By David Hussey, MD, FASTRO, and Roger Robinson, MD
In 2002, ASTRO established the History Committee for the purpose of documenting and recording the history of radiation oncology in the United States. This interview took place at the Gilbert H. Fletcher Society meeting in Las Vegas on April 20, 2002.
Question: This is Dr. David Hussey and Dr. Roger Robison interviewing Dr. Luis Delclos at the Gilbert H. Fletcher Society meeting in Las Vegas on April 20, 2002. We’ll start by asking Dr. Delclos when and where he was born.
Dr. Delclos: I was born in Tarragona, Catalonia, Spain, in 1926, exactly at 2:00 in the morning on the 4th of March.
Question: What part of Spain is Tarragona?
Dr. Delclos: Tarragona is a Roman city that was the capital of the most important province of Rome in Spain, Tarraconensis [city of Tarraco]. It’s now a small city. When I left, it had only 40,000 people. When I was born, it had around 25,000 people, and now has about 120,000. It is the capital of the province of Tarragona in the Region of Catalonia, in the northeastern part of Spain.
Question: So that means you don’t speak regular Spanish, you speak Catalonian?
Dr. Delclos: Well, my mother tongue is Catalan. But in school we all learned Castilian, which is Spanish. So, we are bilingual.
Question: Are they quite a bit different?
Dr. Delclos: They are two Romanic languages, the combination of whatever the people spoke at that time and the influence of the Latin from Rome. So it is a romantic language, but Catalan is different than Castilian. In other words, if you don’t learn it, you can't speak it. Catalan is an old language that has been there for more than 1,000 years. And historically, that part of Spain, before Spain was Spain, was the kingdom of Aragon, county of Catalonia. At that time Spain was Leon, Asturias, Castilla and Galicia. The so-called reconquest of Spain was done by two different groups, the people from Asturias and the Catalonians who may be of the same background as the Franks, of Charlemagne.
Question: Can you go through your early years? What comprised your education? What did your folks do? Were they poor dirt farmers or part of the aristocracy?
Dr. Delclos: I have no blue blood at all. Many people think Delclos is a French name, but it is not. It’s a Catalan name. Because that part of France, Languedoc, was part of Spain at that time. And in the 1600s the kings decided to give that part of Spain to France and in return keep some other parts. The people were given the choice of staying or leaving, and some of the Delclos family stayed in the north of the Pyrenees and some moved to the south side of the Pyrenees. So although I was born in Tarragona, I am really a “man of the Pyrenees.”
My grandfather Delclos was a school teacher who came from a little village Masadet de Cabrenys on the border between France and Spain. That is one of my grandfathers, my father’s father, Delclos. The other grandfather, Luis Soler, which is another Catalan name, was from Tarragona. So one grandfather, Soler, was from Tarragona. The other, Delclos, was from the Pyrenees.
Some of the Delclos family moved across the Pyrenees from north to south, (Spain). The first one that moved was a tanner. Then there was someone who made chocolate, another was also a tanner. Finally, my grandfather Delclos and his brothers became school teachers. My grandfather Delclos then moved to Tarragona, marrying a lady from a city called Cardedeo near Barcelona. And in that branch of my family one of my ancestors became the rector or president of the University of Barcelona; he was a pharmacist.
Question: What did your father do? You are known for your inventiveness. Was he a gadgeteer or inventor, like you?
Dr. Delclos: Yes. My father was a physician with very good ideas. My mother’s father [my grandfather Soler] was also a physician, a general practitioner. And he was prominent locally in Tarragona, where he became president of everything that you can think of: the tourism society, the medical college, the Red Cross, everything that you can think of. He was a prominent general practitioner until the Spanish Civil War. When the Civil War started he had to disappear. He was the physician for the railroad, and some wanted to assassinate him. So he had to disappear. And so we all spent about two years in the mountains.
Question: Two years?
Dr. Delclos: Yes. We moved into the mountains. We were not hiding. My grandfather Soler did not work as a physician during that time. We were living very well, actually, on a farm. I learned lots of things about farming during that time.
Question: When was this?
Dr. Delclos: In 1937-1939.during the Spanish Civil War.
Question: Was this when Ernest Hemingway was in Spain?
Dr. Delclos: Yes. He was with the Republicans.
Question: Was your family on the other side?
Dr. Delclos: No. Actually, geographically, we were on the Republican side. My grandfather, Luis Soler, was a general practitioner and my father was his assistant, as physicians for the railroads. My father gradually became a self-made radiologist. He learned basic radiology during one of the wars between Spain and the Moors in Larache, Morrocco.
Question: Your father was a radiologist?
Dr. Delclos: He was a radiologist. Self-taught in radiology, like everybody else at that time. He was the first one in Tarragona to have an X-ray machine. He did both diagnosis and therapy.
Speaking of inventions, he invented a system to identify people by the X-rays of the frontal sinuses. He spent time in the museum of anthropology in Tarragona, which being a Roman city has a Roman museum. At the museum he X-rayed many skulls from the Romans over 2,000 years old. And he made a table of measurements of the frontal sinuses and showed that they were all different, unique.
For example, suppose they found the skull of Hitler and they took an X-ray of the frontal sinus; they would be able to recognize him provided there was a previous one for comparison. They couldn’t do that with other parts of the skeleton because they deteriorate. But the sinuses remain unchanged 2,000 years later. As a matter of fact, some years ago I read this paper that my father wrote for his doctoral thesis.
In Spain a physician is first licensed in medicine, and then later may get a doctorate like a Ph.D. To practice, you have only to be licensed, like in England (bachelor of medicine). And then you obtain a doctorate degree. He wrote his thesis in 1934-1935. And later he got an award for it in Valencia. But, you know, it’s ironic how things happen in Spain. He was Catalan, but he had to go to Madrid to do the doctorate, as that was the only place where one could get a doctorate. When he presented his work they said it’s beautiful but it’s a pity that you did not come to do this research in Madrid…! And he said, “Well, I had to make a living to support a family of three children, my wife and myself. I could not go to Madrid to do that.” That is how things were in Spain at that time!
Question: Did most radiation oncologists or radiologists in that era have formal training or were in apprenticeships?
Dr. Delclos: There was no formal training.
Question: So basically he wasn’t any different from anybody else in that regard.
Dr. Delclos: He was self-taught. He read books, mainly French. My father didn’t read any English, but he read French very well. He got his information mainly from France, as did everyone else in Spain.
Question: Do you remember when he got his doctorate?
Dr. Delclos: That was in 1935. He obtained his physician license in medicine in
1921. And then he waited more than 10 years to write the thesis paper and obtain his doctorate.
Another invention that he made is a colpostat. Yes, a colpostat. He was working with the Paris brachytherapy system where you used corks. He knew nothing about the Manchester system. I have that colpostat. It’s of historical value, too. And I have the paper that he wrote about the colpostat. He had a good brain and was multitalented! He was a painter also and made model boats. Unfortunately, he was a very heavy smoker, and he had been smoking since he was 11. He died from complications of smoking at the age of 55, while I was in training in Manchester and thus he died very young. He started developing intermittent Claudication at the age of 44.
Question: So, you knew when you went to Manchester that you were basically going to emulate your father?
Dr. Delclos: Yes. I have many physicians in the family. I am number seven, and then after me there are several others. I have two kids who are physicians and cousins as well. I went into medicine because my father thought that I was supposed to be a physician. I really wanted to be a naval engineer and build boats. And then a little bit later I wanted to be an architect. I always liked these kinds of things. But my father convinced me that I should be a physician. So, I finally decided to study medicine.
Question: Do you have siblings who went to medical school?
Dr. Delclos: No. I have two sisters. While my father was sick, it was a very difficult time for us. I was the only one that could go to Barcelona to study at the university. My two sisters studied locally and became school teachers. But there was no money in the family because my father was sick for 10 years. I started medicine in 1944, and he was sick from then on. So we were in very bad shape economically all these years. Even for me to study in Barcelona was very difficult.
Question: Was it lung cancer?
Dr. Delclos: No, no, he had problems with his legs, circulatory problems. Peripheral Vascular disease, similar to Buerger’s disease. Maybe it was Buerger’s disease [Leo Buerger, U.S. M.D. 1879-1943]. And he never stopped smoking; he died from that.
Question: So your training and your father’s training was in Spain. How was the medical education system in Spain?
Dr. Delclos: In 1944, I finished high school and I started at the medical school right away. And I studied medicine in Barcelona until 1950. In 1950 I became a physician, which is the clinical degree. It is like an MD here. And you don’t do the doctorate to treat patients because the doctorate is a higher degree, like in England. I did further training. That’s why I am a doctor in medical science, let’s call it. And I did that later, 10 years later. I took the courses first, and then I wrote the thesis.
But the training for my father was different because my father had no advanced radiology training. He trained himself in radiology and therapy. But I went to Manchester to be trained in therapy.
Question: How long was your training in Manchester?
Dr. Delclos: It was six months of physics, six months of medicine, six months of surgery and then two years of clinical radiotherapy.
First, I was in Bolton (10 miles NW of Manchester) at the royal infirmary hospital doing the six months of surgery part of the training (July 1954 – February 1955). I had been out of medical school for four years, so they gave me a waiver of the medical part, so I did not have to do that six months. I had four years of practicing general medicine.
And then I did the physics and the clinical radiotherapy part (February 1955 – November 1957), and I got my diploma in radiotherapy in England.
Question: Who were the famous people in Manchester at that time?
Dr. Delclos: Well, of course, the most famous was Dr. Ralston Paterson; I trained under Paterson. You asked why I decided to go to England for training? In a way, I was really going to Manchester because I could not find any place to be trained in Spain. There were no places to be trained in Spain. So I decided to go to Manchester. I started at Bolton Royal Infirmary for my six months of surgery, which was very helpful. And then I did all my radiotherapy training in Manchester for my diploma. And then I met Dr. Fletcher when I was finishing my training.
Question: Were they using the Paterson-Parker rules at the time you were there at Manchester?
Dr. Delclos: Yes, the Paterson-Parker rules had been established already. So, I learned all the technology of radiotherapy, both external and intracavity, and interstitial brachytherapy at that time and also the clinical part, how to examine patients, how to examine the larynx and uterine cervix and things like that. So I had a good experience. Then, I married Teresa and she came to Manchester. We had one kid. Then we went to Spain for two years (December 1957 – January 1960).
Question: Let’s talk about Manchester a little bit. Were you the only resident?
Dr. Delclos: No, when I went to Manchester, there were six first year residents there. When I applied to Manchester, Paterson was the person who gave me an interview. I came over from Bolton and Paterson said, “Your English is very bad.” It’s still very bad! But anyway, it was so bad that he sent me every day at 1:00 to the Berlitz School to speak to a young lady for one hour, which was not unpleasant. And then when I had enough money to support a wife, I went to Spain and married my wife, who is also from Tarragona.
With regard to the people in Manchester at that time, there was Paterson and Dobbie, who was an inventor. I learned lots of things, a lot of gadgetry from Dobbie. Margaret Todd was dead already. And then there were many others in there, and I think the most important for me was frank Kelly, my best friend.
Question: Were they all from England, or did they come from all over the world?
Dr. Delclos: Well, Kelly was from Ireland, Leonard Legner was from New York and Kent Holmes was from England. Two were from India—one from the central part of India, Calcutta, and the other from the south of India.
Question: So it was an international group there.
Dr. Delclos: International, yes. And for a short time there was a French-Canadian, J. Desmarais, who later gave up radiotherapy, went to diagnosis and became Senator for the province of Ontario. A true gentlemen, he died recently of lung cancer.
Question: Was it hard to get into Manchester? Did you have to take an exam?
Dr. Delclos: No, the only thing that Paterson wanted was to have interested residents. Later, we had a resident from New York, and there was one from Louisville, Ralph Geott. There was only one English resident. And I say English because he was from England, not from Scotland. All of the people that we trained under, except one, were Scottish. That may be one reason for my bad English.
Question: Did they pay you anything?
Dr. Delclos: They paid very little. They paid the equivalent of $125 a month. But they did give us an apartment, so we were able to survive. But, for instance, we could only eat steak once a month, things like that. We had plenty of spaghetti and rice!
Question: How many patients did they treat each day at that time?
Dr. Delclos: I cannot recall the number, but remember, Manchester was a regional center. It’s still a regional center. So we saw plenty of head and neck and GYN patients, and so this is where I became interested in head and neck and GYN. You know, radiotherapy was not supposed to be good for other cancers, like for instance, the G.I. tract.
Question: Did you develop your interest in gynecological and gadgetry at that time?
Dr. Delclos: Mainly. And since I like to work with my hands—remember, I wanted to be an Engineer—I had the facility and they helped me to train in these two areas.
Question: What kind of equipment or applicators did you use?
Dr. Delclos: Well, in Manchester, of course, we used the Manchester system and their tandem and ovoid applicators.
Question: Did you use radium?
Dr. Delclos: Radium and cobalt. And as far as external equipment, we had a short distance Tele-radium machine. We had a140 KV unit and two 300 KV units and a 500 KV machines. We also had a 4 MV linear accelerator and a betatron that we never used.
Question: So you had high-energy equipment?
Dr. Delclos: Yes, a linac, and we also had the betatron, but it wasn’t being used to treat patients then. It was not very good. But the linear accelerator was a good machine. You know, the British did not want to use cobalt. They preferred accelerators. So I trained in megavoltage on a linac.
Question: You had a 500 KV unit also?
Dr. Delclos: 500 KV. Yes. It was as large as a house.
Question: Was it a resonance transformer?
Dr. Delclos: No, the 500 KV was a very old machine that was not a linear accelerator.
It was a KV X-ray machine.
Question: Do you remember who the manufacturer was?
Dr. Delclos: I think that most of the instruments there were made by Vickers.
Question: Metropolitan Vickers?
Dr. Delclos: Yes. Most of them were made by Vickers.
Question: How about the linear accelerator? Was that made in England?
Dr. Delclos: It was made by Vickers, like the 500 KV orthovoltage machine.
Question: What was the energy on that linear accelerator?
Dr. Delclos: Four MV.
Question: That was very early.
Dr. Delclos: Yeah, it was one of the first.
Question: You had it before we did in the U.S.
Dr. Delclos: Yes, I think so.
Question: Metropolitan Vickers installed an 8 MEV Medical Linac at Hammersmith Hospital in London in June 1952. Four MEV units were installed at Newcastle General in August 1953 and at Christie Hospital In Manchester where operation started in October 1954.
Dr. Delclos: Yes, I was in Manchester from 1955 until 1958. We did the majority of cases with the orthovoltage and the 4 MEV linac was used in head and neck, mainly. Johnny Boland, who later on came to New York, was the one that was responsible for the machine. And then we had the orthovoltage KVs that were very useful. There was Tele- radium, a little short distance Tele-radium unit. You know, we used that Tele-radium to treat vocal cords and practically every patient ended with fibrosis. And it was remote control. You had the machine head set up against the tumor, then left the room, set the machine time, pushed a button and the radium source would go from a lead box through the pipes into the head of the machine.
Question: Pneumatic transfer of the radium source from lead storage box to the head of the machine.
Dr. Delclos: At one of the talks given here the day before yesterday, they talked about IMRT and all these multiple fields. Well, we treated multiple beam fields directed for many years with casts/molds.
Question: Now, what were the molds for again?
Dr. Delclos: Well, the molds/casts showed the entrance and the exit points. So after we put them on, the techs had an entrance point and an exit point. The technicians could then set it up this way, properly.
Question: The mold, was it to keep the patient from moving?
Dr. Delclos: Yes, and for beam direction. Also we used molds for brachytherapy, radium and cobalt. As a matter of fact, we use some cobalt sources instead of radium sources to treat many things at short treating distance. In Manchester there was a lot of skin cancer because of the textile industry.
Question: You used cobalt sources for brachytherapy?
Dr. Delclos: Yes. But not for GYN insertions. For GYN we used radium. The molds we used a lot for lip cancers. We got an excellent cosmetic result with “double molds”.
Question: What was the standard external beam schedule you might use for, say, a lung cancer? I’m talking now about the overall number of weeks, number of fractions per week, fractions per day, etc.
Dr. Delclos: Actually, the only thing I can remember is that the patients at Manchester were treated in four weeks.
Question: 5000 roentgens in four weeks?
Dr. Delclos: Yes, that’s right. Breast was treated in four weeks. And they didn’t develop the severe reaction until after the end of the treatment. And that saved schedule time. And we treated many patients for palliation with one single treatment (fraction) or two treatments (fractions). I still have the table outlining the schedules we used.
Question: Someone was proposing treating with an accelerated fractionation schedule in his talk yesterday? Is what he was recommending basically what you’re talking about?
Dr. Delclos: Yes.
Question:He was suggesting that shortening the time was more important than actually giving them a little bit more dose. And I thought, well, that sounded really familiar.
Dr. Delclos: We treated mainly for a maximum of four weeks.
Question: Manchester was essentially the same as Princess Margaret?
Dr. Delclos: Princess Margaret followed Manchester, yes. And, you know, the four weeks, 5,000 in four. They had radiotherapists who came and spent six months with us in Manchester.
Question: So what kind of person was the chief, Ralston Paterson? Was he austere and aloof or fun and easy going?
Dr. Delclos: He was austere and did not have a lot of sense of humor, but he was very nice to all of us. We were his children, you know. And when he interviewed me, he was very nice. I came from Bolton to see him and explained my history with my father and all those things, and I said I was interested in radiotherapy, not in diagnosis. In the states at that time, most of the radiologists were doing both, while in England the radiologic specialties had been separated for many years. He said, “You can come, but you’ll have to improve your English.” I said fine. So he sent me to Berlitz, as I said.
Question: Is there a Paterson Society similar to the Fletcher Society?
Dr. Delclos: No, there is no Paterson Society that I know of. You know, Paterson was a surgeon. He became the radium curator for the Manchester Royal Infirmary and then developed the cancer institute. He was also a self-made man in therapy. His training in radiotherapy was by going to Paris and Brussels and seeing what the French and Belgians were doing.
Question: So when did you meet Dr. Fletcher? While you were working at Manchester?
Dr. Delclos: Yes, I was finishing my training (1957), and I had written seven letters to the states saying that when I finished my training I would like to go to the states because I didn't think I’d find a job in Spain. And some of the people I wrote didn’t even answer, but two of them answered. One was Fletcher. And he said I’m going to be in England because I’m doing a tour of France and Scandinavia, and I’ll interview you then. So he came to Manchester and met with me there.
So he came to Manchester and he gave a talk about his applicators, preloaded applicators. But the British, in general terms, did not care about what happens in the states. And Fletcher, he was from the states, and he was French, which was even worse! So he presented his preloaded applicators, and I was so sad to see that such a good idea was not accepted that I almost cried. I saw that he was an honest man. A little bit odd, but a good man. So he said, “I’ll send you an offer.” And he went back to the states and then he said, “You can come any time.”
I said, “No, I’m not going to the states unless I get a visa to reside in the United States. I don't want to go there and spend five years and then go home with no job.” So he and Dr. Clark worked on a visa for me. They wrote to a senator that they knew. And I got the visa and came to M.D. Anderson.
In the meantime, I spent two years in Spain doing a little bit of diagnostic radiology and therapy (December 1957 - January 1960). You see my father had been sick, so I worked with him as an X-ray technician. I knew how to take X-rays, so I made a living as a technician after my training in Manchester. And then I came to the states (March 1960). The only position that I accepted was with Fletcher. And the offer was for $500/per month fellowship. And I said, “What can I do with that?” When I met Fletcher in England I already had one child, George. He’s now a physician in Houston. By the time that I came to Houston I had three children. And I asked him, what can I do with $500? He said, “Well, this is only a temporary thing until you get your license. But with $500 I can tell you that you will not be able to have a Texas-sized beefsteak every day.” I think that I still have the letter somewhere.
Question: Was it tax free?
Dr. Delclos: Yes, I didn’t have to pay tax on it. But $500 was all right, it was comfortable because I wasn’t making any money in Spain, you know.
Question: Was that expected to keep you going for a year?
Dr. Delclos: Well, what happened is, when I came, first I had to take the foreign examination.
That took six months to prepare. Then I had to take the Texas basic science examination. Another six months. Then the license, another six months. One year and a half later I got my license. And then six months later I got my radiotherapy diploma from the American college. So I have done everything twice in my life, except marrying. I still have the same wife.
Question: So when you actually started getting a salary, what was it?
Dr. Delclos: Well, it was—I recall that I got a salary after one year and a half, more or less. Because first I recall that my pay was increased to $600. But it was not a fellowship, so I had to pay tax. So $600 was in a way less than $500. After one year and a half, I began to make a salary.
Question: And who were the faculty at M.D. Anderson in 1960?
Dr. Delclos: Sure. Lillian Fuller was there. Johnson was there. He went to California and became a lawyer. Then there was Herman Suit, Lowell Miller and Raoul Herrera who went back to diagnostic radiology. And that’s about it. Oh, and Paul Chau was there, too.
Question: Who did what?
Dr. Delclos: Paul Chau was doing gynecology and Brachytherapy implants. And he was and still is a very good man. But I had so many people above me there that I left and I went to Syracuse, N.Y., (January 1964) because what I wanted was to take care of head and neck and GYN cancer patients. That is what I liked.
And then after I had been there (in Syracuse) for one year, Paul Chau left and went to Colorado and that position became vacant. And Dr. Fletcher offered me the opportunity to treat GYN cancers if I were to come back. So I came back. I spent only one year and a half in Syracuse (January 1964 – April 1965).
Question: When you first went there, you say it was the era of the preloaded applicators. So you loaded them in the operating room?
Dr. Delclos: No, the preloaded applicators were loaded in a room next to the operating room, and Rita Harris, who was the radium curator, used to load them and give them to us. We would say we need this and it was prepared by her and given through a window to us. And Herman Suit had already been working on the afterloading system, which was a little clumsy. As everything else in life, it was a matter of time. And I really worked with Herman because I liked the idea, and then I modified the applicators to make them nicer.
Question: So Herman’s idea was the hollow handle?
Dr. Delclos: Yes, his idea was the hollow handle. And Fletcher didn’t like them. He insisted on using the other (preloaded applicators). But we didn’t pay attention to him and worked with the afterloading system. But we simplified them very much because they used to corrode and break.
Question: But people call it the Fletcher-Suit or Fletcher-Suit-Delclos afterloading system?
Dr. Delclos: Dr. Fletcher developed the preloading with Fernando Bloedorn, who didn’t get much credit, and Bob Shalek , the physicist. Fernando worked with Shalek, they did some of the work. But mainly it was Bailey Moore in the workshop who put it all together. Moore was the head of the workshop and we all worked with him on various projects.
Question: What did the people in Manchester think of Fletcher? You said they didn’t think much of his system.
Dr. Delclos: No, their attitude was interesting. They were very nice people. We had a very good time in England. But, you know, the British are very reserved; they were very reserved at that time. And so, to them, American ideas were not that good or anyone else’s ideas for that matter.
Question: What GYN-brachytherapy system did Paterson use?
Dr. Delclos: Well, the Paterson system … you see, the French started with the corks. And the English people, the Manchester system is what they called it, used ovoids because they are shaped like an ovoid, like an egg. And they were made of rubber. The Dunlop Tire Company (founded 1888 by Scottish veterinarian J.B. Dunlop) was very important and they made the ovoids for them and made three different sizes. The Manchester system was much easier to use than the French system. My father used the French system and he got so tired of it that he made his own applicators and published his system in Spain.
Question: So how did Fletcher’s system differ from what they were doing elsewhere?
Dr. Delclos: Well, the French system was very individualized. You put two, three or four corks against the cervix and tubes in the uterus in France, which to me is the same as in England. You only have two options: put something inside of the uterus and something against the cervix or in the lateral fornices. They use milligram hours in France. And one of the greatest contributions of the group in Manchester was to change all the dosimetry to Roentgens.
Question: I see. They weren’t using milligram/hours.
Dr. Delclos: Well, basically in the back of their mind they were using milligram/hours because
Paterson, Gibson and all these guys, they made sure that the milligram/hours were correct. But they didn’t say that they were using them.
Question: And Fletcher was using milligram/hours.
Dr. Delclos: Fletcher was using milligram/hours, too. And I still used milligram/hours at that time—as a backup protection. The tolerance and effectiveness in milligram/hours were well established at that time, so when we moved to the Roentgen and then the rad and the Grey, the number of milligram/hours was still known. So I always made sure that the milligram/hours were not above or below a certain number. And then I checked the dosages at several critical points and the doses to the vagina. The tolerance of the bladder and the rectum had already been established. So, we made sure that we were within a certain tolerance.
Question: Did you do the reverse when you came to M.D. Anderson? Check the Point A dose in rads?
Dr. Delclos: No.
Question: As a backup?
Dr. Delclos: Well, yes, I was familiar with the Point A and B in the Manchester system. So
When I came to America, I was surprised that we were not using the A and B, and being young, I questioned Dr. Fletcher many times, and he got upset with me. So finally I realized that the best thing was to keep my mouth shut. But then one day, reviewing some old charts, I found out that he had been using both roentgens and rads to points A and B and milligram/hours.
Question: Points A and B?
Dr. Delclos: The A and B. Both milligram/hours and points A and B. But then this changed because he figured out that A and B were not that meaningful. The important thing is the placement of the tandem and the placement of the ovoids and the tolerance of the tissues. The dose to A and B can vary a lot. They were very important at one time.
Question: Who really developed most of the Anderson technique for treating cervix cancer? I’ve heard mixed opinions: that it was Fletcher, that it was Bloedorn, and I’ve heard that it was Paul Chau. Who really developed it?
Dr. Delclos: I think that Fletcher and Bloedorn established the Anderson system. Bloedorn had been trained in Manchester. He was a surgeon from Argentina who was born in Brazil. And then he worked for a while in Milan with Carlo Cuccia. Bloedorn came to the U.S. with Carlo Cuccia. I never worked with Bloedorn, so I don't know exactly what he did contribute other than the bloedorn colpostat. But Fletcher did a lot.
Question: I think it was Bloedorn who came to the United States thinking he was going to New York for a salary of $12,000 a month or something like that. When he arrived he found that it was a fellowship, and the salary was only $12,000 a year. Then Fletcher offered him a job at a higher salary, and so he came to M.D. Anderson.
Dr. Delclos: Yes. He was first in New York and Dr. Fletcher brought him down with Vincent Sampiere. Vincent Sampiere, who was a dosimetrist at that time, came with Fernando Bloedorn.
Question: Vince Sampiere?
Dr. Delclos: Well, Vince was a photographer who became a practical technologist for radium and X-ray. He later became a dosimetrist. And with not much training, but he was a guy who could learn quickly and was a very good practical dosimetrist. I always respected him technically and as an excellent person.
Question: What happened to Dr. Bloedorn?
Dr. Delclos: He died of complications of arterial sclerosis. He had very bad arteries. He was also a heavy smoker.
Question: When did he leave Anderson?
Dr. Delclos: He was not at Anderson when I arrived. When I came Carlo Cuccia had gone with him and Fernando Bloedorn was long gone. Both of them had more formal training than Dr. Fletcher. What happened was that Dr. Fletcher learned from other institutions. Dr. Fletcher had trained in diagnostic radiology and he had only a little bit of therapy training. But then he went to Europe and did a tour and spent three months each in Paris, Sweden and England, etc. You could see from the old charts that he had learned quickly.
Question: Had Cuccia and Bloedorn both trained in Manchester?
Dr. Delclos: No, Carlo Cuccia trained in Milan. But Bloedorn trained in Manchester. When we say training, I don't know whether he spent three years or one year or what. But Bloedorn was basically a surgeon, like Paterson was a surgeon.
Question: So you left Houston briefly in the Sixties and went to Syracuse for one and a half years—1964-1965?
Dr. Delclos: Yes, I went to Syracuse. I came to Anderson in 1960, and then I went to Syracuse. Frank Batrley offered me a position in Syracuse, N.Y., snd I went to Syracuse. And after one year and a half, Fletcher asked me to come back because of the departure of Paul Chau.
Question: What happened to Paul Chau?
Dr. Delclos: One thing that I must state at this point is that I have always been lucky because any time that there has been a major turmoil in the department I have been somewhere else!
Question: What sort of turmoil?
Dr. Delclos: Oh, there was some turmoil between Fletcher and Paul Chau, and you know who won. Paul Chau was a very good man and very knowledgeable.
Question: You mentioned that he is in the Denver area. But has he passed away now?
Dr. Delclos: No, no, he’s alive. He was in Houston about six months ago. We had dinner together. Yes, he comes to Houston once in a while. He’s in good health. He is older and still plays tennis. His wife died, you know, and he has kids grown up already and grandchildren. I must say that Paul Chau was very knowledgeable. I learned a lot from him. I always learn. I learn from everybody. When someone else has an idea, there is always some practical thing that you learn if you listen.
Question: Tell us about your practical things, which you developed.
Dr. Delclos: Oh, my inventions?
Question: Yes. You are known for your innovations. What about those recent colpostats? The Fletcher-Suit-Delclos colpostats?
Dr. Delclos: Well, I did that because I wanted to give credit to Dr. Fletcher, who developed the original preloaded applicator. And I also wanted to give credit to Herman Suit, who developed the first afterloading. Since then I’ve worked a lot on the applicators, and I developed many modifications of it; practical modifications for remote control also, to be used with cesium or radium or any other solid radioactive material. So I continued to work on the system. But I still think that they both deserve the credit for being the first. I am grateful to them, all of them, and to my father.
The colpostats are one of my gadgets, but I did many other gadgets. I spent two years in Spain—May 1969 - June 1971—after nine years at Anderson. I spent two years in Oviedo, Spain, and I started the idea of a cancer center there, which is still there. And while I was there I invented a couple of things. One is a testicular retractor so that you keep the testicle out of the field when you do external beam irradiation. Then the “four quadrant circle” to make treatment set ups easier instead of using a piece of paper and pencil every time that you had to angle the beam for treatment of the breast to set tangential chest wall and breast fields. So I made a four quadrant circle adapted for the cobalt unit. It was very easy; you did not have to think. So that is another thing. And I don't know, many others, small things. But they were practical things.
Question: Well, in addition to intracavitary, you have done quite a bit of interstitial.
Dr. Delclos: Yes, sure.
Question: You had a prostate implant series at one time.
Dr. Delclos: Well, the prostate implants we did at Anderson then were done with gold seeds because at that time the urologists wanted to explore the abdomen and look for lymph nodes. So at that time I did the interstitial implants. And then suddenly that interest in looking at the abdomen disappeared, and so they carried on with external beam radiation only. So I only did that for a while.
With regard to interstitial, I did quite a bit of head and neck interstitial, but I was in competition with surgical resection and gradually that faded away. But I did a lot of vaginal implants. I think that maybe we had the largest series in the world of vaginal implants with iridium, and I developed my own techniques for implants of this site.
Then I also did implants of the anus. I developed a rectal plug to protect the other side of the anus. That is another mini-invention.
Question: Where do you see brachytherapy going now? Increasing, decreasing, staying the same?
Dr. Delclos: Well, brachytherapy at the present time is increasing in some areas. There is less in
head and neck. The GYN implant numbers are about the same. But now there are many more prostate implants, which have become very important and are competing with external beam and IMRT.
Dr. Delclos: I don't think they’ve had better results, but it is competitive.
Question: It seems to me that interest in brachytherapy is at an all-time high.
Dr. Delclos: Yes, I think it’s very high right now.
Dr. Delclos: But there are some other areas, like, for instance, the lip; brachytherapy for lip is very good.
Question: Right. Nobody does it.
Dr. Delclos: And nobody does it. They all go to surgery. It’s a pity, because it is one of the best areas for a lip or nose implant. Breast, you know, they pushed for the breast boost with electrons and less interstitial. I did a lot of boosting breast masses with interstitial. And now they do more chemotherapy, because with the chemotherapy they try to control the distant metastasis, which a local and regional treatment will not be able to control.
Question: Tell us about the early years of the development of the use of radiation therapy for ovarian cancer.
Dr. Delclos: Well, in Manchester we did not treat ovarian cancer by radiation, although the “moving strip technique” was invented in Manchester for lymphomas. But when I came to M.D. Anderson Hospital, they had already done the work to use the moving strip technique for ovarian cancer.
Question: I didn’t realize the abdominal strip technique was first used to treat lymphomas.
Dr. Delclos: Manchester had used the strip to treat from the pubis to the neck with a 250 KV unit, for lymphomas. And the idea was brought to Houston by Dr. Fletcher who adapted it for abdominal irradiation in ovarian cancer. So I got stuck with the strip. However, I must explain that although I treated patients with the strip, I was never very happy about the strip. Nowadays, with the big machines you might as well use open fields if you want to treat the abdomen. I did use the strip and described it in a couple of papers, but it was not my idea.
Question: What didn’t you like about the strip?
Dr. Delclos: Well, one problem was the irregularity. It is very difficult to put those fields in exactly the same place every day. And the bowel moves in and out of the field. Of course, sometimes the bowel is stuck there because of the surgery. So, I was not happy with the idea. To me, on paper it was very nice, but in practice, it’s easier to use open fields. Johnny Boland introduced the strip in New York before Dr. Fletcher introduced it in Houston. But he only used a narrow strip for para aortic irradiation. Later Dr. Fletcher did some work with the strip, and then I took over and modified the technique a little bit.
Question: You have traveled extensively and have given lectures all over the world and have been responsible for teaching courses, especially in Spanish-speaking countries, like in Central America or Latin America.
Dr. Delclos: Well, I have been all over the place, you know. I have been, as I told you, two years in Oviedo in northern Spain. I trained some people there and started the idea of a cancer center, and now they are very well equipped. Now they have two linear accelerators. They use cobalt sources instead of radium. And they treat over 1,400 people a year.
Question: Could you describe what practice is like in Spain?
Dr. Delclos: Well, they treat patients in the hospital in the morning with very little pay, on a small salary. Then they have to make a living in the afternoon somewhere else. And they lack equipment; they don’t have that much equipment. They are well trained brain-wise. They know the medical part of it.
Question: But they have equipment problems?
Dr. Delclos: They have equipment problems and they have a shortage of physicists. Now they have more physicists than they used to, but they cannot do some of the things we do here.
Question: What about Europe? You know, traditionally Europe, the Swedes at the Radiumhemmit, and the French and the English were ahead of us. What is the status there now?
Dr. Delclos: Well, the radiation therapy in Europe, including Spain, is much better than it was when I left. But the best places are in France and England. Now, in Scandinavia they concentrated on GYN mainly. They also had other things, you know. So it was quite good too. You see, things change. But France has had a history of very good radiotherapy.
Question: What about radiation therapy in Germany?
Dr. Delclos: Germany has not been that good as therapy is done by general radiologists. They’re getting there, but you see, they were not at the level of England and France or Scandinavia. I have been there.
Question: Now, these places all have what we would call socialized medicine. And so the equipment I guess could become a problem. The governments have to want to buy/pay for the equipment, right?
Dr. Delclos: Sure. I mean, other places you may have one center that is good, another one that is not so good. It’s very hard to find—say Rome is better than Milan. Maybe Rome is better in one thing and Milan in another.
Now, France is good all over the country, because they have had cancer centers for many years. And in these cancer centers there is cross-fertilization between the chemotherapists, the surgeons and the radiation oncologists.
Question: So France is the best of the European countries for multidisciplinary treatment.
Dr. Delclos: And England. But France is quite good.
Question: Do wealthy Europeans and others still come to the United States, though, for treatment?
Dr. Delclos: Not necessarily. From Spain, yes, because even though the radiotherapy has improved a lot, it still has a ways to go. I mean it’s much better than it was. You know, Spain was in a Civil War (1936-1939), and after the Civil War everything was lacking. So they had a tendency to go to other places. But if they have to go somewhere, they usually go elsewhere in Europe. Some go to the states. But to them, coming to the states is prohibitively expensive. It costs too much money. So they go to England, to France or to Scandinavia.
Question: The foreign patients at Anderson, a lot of them are Arabic people aren’t they?
Dr. Delclos: Arabs are coming here too, yes.
Question: What about the rich people that come from Spanish-speaking countries in South America, Latin America?
Dr. Delclos: Some come from Argentina or Mexico. Central America, too, and Venezuela and Colombia, but they have to be very rich because the prices in the U.S. are outrageous. It costs too much money.
Question: Tell me about the history of shielding in the ovoids.
Dr. Delclos: Well, I think the idea of shielding comes from Dr. Fletcher, and maybe also from Fernando Bloedorn. Shielding is a practical way to cut down the radiation to normal tissues if you cannot pack well. Packing is as good as or better than shielding. But in some vaginas you cannot pack. And the bladder is close and the rectum is there, so you put in shielding to shield part of it. Because tolerance in a way is related to how much area or volume you treat. So the idea of shielding came from M.D. Anderson. And in many places in Europe they don’t use shielding.
Question: Manchester didn’t use any shielding? France didn’t use any shielding? Is that correct? Even today?
Dr. Delclos: Some use shielding. You know, Jean-Claude Horiot has been very good at establishing the use of the Fletcher applicators. He has a model resembling the Fletcher. So the idea of shielding is only in the mind of some people. Some others are reluctant to use it.
Question:When the applicators started being manufactured by companies, and people started ordering them in private practice and started using them, did that go smoothly? It seems just based on your publications and Fletcher’s publications that maybe it didn’t.
Dr. Delclos: Well, I can’t tell you how many times I have seen applicators that were not properly built. The position of the shielding was incorrect. In some cases they were shielding the tumor instead of shielding the normal tissues. And this happened because the commercial companies don’t know right from left sometimes and they go ahead and build things that are wrong. I have found many applicators that were wrong.
I found one that was built in Spain where their shielding was completely wrong. It was one of the worst. There was another one built in Chile that was too big. You could use those colpostats in elephants but not in human females. They were so big, and then some that had no shielding at all
Question: So how did you discover that there was something wrong?
Dr. Delclos: Well, you know, because we took X-rays of our applicators and then somebody else took X-rays of theirs—I recall one in San Antonio and another one somewhere else. They sent the X-rays to us and we looked at it and said, “look, this is wrong.” And Fletcher said, “Luis, you like these sorts of things. Take care of it.” And so I wrote some papers. In some of the publications I showed examples of applicators with the wrong shielding.
Question: What about the mini ovoids?
Dr. Delclos: Well, I designed the minicolpostats. We developed them because some ladies could not hold the small ovoids. Their vagina was too narrow. So we said let’s make a small one, and I did not want to sacrifice the distance, the radius, too much. So we cut one side and in that side there is no tumor and there are no vital structures. So we paid attention to the basics and made sure the geometry was all right, but they should only be used in situations where you cannot insert the small, medium or large. Most patients can be treated with small ovoids.
Question: Did Dr. Fletcher receive the mini-ovoids graciously?
Dr. Delclos: Well, actually, any change took a little while to be accepted by him. He didn’t accept it at first, but finally he did. For example, initially he didn’t like the afterloading. But we were the ones who were doing the implants, but of course Dr. Fletcher was not inserting ovoids anymore. So he probably got a lot of exposure in the past. But we were doing them, and we didn’t want to be exposed. So that’s why the idea of afterloading became popular.
Question: Well, tell us about Heyman capsules and Simon capsules. Did Fletcher like them?
Dr. Delclos: Well, the Heyman capsules came in different sizes, so you could put as much radium as you could in larger capsules so that you’ll not have to insert so many small capsules. Then Simon came with the idea of the afterloading with iridium, and I thought it was a very good idea. But Dr. Fletcher didn’t like that idea, for some reason or another, maybe a personal thing. I don't know why, because it was one way to afterload the capsules. Not with radium but with iridium.
Question: Can you describe for us what the Simon capsules might look like?
Dr. Delclos: They are small capsules with a mini-pipe that you cannot insert radium into, but you can insert iridium. I’ve used both systems, and I had no problems. But for some reason or another, at a prior time, people in Sweden and Fletcher used to see many patients with large endometrial cancers. There aren’t nearly as many big endometrial cancers now maybe because of better education of the population. So many patients today would not need to have capsules any more.
Question: What about physics? You know, some of the dosimetry of this sounds like the “by gosh and by golly” school of dosimetry. You just kind of stick your hands in there and feel around and you load it up and then you just figure out the number of milligrams you inserted. Who needed a physicist? Now we have all these 20-man physics departments. What about the growth of physics during your career.
Dr. Delclos: Well, the need for physics came about because of the need to keep/monitor the radium and then later on the cesium and other isotopes. And there was the need to develop ways to protect the people around them. And then they began to do treatment planning. So gradually those dosimetrists became a necessity. Now, the department at M.D. Anderson hospital always had several physicists, which were mainly doing research because they liked to do research, and this included radiobiology research. They were in a way working with radiobiologists. And at M.D. Anderson we had Peter Almond, who delegated Vince Sampiere, and Vince Sampiere was a very effective dosimetrist, very good at treatment planning. Nowadays the work of Sampiere is done by six people. This is the way it is, like everything else!
Question: What do you think about high dose rates for cervix cancer brachytherapy?
Dr. Delclos: I have nothing against high-dose-rate brachytherapy, if it is done properly. What I do not like is the sudden change in some places from low dose rates to high dose rates. Because with high dose rates, if you make a mistake, it is a big mistake, while with low dose rates, you can usually correct it. With high dose rates, you don’t have time to correct it. So if you use high dose rates, you have to be very knowledgeable about low dose rates and in clinical evaluation of the patient. If you goof, if you make a mistake, it is going to be very big. And with GYN implants, of course, you can cause soft tissue necrosis and fistulas. But if it is properly done by someone who is trained, preferably first on low dose rates, you can do high dose rates in some situations.
Question: But do you think it has any advantages?
Dr. Delclos: The only advantages that I can find for high dose rate is that the patient doesn’t need to be in the hospital for two or three days. You can do the treatment in a shorter period of time. The tendency now is to do high dose rate brachytherapy in offices, in other words, in the clinic instead of in the hospital. And I think this is bad because it is difficult to examine the patient and place the applicators without anesthesia or minimal anesthesia, several times. You have to do seven or eight applications with high dose rates. It’s not easy for the patient.
Question: And the numbers change, the dose you prescribe.
Dr. Delclos: And the numbers change, lots of things change. So if I had a relative who had this kind of cancer, I would like to have her treated with low dose rates because people suffer. In my experience, whenever we had to do a patient in the operating room without anesthesia, with just some sedation, they jump! And you cannot properly examine them or insert the applicators.
Question: What about chemotherapy and GYN cancer? There’s been a change, since you were fully active on the faculty. Chemotherapy seems to have become generally accepted, I guess through GOG reports among others.
Dr. Delclos: I think that chemotherapy is justified if you find a chemical agent that is effective in preventing the growth of distant metastases. But as far as treating the local disease, chemotherapy is no match for radiation therapy.
Question: With head and neck cancer, the problem we’re seeing is that the chemotherapists get the patient first and give some chemotherapy for stage two disease. The problem is that this can complicate our therapy. Do you see the chemotherapy interfering a lot with radiotherapy?
Dr. Delclos: Well, that will depend on where you work. You ask me first if it interferes with the proper application of radiotherapy. Well, it may in some cases interfere with the proper radiotherapy. And the radiotherapy may interfere with the chemotherapy too. But to me the only indication for chemotherapy is if you could reduce the volume of the tumor so that your irradiation is more effective, and if it can control distant metastases. But, for the time being, I’m not very impressed that it does either one of these. There is always one case or two that do well, but you need to look at the effectiveness overall.
Question: Luis, what got you into radiation oncology, anyway, in the beginning? I mean, here your dad was doing both. Why would you pick something like therapy?
Dr. Delclos: Well, to me, diagnostic radiology, although it’s very important, does not have enough contact with the patient. Other physicians send the patient for an X-ray. However, in radiotherapy I had contact with the patient. I saw what my father did. He had contact with the patient when he had to do an interstitial implant or an intra-cavity insertion. He was involved. I wanted to be a physician, not a technologist.
Question: Would you do it all again today, become a physician and a radiation therapist?
Dr. Delclos: I don't know what I’d do today. Maybe I would, or maybe I’d build boats like what I wanted to do when I was young. But I enjoyed medicine.
Question: So you thought about something other than medicine when you were young?
Dr. Delclos: I have six children, I never told them what to be. George is a physician, Marc is a physician, Henry is a dentist, Marta is a mechanical engineer, Luis is an architect and the little one, Sandra, is an audiologist; it’s because they chose it. I never said a word because to me, as long as they did something positive, that was enough. And really, it’s nice. I’m glad to see some of them went into medicine. But I’d be very happy if they would be building bridges. As long as they like it. Whatever they like.
Question: Tell us about how MD Anderson has changed over the years.
Dr. Delclos: Well, MD Anderson has changed a lot. But so many other hospitals have changed a lot also. When I worked in the Sixties and Seventies at MD Anderson Hospital, it was a relatively small institution—an important one, but still relatively small. We had a lot of contact with patients, and we were able not to charge a patient if we did not want to charge them. No one stopped us. Now they have to charge the patients for everything. I think medicine is getting very expensive.
And then there is the paperwork. The red tape is unbelievable. At that time, I could go directly to the head of medicine, the head of surgery and the head of gynecology. The only one who was above them was Dr. Clark, who was the director of the whole place. So it was very, very enjoyable. It was an easy place to work.
Question: By that you mean you could call these people or talk to them at any time?
Dr. Delclos: Yes. I could go see them in the office, yes.
Question: But now you have to file formal consultations?
Dr. Delclos: Oh, it is unbelievable. And when you try to talk to a doctor, they make it difficult instead of easy. It’s because they are busy doing many other things. The paperwork is unbelievable, and the need to produce papers is unbelievable. They need papers to get promoted.
Question: Maybe the colleagues aren’t as helpful.
Dr. Delclos: No, not as helpful as they used to be.
Question: I guess there isn’t as much time to do unfunded research as when you and I were there?
Dr. Delclos: No, I don't think so. They are extremely busy and they have no time for talking with a patient when they see the patient. And to get the doctor to see the patient, if you really feel that a patient should be seen immediately, you have to go to the doctor himself and say, “Look, I think that this patient should be seen now for many reasons. Now.” But now you have to go through channels, and there are many delays. And I’m sorry to have to say that, but that is the way it is.
Question: Tell us about how the radiation oncologist interacted with the gynecologist on a daily basis in a clinic when the clinics were run. I’m talking about when you were running the GYN radiation oncology service. Who did what insertions and so on and so forth when you were in charge. And then I’m going to ask you in a few minutes what you think it’s like now.
Dr. Delclos: Well, I did a lot of clinical work because I like it. So I went to the clinics and the gynecologist and I saw the patients and then decided what the treatment should be. We each decided what the staging was, and if we did not agree we had a third person come in to check it, and then we talked about this patient.
Question: Were they referred to your clinic for you to examine?
Dr. Delclos: No, they were examined together in the same room, at the same time. I think they still do that.
Question: The GYN disposition clinic.
Dr. Delclos: Yes, I know. I think they still do that. But with the people that we worked with, it was very easy. I don't know how it is now. When I retired it was still easy for me to do that.
Question: And who sees the follow-up patients?
Dr. Delclos: The follow-up was done by whoever was available. I did always try to do the follow-up examinations for the interstitial cases. We had a clinic where we saw the interstitial cases. But at M.D. Anderson we trained both gynecologists and radiotherapists to do intracavity insertions for practical reasons because in many places the gynecologists had to do it.
Question: As I recall, on Tuesdays the gynecologist did it, and on Fridays the radiation oncology residents did it. But both of them really were under your direction.
Dr. Delclos: Yes, I was always there. I made final decisions about whether to repack, and how to load the tandem and ovoids.
Question: Is that still the case?
Dr. Delclos: I think that it is more or less, yes. There is always a radiotherapist there. In other words, the gynecologist does not go to the operating room to do an intra-cavity insertion on his or her own. There is always a radiotherapist there.
Question: And I recall one of your developments, I think, while I was there was to get diagnostic X-ray equipment in the operating room so that you could actually do the localization and save a lot of time and so forth, and you had dummy sources and so on.
Dr. Delclos: Yes, this is one of my contributions. Because when I started they had to go down to diagnostic X-ray to have films taken, and you could not bring the patient back to the OR. You had to accept some insertions that were not perfect. Dr. Hickey was the one who helped me get X-ray machines in the operating room. After we installed X-ray machines in the operating room, we did not leave the operating room until we checked the films. In several instances we had to do the intercavitary application five times before it was satisfactory. But to us, to work in the operating room was an honor. We enjoyed going to the operating room. And some radiotherapists nowadays, they hate the operating room. They don’t want to go. And to stay there waiting to do this and do that, which is checking the films; re-positioning the applicator for some of them is a pain.
Question: Yes, I think perhaps that could be an epitaph for you. I remember the famous line, “I’m in no hurry.”
Dr. Delclos: Yes, you’re right. I was never in any hurry.
Question: Dr. D may have said that, but he was about the busiest man that I know.
Question: Yeah, but he wanted to do it right.
Dr. Delclos: Yeah, I wanted to do it right. I enjoyed it very much.
Question: I guess we rely on technology today.
Dr. Delclos: You see, I like, I appreciate and I accept all the improvements in technology. But a physician has to examine the patient. I recall Dr. Fletcher putting the finger in the mouth and pointing to the skin, saying, “That field is in the wrong place. It’s not covering the disease.” Or inserting the finger in the vagina and saying, “This cancer is fixed to the pelvic wall.” You cannot do that with all the modern technology available today.
Question: But you used technology, too.
Dr. Delclos: You have to use both. I mean, you have to accept all the modern technology. I established taking films in the operating room. But I accept all the modern improvements.
Question: What do you think of IMRT and 3-D and all these newfangled ways of focusing the beam on specific areas?
Dr. Delclos: Well, this is all right. I think that any improvement to what you can do clinically is good, but do not forget the basics!
Question: We asked about lymphangiograms before and we ended by talking about the laryngograms.
Dr. Delclos: Well, like Sidney Wallace, I still feel that the lymphangiogram is a very useful procedure. The problem is that it takes time. You know, you have to take the patient to the X-ray room, put the catheter in and take films periodically during the day. And the next day they have to come back and you take more films. But I tell you, you cannot find a metastasis three millimeters in diameter by looking at a CAT scan or MRI. You have to use a lymphangiogram to see nodal metastases that small. And you may miss some, but the ones that you see, then you can put the needle and take a biopsy. The lymphangiogram is unpopular, but it’s still a very precise and useful procedure.
Question: What do you think Dr. Fletcher would think if he were to come back and see these various things we’ve been talking about, chemotherapy for cervix cancer, high-dose-rate brachytherapy, IMRT, gene therapy?
Dr. Delclos: Well, if he would come back suddenly is one thing. But if he had been observing all these changes over the years, that is another thing. You know, he was a very intelligent man. He had the natural resistance to change that we all have. We are resistant to change. So probably he would complain about this, that and the other. But he would finally accept innovations. I think with proper exposure he would accept many of these things.
Question: I think that’s right. He would react immediately, but then embrace them after they were shown to be of value. As I think you would.
Dr. Delclos: Yes. It is important to keep your eyes open and see what they do. That is very important.
Question: If there was one single thing that you thought Fletcher ought to be remembered for or could you possibly do that? I know there are many, many things he contributed. But you knew him better than anyone, probably. Is there any one thing that you think stands out?
Dr. Delclos: Well, I think that one of the best things that he did was to be able to put the clinical knowledge of the patient, the clinical observation, and use physics to help him, instead of being victimized by physics and by machinery and by equipment. He always used the things to help him in the treatment of a patient. I think that would define what he was.
Question: Like you said, he learned from experience.
Question: I guess I only have one more question. How, socially, was Dr. Fletcher? I’m talking about going to the ranch, entertaining, things like that.
Dr. Delclos: Well, you know, Dr. Fletcher had a difficult personality, in a way. But he was in a way noble. In other words, you had to accept what he said because he was not a good enemy. But he was a very practical man. And my father was a practical man, too. Paterson was not practically inclined. Paterson developed the technology and the foundations for modern radiotherapy. He started all this and developed physics to be applied to radiotherapy. Fletcher was a very down-to-earth man, practical. He always gave you a reason for what he was doing. Sometimes we did not understand exactly why he was doing something. But if you asked him, he always gave you a very reasonable answer.
And I learned many things from him. One thing I learned is horseback riding. When I came to Texas, the first time that I went to his ranch they gave me a horse. He had several horses and a lady fell from one of the horses. That was Ethel Von Roosenbek. She was the wife of the physicist, Earl Van Roosenbek, in charge of the Betatron. And she broke her pelvis. And I said, “Look, I don't want that to happen to me. So I’m going to learn how to ride.” And I did.
Then I involved my family, my kids. All of them ride, you know. And I went to the farm and enjoyed these trips with him. He went every week. On Saturday we went and he told me lots of things. You know, he was self-trained in riding, too. I went to a riding school. I learned how to sit on a Western saddle, how to sit on an English saddle, and enjoyed that very much. And we were very close. Very close. So when he died—Kian Ang and I are the last two people to see him alive. And when he died, he accepted it as it was. We were very close.
Question: And after you stopped going to the ranch?
Dr. Delclos: I stopped riding.
Question: When you stopped riding, for the most part, you started fishing. Is that right?
Dr. Delclos: Yes. Well, I have been fishing. Remember, you and I used to go fishing. But in those days, I went horseback some weekends and fishing some other weekends. So now I do the fishing part of it. And the reason is that Fletcher stopped riding at 70. And then he said, “Luis, if you can convince your kids to come once a week to ride the horses, I’ll keep the horses.” And the kids didn’t want to be committed to coming every week. He was a highly disciplined man, regular about timing, walking and things like that, being on time, etc. So the kids said no, and he sold the horses. So I stopped. I haven’t ridden now for 15 years. You have to keep doing it. If you stop, then you don't have the agility anymore. Fishing, yes. I do some fishing.
Question: Still fish. In the Gulf.
Dr. Delclos: Well, I fish mainly in the Gulf. We go to Padre Island, to Port Isabel. We have a good guide that takes us fishing for speckled trout, flounder and redfish. And then occasionally we go deep sea fishing, although the guide we had is gone. We had a very good guide. You remember him?
Question: Captain Dan.
Dr. Delclos: Captain Dan, that died, and it’s very hard to find a good one that is not for the money only because Captain Dan was very good. He charged us reasonably. If we did not catch anything, we still pay. However, if something broke down like the engine or something, he did not charge us. So we had a good time. And so did David. David Hussey and Tom Barkley and Moshe Maor; they were the three that used to go with us and get sick.
Question: Thank you.
Dr. Delclos: You’re welcome. Thank you very much.