History of the Oncology Department

The use of ionising radiation in the treatment of malignant and benign diseases in the Jihlava region dates back to 1928, when the surgical building was opened at the Jihlava hospital, with an X-ray station put into operation in its basement at the same time

After the Jihlava Region was established in 1949, a number of specialised departments were set up at the Jihlava hospital. One of them was the Radiology Department, which opened on 1 July 1950. Its first head was MUDr. Vladimír Malý, previously a physician at the Radiological Institute in Olomouc.

The department had a radiological (= diagnostic) section and a radiotherapy section. In the early 1950s the department was expanded to include an inpatient ward. Interestingly, from today's point of view, the reason why radiology required beds was the need to hospitalise patients with severe reactions after irradiation.

At first, the patients were cared for by the Sisters of Mercy of the Third Order of St Francis in Brno. In 1954–1955 they were replaced by civilian nursing staff. At the end of the 1950s the inpatient ward had 24 beds. Irradiation was carried out using Stabilivolt and Siemens bombe deep X-ray therapy units and a Siemens contact X-ray unit dating from the pre-war period.

Although the administrative structure of the state was reorganised in 1960 and the Jihlava hospital lost its status as a regional facility, this had no significant impact on the development of the Radiology Department. In 1959 building work began in the basement of the surgical building so that the first cobalt unit (the so-called cobalt bomb) could be installed there. The new Soviet-made GUT-400-2 unit was put into operation on 3 January 1961 and represented a significant qualitative change compared with the X-ray units used until then. Interestingly, this unit in Jihlava was the first to be installed in South Moravia, even earlier than in Brno at Žlutý Kopec. The possibilities of radiotherapy were further increased by the purchase of radium treatment equipment and the conversion of one of the basement rooms into a “radium” room with 2 beds.

The continuing increase in the incidence of cancer, the development of irradiation techniques, the introduction of new treatment procedures and, in particular, the rapid arrival of new anticancer drugs (cytostatics) in the treatment of cancer led to the increasing separation of the original unified radiology into radiodiagnostics and radiotherapy. On 1 February 1972 a separate Radiotherapy Department was established, headed by MUDr. Jan Štěpánek. The number of hospital beds gradually increased to 37, but their location in the existing premises was still provisional.

The opening of the new internal medicine building in the so-called New Hospital in 1983 meant an increase in the number of beds to 64 as well as greater comfort and privacy for patients. At the same time, however, the inpatient ward was separated from the irradiation unit, as radiotherapy continued to be provided in the completely unsuitable conditions of the basement of the surgical building in the Old Hospital, and hospitalised patients were brought there for irradiation by ambulance. Treatment planning was carried out in a way that would be considered primitive today: organs were drawn with the help of an anatomical atlas and isodose plans were put together by hand. Nevertheless, some quite unique techniques were performed in the irradiation rooms, such as intraoperative irradiation of bladder tumours or irradiation of bone metastases with high fractions of radiation. At the end of the 1970s the GUT cobalt unit was replaced by a more modern Chisostat from the Czechoslovak company Chirana, and at the same time the deep X-ray units were replaced by a Hungarian THX-250. Beam dosimetry and other measurements were initially carried out externally; it was only in 1982 that a part-time physicist was employed.

In 1986 the construction of new irradiation rooms within the New Hospital was completed and the official opening took place on 2 February 1987. This finally brought the inpatient ward together with the therapeutic and outpatient sections. By the standards of the Czechoslovakia of the time, the new complex brought together state-of-the-art irradiation equipment covering the full range of indications for radiotherapy. The irradiation rooms were gradually equipped with 2 new megavoltage radiation sources: a Chisobalt 2n-B-75 cobalt unit with a rotating gantry, and thus the possibility of rotational therapy, and an Ostron E-19L betatron accelerator, both of domestic origin. A Hungarian MFT 60 Medicor was purchased for contact X-ray therapy of superficial tumours. The department also received older equipment from the Radiotherapy Institute at Bulovka in Prague: a Siemens Stabilipan deep X-ray therapy unit, a Monopan contact X-ray unit from the same company and a Czech Chirasim simulator, used for treatment planning under standard conditions in the irradiation position. Brachytherapy was also performed in the irradiation rooms, using a continually replenished set of radium and later caesium) tubes and needles. For intracavitary applications the manual afterloading method was used, and patients were placed on 4 special “radium” beds for the duration of the application. Thanks to the growing use of computers in the 1980s, treatment planning could be carried out using the planning program developed by Ing. Mach. After a CT scanner was installed in the Radiodiagnostic Department in 1991, CT scans were increasingly used for planning as well, which made the planning process significantly more accurate and provided information on the dose distribution throughout the irradiated volume.

The Radiotherapy Department in Jihlava provided care to patients in a catchment area of approximately 500,000 inhabitants. This comprised the then districts of Jihlava, Žďár nad Sázavou and Třebíč and the border parts of the districts of Jindřichův Hradec (the Dačice area), Pelhřimov and Havlíčkův Brod. In addition to cytostatic and hormonal treatment, the department provided curative and palliative radiotherapy for all common types of malignant tumours in adult patients. Irradiation of benign diseases was also an integral part of its work.

In the early 1990s, rapid technological development and the emphasis on constantly improving the quality of radiotherapy caused increasing difficulties for most radiotherapy departments in the Czech Republic. It was clear that new equipment could only be acquired with state subsidies. Therefore, in 1994, at the initiative of the Ministry of Health of the Czech Republic, the professional Society of Radiation Oncology, Biology and Physics (SROBF) drew up a concept for the further development of the field. It was proposed that 11 selected departments be equipped with the necessary technology in 1994–1999 through direct subsidies from the state budget. These were departments in university hospitals and departments of a regional nature. One of them was the Radiotherapy Department (RTO) in Jihlava. However, in the case of Jihlava this plan was never carried out.

After the Atomic Act was passed in 1997, it was clear that the department could not continue to operate under the existing conditions. In August 2002 the betatron had to be shut down. In May 2003, by decision of the State Office for Nuclear Safety (SÚJB), operation of the cobalt unit was also terminated, which brought radiotherapy for cancer at the Jihlava hospital to a complete halt, and patients had to be transported for irradiation to the radiotherapy department in Havlíčkův Brod.

In July 2003, the management of Jihlava Hospital, with the consent of its founder, signed a contract with Amedis, s.r.o. for the provision of state-of-the-art Varian irradiation equipment under a lease. The new irradiation rooms were officially opened on 6 February 2004.

From 2014 the Oncology Department had 2 linear accelerators and a simulator from Varian, purchased from EU funds. The most recent major modernisation of the irradiation rooms took place in 2022, when 2 state-of-the-art Varian TrueBeam linear accelerators, a Bravos brachytherapy afterloader and a Siemens CT simulator were installed. The technical parameters of the equipment make it possible to perform very advanced irradiation techniques. These techniques make it possible to deliver a high dose of radiation to the tumour while significantly sparing the surrounding tissues and organs. Increasing the dose to the affected area also significantly increases the probability of complete destruction of the tumour and cure of the patient.

Ambulatory tract for providing systemic treatment, patient follow-up and multidisciplinary team meetings has been continually expanded owing to the growing number of patients and the introduction of new drugs, and has therefore been relocated, first from the irradiation complex to the 1st floor and then to the 4th floor of the internal medicine building of the Jihlava hospital. It currently comprises a follow-up outpatient clinic, a consultation clinic, 3 clinical oncology outpatient clinics and a chemotherapy day unit. The day unit has 2 treatment rooms with 1 bed and 9 chairs for outpatient administration of chemotherapy, biological therapy and immunotherapy. The chairs are equipped with stands with infusion pumps and syringe drivers. Until 2007, cytostatics were prepared and diluted within the department. Since June 2007, when the new pharmacy department was put into operation, drug preparation has been centralised. It currently takes place in the modern pharmacy facility, equipped with 2 isolators and air handling.

Inpatient department currently has 35 standard beds, and 2 internal medicine intensive care beds are reserved for oncology patients within the joint ICU.