Radiation Medicine at the Cross Cancer Institute
Article written by:
Raul Urtasun MD, with contributions from J. Donald Chapman PhD, David McGowan MBChB, and Matthew Parliament MD.
Prior to 1965
The Alberta Provincial Health Department first listed cancer as a reportable disease in 1931. However cancer care was fragmentary and limited until the passage in 1940 of the first Cancer Treatment and Prevention Act. This gave the authority for the province of Alberta to establish dedicated cancer clinics in Edmonton and Calgary in 1941. In 1951, the Edmonton Cancer Clinic moved from the Provincial Building at 101A Avenue and 101A Street to the renovated space of the “old maternity wing” of the University of Alberta Hospital. This was next to the Residents-in-Training housing. In 1963, planning began for a new Edmonton Cancer Clinic on the campus, to accommodate all cancer services including research, with a complement of 76 inpatient beds.
The Edmonton Cancer Clinic, Radiotherapy, was staffed by 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. S. Usiskin was the medical physicist at the time. There were no residents or medical students. Dr. Ian Scott-Brown moved to the Calgary Cancer Clinic – a predecessor of the Tom Baker Cancer Centre - shortly before the Edmonton Cancer Clinic moved in 1968-69 to the present building, and was renamed the Dr. W. W. Cross Cancer Institute (CCI). Dr. Marchant Tulloh went to Dartmouth-Hitchcock Medical Centre in Hanover, New Hampshire USA. Dr. David G. McGowan was the only Radiation Oncologist at the CCI. However, Dr. Walter C. MacKenzie, Dean of the University of Alberta’s Faculty of Medicine, recruited Dr. James Pearson from Edinburgh, Scotland, an internationally recognized Radiation Oncologist for his work on the definitive use of 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 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 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. Scott-Brown. The new building in Edmonton had one entire floor for radiation therapy in-patient beds and Dr. Charles (“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 prescribing 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 - one of the few Medical Oncologists trained in Canada, at the Memorial Hospital in Buffalo, New York - arrived. A few years afterward, Dr. Pierre Band, trained in Paris and also Memorial Hospital in Buffalo, became the two Medical Oncologists in Edmonton. The first 6MV linear accelerator was installed in 1968-1969. A conventional fluoroscopic 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 CCI. At the time, Dr. McDonald 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-trained team of Radiation Oncologists. During the early ‘70s, 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 (chaired by Dr. Jack Miller). Dr. Walter C. MacKenzie recruited both Dr. J. Donald Chapman, a radiobiologist and Dr. Malcolm (“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 Michael 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 the group in Berkeley, California during the mid ‘80s on three sabbatical leaves. During one of Dr. Urtasun’s sabbaticals, he was made a visiting member of staff of the Department of Radiation Oncology at UCSF, courtesy of Dr. Ted Phillips. He collaborated with the Department of Neurosurgery (Neuro-Oncology under Dr. Victor Levin) treating malignant gliomas on research protocols with patients from UCSF Medical Centre, treating them with high LET neon particle beam at the Lawrence Berkeley Laboratory 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 Canadian (1980) dollars. Unfortunately two years later came an economic crisis in Alberta with falling resource revenues and consequently the premier of Alberta, Mr. Peter Lougheed, explained to the investigators at the Cross Cancer Institute, that the project was to be called 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 North American scientific societies. Dr. Brian Lentle, from Nuclear Medicine became President of Radiological Society of North America (RSNA), Dr. Prabhakar Tripuraneni, a previous resident in-training in our Radiation Oncology Program became President of the American Society for Therapeutic Radiology and Oncology (ASTRO) and also an ASTRO Gold Medallist. Most recently in the decade of 2000-2010, Dr. A.J.B. (Sandy) McEwan, became President of the Society of Nuclear Medicine. Finally, Dr. Robert Pearcey and Dr. Matthew Parliament became Presidents of the Canadian Association of Radiation Oncology.