125 years of head and neck radiotherapy: could organ-sparing radiotherapy of larynx cancer have prevented World War I?

Abstract

Purpose: We aim to recapitulate the rapid development of head and neck radiotherapy in the context of otorhinolaryngology (ORL) medicine starting 125 years ago. This is put into context with the unsuccessful treatment of the laryngeal cancer (LC) of the German emperor Frederick III and its historical consequences.

Methods: The three-step process consisted in the analysis of (1) historical sources of the development of ORL radiotherapy from the discovery of x‑rays and radioactivity until World War I, (2) course and treatment of Frederick's III LC, (3) political context with a special focus on the escalation towards World War I. Pertinent historical illustrations of technical developments of radiotherapy were summarized in a video.

Results: ORL radiotherapy initiated on 03 February 1896, only 65 days after the discovery of X‑rays. By 1914, organ-sparing LC radiotherapy was established with a predominance of curietherapy over roentgentherapy. Correct diagnosis of Frederick III's primarily radiocurable cT1a glottic LC was delayed by one year, which resulted in advancement to a fatal pT4 pN1 Mx tumour stage. Historically, his successor, William II, was assumed to have contributed to the causes of World War I.

Conclusion: ORL radiotherapy came only eight years late to treat Frederick III who might have impeded World War I. This illustrates the potential impact of modern curative radiotherapy on the future course of public life beyond the personal fate of the patient himself.

Keywords: Celebrity; Diagnosis; Glottic tumors; History; Primary therapy.

Fig. 1

a Drawing of an applicator for intracavitary treatment of larynx cancer with an x‑ray tube described: “Handle, shield, short-circuiting switch, and tube.” (From: Pusey and Caldwell [27]) b Brachytherapy applicator with radium as used by Delsaux [31] for cancer of the larynx and other head and neck tumours. (From: [32])

Fig. 2

Drawing of the primary examination in May 1887 revealing a left glottic tumour in the posterior third of Emperor Friedrich III by Morell Mackenzie as the cause of his persistent hoarseness. (From: Mackenzie [54])