By Gustavo Montana, MD
In 2000, ASTRO established the History Committee for the purpose of documenting and recording the history of radiation oncology in the United States. The following interview of Gerald E. Hanks, MD, was conducted at ASTRO’s 43rd Annual Meeting in San Francisco by Gustavo Montana, MD.
Question: I’m very honored to be a member of the ASTRO History Committee and to have the opportunity to interview Gerald Hanks, MD. Dr. Hanks has been at the center of radiation oncology for many years, and has played a very important and prominent role in the development of our specialty. I should begin by asking where you were born, Gerry.
Dr. Hanks: I was born in Ellensburg, Wash., a town of 4,000 people. My dad was a livestock dealer who died when I was young. My mother had always encouraged my education and interest in medicine.
Question: Tell us about your education.
Dr. Hanks: I went to Washington State University on a basketball scholarship, and after three years moved on to Washington University School of Medicine in St. Louis. I interned in medicine at Yale, and returned to the West Coast to Stanford where I was their first radiation oncology resident and the first in the country trained under a National Cancer Institute program to promote training in the specialty. I completed my training in 1963.
Question: I understand your career has been divided into three distinct periods.
Dr. Hanks: Yes, that is true. My first career was the eight years after residency, which were spent in full-time academics, doing full-time and then part-time laboratory research and clinical care at the Radiological Defense Laboratory, Stanford Medical Center and the University of North Carolina.
The next phase was 14 years in private practice in Sacramento, where I got involved with Simon Kramer and the Patterns of Care Study, RTOG and organized clinical research and radiation oncology politics in ASTRO and ACR. My last career was a return to full-time academics in Philadelphia at the Fox Chase Cancer Center. During those 16 years, I participated in RTOG and institutional clinical research, pushed technology development, ran the Patterns of Care project, specialized in prostate cancer and developed a real love for patient care.
Question: Tell us more about the early days at Stanford.
Dr. Hanks: Stanford was an unbelievably stimulating department in the 60s. Henry Kaplan and Malcolm Bagshaw were on the forefront of clinical research, laboratory research and patient care in prostate cancer, Hodgkin’s disease, bladder cancer, ovarian cancer and others. I believe the inpatient clinical research center was the first of its kind. The Stanford model that was developed during the 60s was very effective at training residents. My lab interests were in stem cell kinetics and dose response in mouse lymphoma. My first paper in radiation oncology was published in Nature. In 1968, I assumed the directorship of a new division at the University of North Carolina. We brought a new view of lymphoma and prostate cancer management to the area and had many patients with gynecologic cancers, helping to initiate the GOG.
Question: Did you enjoy the time you spent in private practice?
Dr. Hanks: Private practice is what you make of it. We were able to make our practice somewhat academic by treating the patients from the University of California at Davis, by becoming full members of RTOG, by introducing IORT to the West Coast and IORT research to RTOG and by maintaining a residency training program. While in practice, I was President of ASTRO and played a major role in keeping ASTRO within ACR. I still believe that staying together was the correct decision at the time, and we gained far more than we gave. The new role and independence of ASTRO is appropriate for this new era when a stronger and financially solid ASTRO can do more on its own.
Question: Your return to full-time academics is unusual and has been a success. Tell us about that change.
Dr. Hanks: In 1985, I had the opportunity to return to academics at the University of Pennsylvania. My early publications and later work in the Patterns of Care Study gave me the academic credentials to move back into academics, and the move to Philadelphia gave me the opportunity to be with my wife, Barbara Fowble, who has made the last 18 years speed by.
The PCS began in 1971, and Simon Kramer asked me to direct the outcome studies. Radiation oncology was the first specialty to examine how the specialty was practiced on a national basis, and we were able to improve care as well as document the patterns of care and the changes in care. Simon became ill in the early 80s, and I directed the study from then until my retirement in 2001. Simon was an important mentor to me in the 70s and I am forever grateful.
Fox Chase Cancer Center is a wonderful place and gave me the freedom to follow my interests. The decade of the 90s was the most exciting time since the 60s in my judgment, pushed by computer enabled technology development that has revolutionized treatment. The conceptual return to basic principles of identifying the target and adjacent tissues in three dimensions and then treating with a combination of beams that maximize target dose and minimize dose to normal tissues has been at the heart of this change. Our group at Fox Chase was able to play an important role in this progress, installing the first commercial CT simulator, the first MRI simulator and conducting one of the first phase-two dose escalation studies.
Our studies have shown a 20 to 40 percent advantage to giving high doses compared to the standard 68 to 70 Gy. Conforming the beam has made morbidity of external beam treatment of prostate cancer trivial. In these phase-two studies, we can show a survival advantage to being treated with high dose, although it will take a random trial and 10 more years for many to believe this.
Lastly, during the last 16 years I have learned the joy of patient care and the great responsibility we accept when patients ask us to treat them. This joy of direct patient care and unlimited opportunity for clinical research is, for me, the essence of radiation oncology.
Question: Please give us your thoughts about the future of our specialty.
Dr. Hanks: Randomized trials will be more and more important in determining optimal treatment. RTOG is a terrific mechanism for these studies, and we should all be proud of their successes. The march of technology development will continue and cannot be stopped by HMOs or the federal government. Patients will continue to be educated and demand the most technically advanced treatment. Academicians and practitioners will have to keep up as new technologies are developed or fall behind and they see their patients go elsewhere. Ignore the organizational fragmentation of radiation oncology; this will be settled with time and an avoidance of duplication.
Question: On behalf of the Society and our committee, I really want to thank you for taking the time to speak with me today. I immensely appreciate your candid remarks and your words of wisdom.
Dr. Hanks: Well, Gus, thank you.