By Naomi Schechter, MD and Ron R. Allison, MD, FASTRO
The following interview of Helmuth Goepfert, MD, was conducted on July 15, 2019, by Naomi Schechter, MD and Ron R. Allison, MD, FASTRO.
Ron Allison: We have sort of an outline where we start with how you got into medical school and all that stuff, and then your residency and all the good things you’ve done since then. We sort of end up with your family and whatever you’d like to talk about. So where are you calling in from today?
Helmuth Goepfert: I’m calling in from my home in Bellaire, Texas.
Ron Allison: How long have you been there?
Helmuth Goepfert: Since 2007. Before that we lived in Sugar Land, a suburb of Houston.
I was born in Santiago, Chile in 1936. My education from 1st-12th grade was at a German school, where I spoke German, Spanish and later learned French. I graduated from the Medical School of the Universidad de Chile in 1962. My father, Dr.Juan Pablo Gopfert, was a general surgeon, and I decided to follow his path. I completed a one-year internship followed by two years of general surgery in Valdivia, Chile. My father also lived in Valdivia and was instrumental in my general surgery training.
In 1964 I was granted a fellowship at UCLA, Los Angeles, California, in the Department of Surgery under Dr. Longmire to learn the use of chemotherapy. At that time solid tumors were treated by surgeons,radiation oncologists or hematologists. After two years at UCLA, I was granted a two year fellowship at M.D. Anderson, Houston, Texas where I trained in regional chemotherapy under Dr. Richard Jesse, chairman of the Department of Head and Neck Surgery, for a year and in general surgery for a year.
In 1968, I returned with my first wife and two children to Chile to practice general surgery and treated adult and pediatric patients with cancer. In 1970, Salvador Allende was elected as the communist president in Chile. Fearful his government may close the borders, the best option for me and my family was to emigrate. Fortunately, that same year I was granted a visa to Germany. I spent six months in Stuttgart in a radiotherapy institute until the quota into the USA was granted. We returned to Houston in May, 1971 with a fellowship extension at M.D. Anderson under Dr. Richard Jesse, department chairman, while waiting for a residency opening in Otolaryngology/Head and Neck Surgery.
Dr. Bobby Alford was the chairman of the Department of Otolaryngology/Head and Neck Surgery at Baylor College of Medicine. He gave me a position as a resident in Otolaryngology/Head and Neck Surgery. The board of Otolaryngology reviewed my surgical experience in Chile and concluded I had sufficient training with only 2 years of surgical residency, which I completed in 1974.
A new medical school, The University of Texas at Houston Medical School opened and in 1974 I was appointed as the director of the Section of Otolaryngology in the Department of General Surgery. I was also interested in splitting my time 50-50 with M.D. Anderson. I was given a dual appointment at both The UT Medical School and M.D. Anderson.
Ron Allison: So you were doing cancer surgery for both places?
Helmuth Goepfert: Yes, I was. In 1979 my focus was the care of head and neck cancer patients. I resigned from the medical school and became a fulltime head and neck surgeon at M.D. Anderson.
I had the privilege to work as a research project investigator under Dr. Gilbert Fletcher, chairman of Radiation Therapy. He was masterful in teaching about the spread of cancer during morning conferences. Dr. Fletcher and I co-authored several book chapters together. Throughout my training I had exposure to countless learning opportunities not only in head and neck tumors.
In 1982, Dr. Jesse died of complications from a patient-acquired hepatitis. I was then appointed as Dr. Jesse’s successor and worked as chairman of the Department of Head and Neck Surgery for 22 years.
Ron Allison: Let me ask you. I’m sorry to interrupt. Were you doing implants, radioactive implants? Were you doing all those as part of your surgery?
Helmuth Goepfert: No. They were done by Dr. Fletcher and his team of radiotherapists- both head and neck implants as well as intracavitary GYN. Before clinic started in the morning, Dr. Fletcher would bring lots of questions and this began the teaching conferences that later developed into today’s multidisciplinary conferences at which pre-selected patients were presented and discussed. From this example, in 1982, the Head and Neck service implemented weekly multidisciplinary planning conferences that continue today.
Radiation therapy was used in combo with intra-arterial chemotherapy in advanced paranasal sinus cancers in 1980’s. In general, the three modalities- medical, radiation and surgical oncology all should work in parallel. At M.D. Anderson the Head and Neck Surgery Department is the initial triage service for head and neck tumors. The weekly planning conference allows the discussion of the three modalities to suggest a treatment plan for each patient. It’s my opinion, this multidisciplinary approach was one of the biggest advancements related to cancer management and many other specialities adopted a similar practice thereafter.
As Neurosurgery became a department it grew in its competence treating base of skull-related tumors.
Plastic surgery became a department and developed a substantial reconstructive expertise.
I also strongly encouraged- and what I think was an important contribution to the department and to the field was my early support of the physician-scientist. The original concept of the physician-scientist program was created by Dr. Emil Freireich, the renowned medical oncologist. When I became chairman, I implemented a similar approach and several of Head and Neck fellows were exposed to basic scientists and successfully continued in that path.
Ron Allison: Could we go back a little bit in time? So you were a spearhead of the larynx preservation.
Helmuth Goepfert: Yes
Ron Allison: That took a long time for the world to accept, particularly at even other surgical centers and oncology centers. Can you talk a little bit about some of the resistance that you experienced?
Helmuth Goepfert: I did encounter resistance from surgeons as well as radiation therapists. Both groups had difficulty accepting the protocol of 91-11 and this was the main reason the patient accrual was so protracted. In 10 years the study was completed.
At this point I also wish to mention that the delayed morbidity was not only associated with radiation therapy but with chemotherapy as well. Hopefully, we can continue to find better ways to address it. Its tough to have patients considered “cured” from a base of tongue cancer, only to see them with severe dysphagia or the need of a feeding tube ten years later.
I am also fascinated by the new field of immunotherapy that not only promises dramatic tumor changes, but brings a new set of complex side-effects that must be managed.
Ron Allison: Yes, we are sorry that happens. We don’t like it either. So did you ever have any formal training on radiation oncology?
Helmuth Goepfert: No.
Ron Allison: But you just learned it from the masters?
Helmuth Goepfert: Yes
Naomi Schechter: Dr. Goepfert, we had a question on the list. How did you maintain balance with such an active career and family life? There were so many lovely pictures of you with your family in the book, as well as colleagues. How did you balance that?
Helmuth Goepfert: I had four children with two marriages. Paul, my oldest, is a professor of medicine in Infectious Diseases at UAB, Birmingham, Alabama. Susana, is president and general manager for WVTM 13 in Birmingham, Alabama. I have two sons with my current wife, Joann. Eric was a child/adolescent psychiatrist at Tufts, Boston. We lost him to a glioblastoma at age 36 in March, 2018. The youngest, Ryan has followed me as a head and neck surgeon currently on the faculty at M.D. Anderson. I never influenced my children to choose a career path, but luckily, they all did well and are very close.
So, how did I balance life? I tried to separate work and home. I never woke up not wanting to go to work. I enjoyed and looked forward to going home and the same leaving home and driving to work. I never saw my children in the mornings, so it was a principle to be home by 7pm so that we could have a family dinner together and discuss the day. We enjoyed extended family vacations in the summers. One week’s vacation was not enough for my mind to unwind.
Naomi Schechter: I can see you treated people at work like your family. It was multi-disciplinary. Not just including medical oncology, radiation and surgery. We certainly felt your respect for radiation and appreciated that. We appreciate that you included us before there were discussions about what to do for the patient. So we had seen the patient ahead of time with you. But we also enjoyed the commitment to the nutrition, and diet, and the oral stents since there were so many different aspects to head and neck care that you made sure were all well-respected. And you’ve got support from all those different groups and the plastic surgery like you mentioned. You created a --
Helmuth Goepfert: Yes….it's come a long way.
Naomi Schechter: You brought up the feeding tube. I think I was well-trained at M.D. Anderson about managing the feeding tube. But I had worked at other places and I see other places. Sometimes patients really end up on them too long a time and it’s difficult to remove. But I think there's a healthy usage and then removal. So that timing I think is really key. Do you want to speak more to that for advice for the future?
Helmuth Goepfert: Yes. The use of the feeding tube is important. But those decisions still hinge on the multi-disciplinary approach- between the nutritionists, speech pathologists, dentists and others.
Ron Allison: But you’re a man ahead of your time, I will have to say that.
Helmuth Goepfert: Thank you. I think I had a pretty good career. I never really planned my life, but somehow I seemed to be in the right place at the right time.
Ron Allison: I think you made a gigantic difference to so many cancer patients and treatment centers around the world. I’m in awe of what you’ve accomplished and really been honored to be a part of this conversation. We’re coming towards the end of it. Thank you so much for your time. We should probably be able to get you a copy of this in the next few weeks. So it will be coming to you.
Naomi Schechter: It’s so nice to have this opportunity, Dr. Goepfert, so thank you for giving us the time.
Ron Allison: Yes, thank you very much.
Helmuth Goepfert: Thank you for doing this.
Acknowledgement: Special thanks to Stephen Grant, MD for his assistance with this interview.