- Email: [email protected]
A Tribute to Malcolm A. Bagshaw—An Innovative Physician Who Soared to Success
International Journal of
Radiation Oncology biology
physics
www.redjournal.org
Feature Article: Obituary
A Tribute to Malcolm A. BagshawdAn Innovative Physician Who Soared to Success Richard T. Hoppe, M.D., and Sarah S. Donaldson, M.D. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA Received Jan 31, 2012, and in revised form Jan 31, 2012. Accepted for publication Feb 5, 2012 Malcolm A. Bagshaw, MD, an extraordinary physician, investigator, teacher, and leader, died September 18, 2011, at age 86. He passed away peacefully, surrounded by family, at his home in Palo Alto, California, after an extended illness. Born June 24, 1925, in Adrian, Michigan, Mal joined the U.S. Navy immediately out of high school and was accepted into the V12 program that enabled him to set his sights on becoming a physician. He attended Wesleyan University in Middletown, Connecticut, and then graduated from Yale University School of Medicine in 1950. He completed a surgical internship and began a surgical residency. However, shortly thereafter, he developed acute glomerulonephritis necessitating hospitalization and a year of bedrest. Thinking that perhaps surgery might be too physically demanding and having acquired an interest in radiology, he decided to switch to a career as a radiologist and was accepted into the University of Michigan radiology residency program. There he trained under Dr Isadore Lampe along with coresidents Drs Phil Rubin and Bob Parker. The University of Michigan was the first department in the United States to acquire an Atomic Energy of Canada (AECL) cobalt unit. Mal was assigned to assist the physicist in developing the depth dose data for this new machine. That experience served him well in the next phase of his career. Mal looked initially at a job opportunity in Southern California but decided it was not for him, although he found California to be appealing. Earlier he had met Dr Henry Kaplan at Yale. Kaplan had been recruited to chair the Department of Radiology at Stanford, and so he contacted Kaplan to ask whether he had an available position at Stanford. Kaplan did. Thus, in 1956, Mal joined the faculty in the Department of Radiology at Stanford, which at that time was located in the Stanford-Lane Hospital in San Francisco. However, Mal was surprised to learn, shortly after his arrival, that the Stanford Hospital was scheduled to move to the main Stanford campus in
Palo Alto in 1959! This provided Mal another professional opportunity. Although an astute diagnostic radiologist, Mal’s first love was therapy. He was appointed head of the Division of Radiation Therapy at Stanford in 1960 and ultimately became chair of the Department of Radiology in 1972, succeeding Henry Kaplan. Under Bagshaw’s leadership, in 1986, the department separated into 2 separate departmentsdDiagnostic Radiology and Therapeutic Radiology. Bagshaw continued as chair of the latter, which became Radiation Oncology in 1988. Mal’s arrival at Stanford put him at the “front of the line” to develop applications for the original Stanford medical linear accelerator, and he joined Henry Kaplan in pioneering its use. At that time, no one else in North America had access to such a device. The characteristics of the Linac made it a perfect tool for treatment innovation. Mal was resourceful, filled with scientific curiosity, and thrived in the environment of innovation. In a paper published in 1957, just 1 year after Bagshaw arrived at Stanford, he described double exposure portal imaging, custom bolus, lens shielding, rotational treatment, arc therapy, and image guidance by fluoroscopy. How visionary these innovations were! Over the next 10 years, he published major papers documenting novel techniques and the efficacy of treatment for cervix cancer, sarcoma, bladder cancer, ependymoma, larynx cancer, retinoblastoma, and testicular and prostate cancer. He soon became well recognized for the novel technique of treating ovarian cancer with whole abdominal irradiation and for treating mycosis fungoides with total skin electron beam therapy. At the same time, Malcolm was interested in the basic biology of cancer and ways to modify the radiation response. He undertook basic laboratory studies focusing on translational research, which lead to clinical trials to test radiation sensitizers, thus establishing a portfolio of research that continues to the present day at Stanford. Always interested in technology, he was also
Reprint requests to: Sarah S. Donaldson, M.D., Stanford University Medical Center, Radiation Oncology Department, G226, 875 Blake Wilbur
Dr, Stanford, California 94305-5847. Tel: (650) 723-6195; Fax: (650) 7253865; E-mail: [email protected] Conflict of interest: none.
Int J Radiation Oncol Biol Phys, Vol. 83, No. 1, pp. 6e7, 2012 0360-3016/$ - see front matter Ó 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.ijrobp.2012.02.010
Volume 83 Number 1 2012 attracted to the utility of particle therapy; in concert with a sabbatical in Los Alamos, he initiated a novel program at Stanford to develop cancer treatment using negative pi-mesons. Another of his major research programs was to design and define the role of hyperthermia in cancer therapy. Mal’s greatest achievement, however, was the development of radiation therapy as a primary treatment for prostate cancer. In the years immediately before his studies, only 0.2% of men with localized prostate cancer were treated with irradiation. Prostate cancer was considered to be a radioresistant tumor. But in 1965, based on his early experience, Mal reported a 5-year survival of better than 50% using radiotherapy in the treatment of localized prostate cancer, quite competitive with contemporary surgical series. He showed that high-dose, small-field irradiation allowed patients to undergo curative therapy without the need for surgery. This was achieved with a very low incidence of incontinence and frequent preservation of sexual potency. Mal’s techniques became the standard of the day. All of us recall the heated debates over the next 3 decades between Mal and the giants of urology at our national meetings, each laying claim to the more effective and less toxic treatment. The debate was not to be settled while Mal was still in practice, but it has been now. The urologists have conceded, for nearly 20% of urology practices now own radiation therapy facilities purely for the treatment of localized prostate cancer with irradiation. Mal’s voice has finally been heard in that debate. Mal excelled in his role as chair of the Radiation Oncology Department at Stanford. He instilled an exceptional sense of loyalty and dedication among the faculty and staff. In addition, he inspired his faculty to achieve leadership skills and productivity in the discipline. Mal was, as well, an expert and caring physician. But at the same time, he created an environment of camaraderie that we still refer to as the “Stanford family.” He was a passionate educator and highly skilled teacher. He was a fierce champion of his trainees, exuding pride in their accomplishments. One of his most prized possessions was a plaque his residents presented to him at his retirement party in 1992, attaching each of their signaturesda gift that he cherished always. We count 8 American Society for Therapeutic Radiology and Oncology (ASTRO) presidents, 12 ASTRO Gold Medalists, and many department chairs and leaders who were trained by or worked with Malcolm at Stanford. Mal was both an astute diagnostician and a master clinician. His teaching skills in the clinic were notable. He was particularly good at picking up subtleties on physical examination, making key observations on imaging studies, and drilling residents on anatomy. His early training in surgery and diagnostic radiology gave him a special appreciation for anatomic findings and the pathways for local-regional spread of cancer. At the same time, he was particularly compassionate in dealing with patients and families. He inspired confidence in all those around him. Mal contributed significant service to important organizations, including the National Institutes of Health, American Cancer Society, National Aeronautics and Space Administration, International Union Against Cancer, World Health Organization, and virtually every organization related to radiology, radiation oncology, and radiation research. He served as president and chairman of the board of ASTRO in 1972-1973. For this lifetime of contributions, he was awarded the highest honors in the field,
A tribute to Malcolm A. Bagshaw
7
including Gold Medals from ASTRO, the Nihon University in Toyko, the del Regato Society, the Gilbert Fletcher Society, the American College of Radiology, and the Radiological Society of North America, as well as the Medal of Honor from the American Cancer Society and the National Cancer Fighter of the Year Award. In 1996, he received the General Motors Charles F. Kettering Prize for Cancer Research, given for the most outstanding recent contribution to the diagnosis and treatment of cancer, in recognition of his role in improving prostate cancer treatment, facilitating nonoperative therapy and thus helping to preserve sexual potency and reducing the incidence of incontinence. He touched the lives of everyone with whom he came in contact. With his ever present ear-to-ear grin, everyone loved Mal. He was a man with endless numbers of friends who respected and admired him; a role model to countless numbers of students, residents, fellows and colleagues; and a compassionate physicianhealer to four decades of grateful patients. One of his greatest attributes was his infectious personality; he inspired loyalty from all who worked with and for him, with an ethic of “work harddplay hard.” Filled with an exuberance for life and true joie de vivre, Malcolm had many loves outside of medicine. He was a passionate fan of Stanford athletics. He was thrilled at a chance to lead the Stanford marching band on the football field, holding a baton that he rigged with a mechanism so that it twirled effortlessly despite his lack of baton-twirling skills. The opportunity to lead the band itself was a gift from his residents who had won it through an auction, bidding furiously against stiff competition. He was a pilot, the first to soar over the Sierra Nevada range, and he built his own sail planedin the living room of his home. He loved bike riding, often joining his residents for a trip through the foothills to the Pacific coast. He collected native American art and enjoyed a special personal collection of Kevin Red Star’s works. He loved to garden, work in the darkroom he had built in his home, and play his homemade guitar; after his retirement he also took up painting. Mal was devoted to his family. He had met his future wife, Muriel Hanley, while still an undergraduate, and he decided that since she was in Connecticut College for Women in New London that he would apply to medical school at Yale to be near her. He got his wish, and Muriel herself, who had become Muriel Bagshaw, entered Yale Medical School as well. She was one of a handful of women to graduate from medical school in the early 1950s. Muriel worked as a Stanford pediatrician for many years. The Bagshaws often opened their campus home for department parties and events, which frequently proved to be memorable. Muriel died in 1998, shortly before the couple’s 50th wedding anniversary. They raised three children together, Cassie, David, and Sarah. They are survived by their three children, their spouses, and eight grandchildren, as well as Mal’s sister and her husband. The fields of cancer research, radiology, and radiation oncology have been blessed to have such an innovative researcher as Malcolm Bagshaw. Hundreds of thousands of men have been blessed that he undertook this innovative approach to the treatment of prostate cancer. Stanford University has been blessed to have him as an outstanding member of its faculty, someone who has advanced the reputation of the university in uncountable ways. Malcolm will remain a significant portion of whom we are and what we represent; we will continue to love him always.
Radiation Oncology biology
physics
www.redjournal.org
Feature Article: Obituary
A Tribute to Malcolm A. BagshawdAn Innovative Physician Who Soared to Success Richard T. Hoppe, M.D., and Sarah S. Donaldson, M.D. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA Received Jan 31, 2012, and in revised form Jan 31, 2012. Accepted for publication Feb 5, 2012 Malcolm A. Bagshaw, MD, an extraordinary physician, investigator, teacher, and leader, died September 18, 2011, at age 86. He passed away peacefully, surrounded by family, at his home in Palo Alto, California, after an extended illness. Born June 24, 1925, in Adrian, Michigan, Mal joined the U.S. Navy immediately out of high school and was accepted into the V12 program that enabled him to set his sights on becoming a physician. He attended Wesleyan University in Middletown, Connecticut, and then graduated from Yale University School of Medicine in 1950. He completed a surgical internship and began a surgical residency. However, shortly thereafter, he developed acute glomerulonephritis necessitating hospitalization and a year of bedrest. Thinking that perhaps surgery might be too physically demanding and having acquired an interest in radiology, he decided to switch to a career as a radiologist and was accepted into the University of Michigan radiology residency program. There he trained under Dr Isadore Lampe along with coresidents Drs Phil Rubin and Bob Parker. The University of Michigan was the first department in the United States to acquire an Atomic Energy of Canada (AECL) cobalt unit. Mal was assigned to assist the physicist in developing the depth dose data for this new machine. That experience served him well in the next phase of his career. Mal looked initially at a job opportunity in Southern California but decided it was not for him, although he found California to be appealing. Earlier he had met Dr Henry Kaplan at Yale. Kaplan had been recruited to chair the Department of Radiology at Stanford, and so he contacted Kaplan to ask whether he had an available position at Stanford. Kaplan did. Thus, in 1956, Mal joined the faculty in the Department of Radiology at Stanford, which at that time was located in the Stanford-Lane Hospital in San Francisco. However, Mal was surprised to learn, shortly after his arrival, that the Stanford Hospital was scheduled to move to the main Stanford campus in
Palo Alto in 1959! This provided Mal another professional opportunity. Although an astute diagnostic radiologist, Mal’s first love was therapy. He was appointed head of the Division of Radiation Therapy at Stanford in 1960 and ultimately became chair of the Department of Radiology in 1972, succeeding Henry Kaplan. Under Bagshaw’s leadership, in 1986, the department separated into 2 separate departmentsdDiagnostic Radiology and Therapeutic Radiology. Bagshaw continued as chair of the latter, which became Radiation Oncology in 1988. Mal’s arrival at Stanford put him at the “front of the line” to develop applications for the original Stanford medical linear accelerator, and he joined Henry Kaplan in pioneering its use. At that time, no one else in North America had access to such a device. The characteristics of the Linac made it a perfect tool for treatment innovation. Mal was resourceful, filled with scientific curiosity, and thrived in the environment of innovation. In a paper published in 1957, just 1 year after Bagshaw arrived at Stanford, he described double exposure portal imaging, custom bolus, lens shielding, rotational treatment, arc therapy, and image guidance by fluoroscopy. How visionary these innovations were! Over the next 10 years, he published major papers documenting novel techniques and the efficacy of treatment for cervix cancer, sarcoma, bladder cancer, ependymoma, larynx cancer, retinoblastoma, and testicular and prostate cancer. He soon became well recognized for the novel technique of treating ovarian cancer with whole abdominal irradiation and for treating mycosis fungoides with total skin electron beam therapy. At the same time, Malcolm was interested in the basic biology of cancer and ways to modify the radiation response. He undertook basic laboratory studies focusing on translational research, which lead to clinical trials to test radiation sensitizers, thus establishing a portfolio of research that continues to the present day at Stanford. Always interested in technology, he was also
Reprint requests to: Sarah S. Donaldson, M.D., Stanford University Medical Center, Radiation Oncology Department, G226, 875 Blake Wilbur
Dr, Stanford, California 94305-5847. Tel: (650) 723-6195; Fax: (650) 7253865; E-mail: [email protected] Conflict of interest: none.
Int J Radiation Oncol Biol Phys, Vol. 83, No. 1, pp. 6e7, 2012 0360-3016/$ - see front matter Ó 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.ijrobp.2012.02.010
Volume 83 Number 1 2012 attracted to the utility of particle therapy; in concert with a sabbatical in Los Alamos, he initiated a novel program at Stanford to develop cancer treatment using negative pi-mesons. Another of his major research programs was to design and define the role of hyperthermia in cancer therapy. Mal’s greatest achievement, however, was the development of radiation therapy as a primary treatment for prostate cancer. In the years immediately before his studies, only 0.2% of men with localized prostate cancer were treated with irradiation. Prostate cancer was considered to be a radioresistant tumor. But in 1965, based on his early experience, Mal reported a 5-year survival of better than 50% using radiotherapy in the treatment of localized prostate cancer, quite competitive with contemporary surgical series. He showed that high-dose, small-field irradiation allowed patients to undergo curative therapy without the need for surgery. This was achieved with a very low incidence of incontinence and frequent preservation of sexual potency. Mal’s techniques became the standard of the day. All of us recall the heated debates over the next 3 decades between Mal and the giants of urology at our national meetings, each laying claim to the more effective and less toxic treatment. The debate was not to be settled while Mal was still in practice, but it has been now. The urologists have conceded, for nearly 20% of urology practices now own radiation therapy facilities purely for the treatment of localized prostate cancer with irradiation. Mal’s voice has finally been heard in that debate. Mal excelled in his role as chair of the Radiation Oncology Department at Stanford. He instilled an exceptional sense of loyalty and dedication among the faculty and staff. In addition, he inspired his faculty to achieve leadership skills and productivity in the discipline. Mal was, as well, an expert and caring physician. But at the same time, he created an environment of camaraderie that we still refer to as the “Stanford family.” He was a passionate educator and highly skilled teacher. He was a fierce champion of his trainees, exuding pride in their accomplishments. One of his most prized possessions was a plaque his residents presented to him at his retirement party in 1992, attaching each of their signaturesda gift that he cherished always. We count 8 American Society for Therapeutic Radiology and Oncology (ASTRO) presidents, 12 ASTRO Gold Medalists, and many department chairs and leaders who were trained by or worked with Malcolm at Stanford. Mal was both an astute diagnostician and a master clinician. His teaching skills in the clinic were notable. He was particularly good at picking up subtleties on physical examination, making key observations on imaging studies, and drilling residents on anatomy. His early training in surgery and diagnostic radiology gave him a special appreciation for anatomic findings and the pathways for local-regional spread of cancer. At the same time, he was particularly compassionate in dealing with patients and families. He inspired confidence in all those around him. Mal contributed significant service to important organizations, including the National Institutes of Health, American Cancer Society, National Aeronautics and Space Administration, International Union Against Cancer, World Health Organization, and virtually every organization related to radiology, radiation oncology, and radiation research. He served as president and chairman of the board of ASTRO in 1972-1973. For this lifetime of contributions, he was awarded the highest honors in the field,
A tribute to Malcolm A. Bagshaw
7
including Gold Medals from ASTRO, the Nihon University in Toyko, the del Regato Society, the Gilbert Fletcher Society, the American College of Radiology, and the Radiological Society of North America, as well as the Medal of Honor from the American Cancer Society and the National Cancer Fighter of the Year Award. In 1996, he received the General Motors Charles F. Kettering Prize for Cancer Research, given for the most outstanding recent contribution to the diagnosis and treatment of cancer, in recognition of his role in improving prostate cancer treatment, facilitating nonoperative therapy and thus helping to preserve sexual potency and reducing the incidence of incontinence. He touched the lives of everyone with whom he came in contact. With his ever present ear-to-ear grin, everyone loved Mal. He was a man with endless numbers of friends who respected and admired him; a role model to countless numbers of students, residents, fellows and colleagues; and a compassionate physicianhealer to four decades of grateful patients. One of his greatest attributes was his infectious personality; he inspired loyalty from all who worked with and for him, with an ethic of “work harddplay hard.” Filled with an exuberance for life and true joie de vivre, Malcolm had many loves outside of medicine. He was a passionate fan of Stanford athletics. He was thrilled at a chance to lead the Stanford marching band on the football field, holding a baton that he rigged with a mechanism so that it twirled effortlessly despite his lack of baton-twirling skills. The opportunity to lead the band itself was a gift from his residents who had won it through an auction, bidding furiously against stiff competition. He was a pilot, the first to soar over the Sierra Nevada range, and he built his own sail planedin the living room of his home. He loved bike riding, often joining his residents for a trip through the foothills to the Pacific coast. He collected native American art and enjoyed a special personal collection of Kevin Red Star’s works. He loved to garden, work in the darkroom he had built in his home, and play his homemade guitar; after his retirement he also took up painting. Mal was devoted to his family. He had met his future wife, Muriel Hanley, while still an undergraduate, and he decided that since she was in Connecticut College for Women in New London that he would apply to medical school at Yale to be near her. He got his wish, and Muriel herself, who had become Muriel Bagshaw, entered Yale Medical School as well. She was one of a handful of women to graduate from medical school in the early 1950s. Muriel worked as a Stanford pediatrician for many years. The Bagshaws often opened their campus home for department parties and events, which frequently proved to be memorable. Muriel died in 1998, shortly before the couple’s 50th wedding anniversary. They raised three children together, Cassie, David, and Sarah. They are survived by their three children, their spouses, and eight grandchildren, as well as Mal’s sister and her husband. The fields of cancer research, radiology, and radiation oncology have been blessed to have such an innovative researcher as Malcolm Bagshaw. Hundreds of thousands of men have been blessed that he undertook this innovative approach to the treatment of prostate cancer. Stanford University has been blessed to have him as an outstanding member of its faculty, someone who has advanced the reputation of the university in uncountable ways. Malcolm will remain a significant portion of whom we are and what we represent; we will continue to love him always.