At first, though, x-rays only seemed to be capable of slowing some cancers down temporarily.

One of our parent organisations, the Imperial Cancer Research Fund (ICRF), helped show the way forward. 

Just two years after the ICRF was formed in 1901, its researchers found that aiming x-rays at a slow-growing type of skin cancer (basal cell carcinoma) led to complete healing in more than 6 out of 10 patients.  

The x-ray machines available at the time weren’t powerful enough to stop fast-growing cancers, or cancers deeper inside the body, but this study helped lay the foundation for external radiotherapy as it’s used today. 

1904

We prove that radium kills cancer cells

In 1898, Marie and Pierre Curie discovered another source of radiation: a mysterious, softly glowing metal they called radium. 

Unlike x-rays, which are essentially a super-powered form of light, you can put radium in your pocket. At least one scientist did. Within a few hours, it had given him an ulcer. 

Radium’s damaging effects come from its unstable atoms, which slowly and steadily fall apart, leaking radiation into their surroundings.  

When scientists realised this process could harm healthy tissue, they started wondering if they could turn it on cancer. Once again, the ICRF put the idea to the test. 

By closely monitoring how radium interacted with tumours in mice, ICRF researchers proved that the new material was able to stop some cancers growing. It even made a few cancers wither away completely. 

It would take decades before machines could produce x-rays powerful enough to compete. 

1920s

We help bring better radium treatments to the UK

So, for the first time in the history of cancer treatment, there was new hope. But there were also problems. Radium was incredibly hard to come by. At the start of the 1920s, a single gram cost $100,000 (US) – roughly £1.4m in today's money. 

Enter our other parent organisation, the British Empire Cancer Campaign (BECC).  

In 1923, the BECC introduced itself to the country by setting up a commission for buying radium and distributing it to hospitals. From there, the BECC’s doctors put a special focus on investigating how they could use it to treat cervical cancer. 

This internal radiotherapy approach, which involves putting sealed radiation sources directly into tumours, is called brachytherapy. The name comes from the Greek for ‘short’, as in ‘short distance radiotherapy’. 

In 1926, the ICRF also used brachytherapy (with needles of radium embedded in rubber sponges) to successfully treat mouth and stomach cancers. 

Encouraged by the results of our studies, in 1929, the Ministry of Health promised to match donations up to £100,000 to buy a large amount of radium for cancer treatment. Up stepped the British public. Within a matter of months, the BECC’s appeal had raised £150,000. 

1929

The ‘radium bomb’ makes radiotherapy safer and more targeted

Some of the newly purchased radium was delivered to the Westminster Hospital in London. There, our researchers set about fashioning it into a ‘radium bomb’. 

Despite its nickname, the radium teletherapy apparatus was actually designed to minimise damage. It worked by channelling radium radiation from a spreading cloud into a tight beam that could be directed at cancers from outside the body. 

The bomb made it possible to target external radiotherapy much more precisely. Its lead casing also kept doctors and nurses out of the firing line. 

The tools and techniques have changed, but the same design principles have been used in every radiotherapy machine since.   

Researchers kept rebuilding and refining the radium bomb throughout the 1930s.

In 1940, as actual bombs fell on London, the Ministry of Information sent a photographer to capture the country's most advanced radium apparatus in action.

1934

Manchester shows the way to treat cervical cancer

In radium, doctors finally had an effective tool for treating a range of different cancers. But, over 30 years of excitement, they still hadn’t fully agreed on how best to use it.  

Different doctors applied radiation sources in different configurations, giving different doses of radiation over different periods of time. 

A team of our researchers at the Holt Radium Institute in Manchester (now the Christie Hospital) changed that. 

First published in 1934, their radiation delivery system defined a clear and consistent way for doctors to use brachytherapy to treat women with cervical cancer. Unlike the dosing systems that had been tried previously, it was designed to work well across all body types.  

It took 50 years, and the arrival of computers, to improve on the ‘Manchester System’.  

Professor Ralston Paterson, who developed the system with Dr Herbert Parker, has since given his name to the Paterson building, home to the Cancer Research UK Manchester Institute. 

1939

A science of radiotherapy

Meanwhile, another of our researchers, Dr Louis Harold (‘Hal’) Gray, was putting the pieces together for something even bigger than a system – a whole new science. He’s now known as the father of radiobiology, the study of radiation’s impact on living cells.  

If you’ve ever received radiotherapy, you'll be more familiar with Hal Gray than you might think. Your treatment will have come in ‘Grays’ or Gys.  

Radiation doses are measured in Grays because, in 1939, Gray and his colleagues were the first people to standardise a way of measuring how radiation is actually absorbed by different parts of the body. 

1943

Radiotherapy's master mapmaker

But there was still a piece missing from the radiographer’s toolkit: a way of tracking how radiotherapy beams move through patients during treatment.  

The third of our early pioneers sorted that part. In 1943, Professor Valentine Mayneord and his team shared their full collection of isodose curves, which showed how the different beams available at the time deposited radiation in tissue.

Mayneord, a physicist, had been slowly piecing together the knowledge needed to produce the most accurate 2D isodose curves and 3D isodose surfaces since he first found a medical job in the 1920s.

Isodose images are a bit like maps, with their contour lines marking radiation dose instead of elevation. They make it much easier to guide the most powerful points of radiation beams away from healthy tissue and onto tumours.

Versions of Mayneord's elegant beam maps are still used to plan cancer treatment today. 

1953

We fund the world’s first radiobiology institute 

By the 1950s, Gray and his colleagues had taken radiobiology from a set of ideas into a science of healing. It just needed a home.   

With our funding, Gray was able to set up the world’s first radiobiology institute at Mount Vernon Hospital, London, in 1953. 

Using a new high-powered radiotherapy machine at Mount Vernon, Gray’s team continued his investigations into the oxygen effect, or the fact tumours with higher levels of oxygen in them are much more sensitive to radiotherapy. 

Later in the 1950s, researchers at the institute helped develop pulse radiolysis, which is now the main technique for investigating how radiotherapy damages the DNA in cancer cells. They also used it to identify the 'hydrated electron', one of the most important particles radiotherapy needs to generate to keep pressuring cancer cells over time. 

1960

We test some of the first modern radiotherapy schedules

By showing how cells react to radiation, radiobiology made it possible to work out the best ways of organising radiotherapy doses.  

In 1960, we launched an early randomised control trial to test a schedule designed to put tumours under as much strain as possible without causing too many side effects. The trial looked at ‘accelerated fractionation’, which cuts the gaps between radiotherapy doses to make it harder for cancer cells to recover or resist. 

Accelerated fractionation is central to the way we treat multiple types of cancer today - and randomised control trials are now the gold-standard for clinical research.

1961

Radiotherapy helps cut back on surgery

We're roughly halfway through our story.  

By the 1960s, radium had been replaced by artificial sources of radiation, which were much safer and easier to control.

X-rays were getting stronger than radium, too. In some hospitals, they were dozens of times more powerful than those used for our first treatments. 

Surgery was at risk of being left behind. 

Since the 1890s, most surgeons had treated breast cancer by completely removing the affected breast, along with as much of the surrounding tissue as possible. 

The emotional and physical side effects of this procedure could be devastating. As our understanding of cancer grew, people began to question whether it was always necessary. 

In 1961, we funded the world’s first trial to find out. Over the next decade, our researchers combined radiotherapy with surgery and found that just removing the tumour (lumpectomy) is as effective as removing the whole breast (radical mastectomy).  

Lumpectomy, or breast conserving surgery, is now the standard surgical treatment for early-stage breast cancer all around the world.  

The trials we’ve run since have confirmed that giving radiotherapy after surgery helps to kill any remaining cancer cells and stop the disease coming back.  

1970s

Bringing chemotherapy and radiotherapy together

Combinations of treatments were the way forward. 

Starting in the mid-1960s, doctors and researchers also found that they could make chemotherapy far more effective by combining multiple drugs, each with a slightly different way of killing cancer cells.  

The first big success for combination chemotherapy was in Hodgkin lymphoma, a cancer that starts in the blood. But solid tumours like lung cancer present a different challenge. They pack most of their cancer cells together in tight, defensive groups, where even combinations of chemotherapies can struggle to get to them. 

That’s where radiotherapy can help. Through the 1970s, our researchers ran a range of trials testing what's now called chemoradiotherapy. The technique combines the ability of chemotherapy to kill cancer cells as they spread through the body with powerful radiation aimed directly at the tumour. 

Many cancers are now treated with chemoradiotherapy, and we're still finding effective new combinations.  

In 2010, for example, the results of our ACT1 trial showed that combining radiotherapy with chemotherapy reduces deaths from anal cancer by a third. The treatment tested in the trial is now the standard treatment for anal cancer around the world.  

Similarly, in 2012, results from our trial of chemoradiotherapy for bladder cancer showed that it halves the risk of the disease returning. 

1989

A new type of beam

X-ray treatments expose cancers to quivering packets of light called photons. Since the late 1980s, we’ve also had a more specialised tool for the most delicate cases.  

Instead of using light, proton beam therapy pelts tumours with tiny particles pulled from the hearts of atoms.  

Photons are bubbly and excitable, steadily pouring out their energy until they’ve got no more to give. That means they can damage healthy cells on their path in and out of the body.  

Protons are much heavier. They release their energy in a sudden burst right when they stop. That means doctors can precisely target tumours with protons by firing them at different speeds.  

This approach is helpful for treating patients whose tumours are near sensitive parts of the body like the brain or spinal cord – especially in children, as their organs are still developing.  

In 1989, we paid for the world’s first hospital-based proton beam therapy machine, at Clatterbridge Cancer Centre in Liverpool. It produces a low energy proton beam specifically designed for treating rare eye cancers. 

1997

Radiotherapy gets personal

Of course, the type of radiation is only part one. Part two is how you use it.  

Today, more than half of the people who receive radiotherapy with the intent to cure their cancer (rather than to relieve symptoms) are given intensity modulated radiotherapy (IMRT).

IMRT is a personalised treatment that sculpts radiotherapy beams into specific shapes for each patient.  

It uses technology first developed in the 1970s and 80s to create 3D images of tumours and guide multiple beams together over the area of the tumour. By customising (or modulating) the intensity of individual beamlets in each beam, radiographers can then tighten and tweak that area to match the tumour’s exact shape. 

This helps minimise side effects by ensuring that the healthy cells around the tumour are exposed to much less radiation than the tumour itself. 

In 1997, we launched the world's first randomised trial of IMRT in breast cancer. Through the 2000s, we also used it to change how prostate cancer and a range of different head and neck cancers are treated. Now, our ongoing TORPEdO trial is even testing a version of intensity modulated proton beam therapy for oropharyngeal cancer. 

 1998

We start reducing the time radiotherapy takes

Over the 1980s and 90s, studies also began to suggest that it might be possible to cut the number of hospital trips and radiotherapy doses needed to keep early-stage breast cancer from coming back or growing again after surgery. 

Between 1998 and 2003, our two START trials proved we could cut radiotherapy treatment time from five weeks down to three, and from 50 Gys to 40, by giving fewer, stronger doses.  

As well as lowering the radiation’s effect on heathy tissue, the new fractionation plan saved women and the NHS time and money. It was recommended for use across the country in 2009. 

Starting in 2002, our CHHiP trial for prostate cancer combined this ‘less and more’ approach with IMRT. It has almost halved the number of radiotherapy doses needed to treat men with prostate cancer. 

2011

£300m to bring UK radiotherapy into the 21^st century 

We’re more than a century on from the UK’s first radiotherapy treatments. By this point, the cost of radium was no longer a concern. But the specialists and advanced machines needed to deliver truly modern radiotherapy also need funding. 

In 2011, we launched our A Voice for Radiotherapy campaign, calling on the Government to provide more advanced and targeted radiotherapy treatments to more patients. 

Our petition was signed by 36,000 people and helped secure a total of £300m in Government funding for radiotherapy services, starting with £23m for a Radiotherapy Innovation Fund. 

Our report on the fund’s impact led to a further £30m investment in 20 cutting-edge linear accelerators able to deliver the most advanced forms of standard radiotherapy and IMRT. 

After that, the Government invested £250m in two high-power proton beam therapy units in London and Manchester. They’ve been treating complex cancers, often in children and young people, since 2018. 

2019

A research network ready to take us further

We followed up on the Government’s commitment to advanced radiotherapy treatments by making our own commitment to advance them even further. Our radiation research network (RadNet) combines the strengths of seven universities and hospitals across the UK. 

Our initial £43m investment in Radnet has already led to sustained research into a new way of giving radiotherapy called FLASH. The name gives a sense of how it works. FLASH radiotherapy delivers very high radiation doses for less than a second at a time. Evidence so far suggests it could be a more effective way to control tumours with fewer side effects. 

In 2024, we committed a further £24m to RadNet, which is now a world-leading research initiative. 

The future

Over a million people in the UK have received radiotherapy over the past decade, either to treat their cancer or help them live with it.* Millions more cancer patients around the world benefit in the same way every year.

That might surprise Anna Röntgen. Back in 1895, she looked at her shadowy hand in the world's first x-ray and said: "I have seen my own death."

It’s thanks to 130 years of work that radiotherapy has become a treatment capable of supporting so much life.  

Right at the start of that journey, we helped lay the foundations that turned DNA-damaging radiation into a tool for good. Through all the years since, we’ve committed to understanding, targeting, cutting and combining radiotherapy – doing everything we can to make it kinder and more effective. 

In fact, just last year, our RAIDER trial showed another way that we can focus more radiation on tumours while keeping side effects down. As well as being 3D, this approach can be adapted over time, with the area covered by the beams altered to match the way our bodies might change between treatment sessions. 

It's a fitting finding to end on. Radiotherapy is old and radiotherapy is futuristic, but, most importantly, it's changing and adapting right now. We’re still working to make it the best treatment it can be for the people who need it.

*Statistics in this article are estimated based on Cancer Research UK analysis of England data for 2022/23.