JASH GALA 2016 HONORARY CHAIR

 

Ritsuko Komaki, M.D. FACR, FASTRO       

Professor of Radiation Oncology

Gloria Lupton Tennison Distinguished Professor in Lung Cancer Research

U.T. MD Anderson Cancer Center

When Ms. Sadako Sasaki, one of my elementary school friends in Hiroshima, died of Acute Granulocytic Leukemia at the age of 11 years old, I decided to be a researcher of Leukemia or a Physician to help others like her in the future.

Now, I am a professor of Radiation Oncology at the UT M. D. Anderson Cancer Center to treat patients with thoracic malignancies. I am interested in clinical trials, multidisciplinary treatment, normal tissue toxicities and transnational research.

While I was growing, my role model was Marie Sklodowska-Curie who has received two Nobel Prizes: one for Physics based on discovery of radioactivity in 1903 and the other one for Chemistry based on identification and production of metallic radium and description of the transmutation of one element into another element in 1911. She was a scientist, wife and mother of two daughters. Pierre Curie who shared his work with his wife and the Nobel prize in Physics, died in an accident when their daughters were still small. In 1904, Pierre was given a chair of at the Sorbonne and promised a new laboratory. The laboratory was never forthcoming, and tragedy struck on April 19, 1906, a rainy day in Paris--Pierre was run over and killed by a horse-drawn wagon while walking from his laboratory.

I have read Marie Curie’s biography so many times that I have memorized a part of her life story. Her background in Poland where she grew up was fascinating to me. While Russia occupied Poland, children were forced to read their textbook in Russian in front of Russian soldiers when they came to their school to observe the students performance under Russian rule. She was usually picked up by her teachers to read textbooks in Russian, since she was the best student in her class or school.  I am certain that her desire to be free from communists and enthusiasms to learn more science, made her to escape from Poland to France to succeed her education and being a leader of scientific society. Her older sister was in Paris for her education, which helped Marie to follow her sister’s step. Because of her father being a teacher, she was always interested in education. Reading her persistence to discover Polonium from the large amount of Pitch blend fascinated me. Her passion to discover the Radioactive Material based on the theory developed by Pierre and herself never destroyed her persistence in spite of her husband’s unexpected sudden death.

During my childhood in Hiroshima, I have heard so many terrible stories of deaths related to the Atomic Bomb, which were due to acute or late effects including malignancies, psychological depression and suicides. I started to think who discovered radiation, how the radiation was used for human beings and how the radiation effects to human beings. It is ironic that the discovery of radioactive material eventually killed Marie Curie, but her persistence to achieve her goal and death of Sadako’s death lead my life to persuade to become a scientist, clinician and educator.

My father was the youngest among the twelve children of Sake brewing family on a small island near Hiroshima. His father died when he was ten years old.  And his oldest brother had succeeded their family business. When a severe typhoon hit the inland-sea, the family owned ship caring Sake Barrels sunkand hisfamily bankrupt without any insurance coverage. My father had to work in his oldest brother’s new small liquor store in Hiroshima when he was 13 years old by delivering Sake bottles, so he could stay in his house. He decided to get scholarship in the Hiroshima University School of Education which means he had to commit himself to teach children between ages of seven and twelve in a small village for four years after completion his education in Hiroshima University. He saved his money during the most boring time of his life and he developed peptic ulcer in this tiny village. But he could save money and passed entry examination to go to Kyoto University where he majored economy. After his graduation from the Kyoto University, he got married with my mother through marriage arrangement and worked in Osaka city, second biggest city in Japan after Tokyo, approximately 250 miles east and north to Hiroshima. He started to work for one of prestigious companies “ Hanshin”. Then the Atomic Bomb was dropped in Hiroshima at 8:15 am on Aug.6th, 1945. He walked into Hiroshima city the day after of the Atomic Bomb.  And he was exposed to the black rain containing high dose of radiation. He lost many of his family members, but some of survivors in his family were exposed to high radiation from the Atomic Bomb. He decided to move back to Hiroshima to help his and my mother’s family and took a job of Hiroshima Bank. Every time he was promoted to be a chief of Hiroshima Bank’s branch, we had to move to different cities. I had to change my school 4 times during the elementary school, although I never complained. When we moved to Matsuyama City a small city in Shikoku Island, my teacher always asked me to read the textbook in our class. My classmates laughed at me because of my Hiroshima accent, which made me furious. My father was always busy and came home around 2 am. Being a banker, he had to entertain his customers after 6 pm every night. I never saw him other than Sunday. I always missed him and was puzzled about Japanese working system. He was the leader of Union and eventually dad to retire when he was at age 55 year old instead of being promoted to be the executive members of Hiroshima Bank. According to his educational backgrounds, he was supposed to be one of executives, but the rest of the executive members were afraid if his idealism or higher education than theirs.  He eventually died of disseminated Bladder Cancer at age of 72 years-old possible due to exposure to the Atomic Bomb and the tobacco smoking. He smoked one to two packs of “ Peace” per day for at least forty years. I was so afraid that he might develop lung cancer, but he developed, diabetes, bladder cancer and peripheral vascular disease . My father was a very hard workingman who was so disappointed by his first child’s and only one son’s incurable illness, which kept him very distant from three daughters. I was the middle of three daughters and felt that the presence of daughters did not mean much for him and wished I were born as a boy to succeed my father’s wishes.

My mother was the oldest daughter of Samurai family. Her father graduated from Tokyo University and served once as the chief officer of the ministry in Agriculture in Japan. After he retired, he served a secretary of Mr. Asano who was the lord of Hiroshima Prefecture. My grandparents had a huge samurai house with several maids and secretaries to serve them. My mother was raised by a bay sitter, since her mother (my grand mother), was too busy to visit temples and shrines. My grand mother was the second wife to my grand father after he lost his first wife due to tuberculosis. He decided to get married with the strongest woman in the town. My grand mother was 6 feet tall and no men wanted to get married because she was too tall. She had red hair and fair skin and everybody said that she had one-eighth Russian blood. My mother was so proud of her samurai family background and blamed that her marriage to a lower class person, my father, was due to the first world war. She talked about her Grandmother named “ Chika” who was the most elegant and caring person for her. My mother truly loved me and hugged me when I had a good grade in school, which I never had from my father or anybody else.  My mother read almost all books in her father’s library by age of seven years old. Because of her father being the secretary of the Lord, he had so many books of European and Asia history, which she read and memorized all. When my husband and I took my mother to France and Vienna, she was a guide for us regarding Royal Family’s Trees in Europe.  She read many Chinese History and Russian History Books and all of twelve volume book “ Gig Earth” by Pearl Buck regarding China. However her incredible knowledge of worldwide history did not help to support family members when everything was destroyed by the A.B.  She wanted her three daughters to become more capable women to support their family in case any tragedy would happen to their spouses. My mother had a high pride but always so kind to poor people that she told me to give my extra pencils and notebooks to some of my classmates who were orphans after their parents died due to the A.B or had only mothers because of their fathers died of due to the war. She loved to cook for us and to make Haiku (Japanese Poem) entire her life. Also she traveled with us after my father died.  Her knowledge about histories of European Countries and Japan and beautiful Haiku making amazed us wherever we traveled. My mother died of the stomach cancer when she was 80 years old. I still miss her so much. 

I was born in Amagasaki City, Hyogo prefecture between Osaka and Kobe in Japan while my father was working in Osaka. I was the third child for my parents and my family decided to move back to Hiroshima when I was four years old, since my parents originally came from Hiroshima and had to help their family members whoever survived after the AB.  However, we had to move around so many times in Hiroshima after we moved back to Hiroshima due to the lack of houses and my father’s promotion in the Hiroshima Bank. I had to change my elementary school four times within six years.

I met Sadako Sasaki at Nobori-Cho Elementary School in fifth grade. We were both 10 years old, and she and I were in different classes competing in track and field events for our school's fall sports day. Sadako was very fast, and I had a tough time trying catch up with her. She eventually became shortness of breath due to anemia and was found to have Leukemia. She was hospitalized and died of Leukemia nine moths after the diagnosis, although she has registered to attend to the Nobori-Cho Junior High school which she could not make. Sadako was exposed to the radiation from the AB when she was two years old. While Sadako was hospitalized because of her Leukemia, she tried to fold one thousand Origami Cranes. In Japan, Crane is a symbol of “Longevity and Happiness.” If you could fold one thousand Origami Cranes, you will recover from your illness. After she took medication, she folded her Origami Carnes from the wax paper, which wrapped her medication. Sadako wanted to live! In spite of our prayers and helping to folding Origami Cranes, she passed away before she entered to the Junior High School. She had registered to enter to the Junior High School where I became the president two years after her death. When she died, all our school kids expressed sincere sorrow to her brothers and parents.

I started to communicate more often with Sadako’s older brother when I became the president of the Nobori-Cho Junior High School Student Council. Her brother and I initiated the idea of a memorial statue for Sadako.

We decided to stand on streets to collect donations from citizens of Hiroshima and wrote many letters to deans of schools in Japan asking for contributions.

Also we have got a young gentleman, Mr. Kawamoto, who helped us to get an public educational film making group to create “ Sadako’s story “ which became a big hit film entitled“ One thousand carne” shown in many movie threatens. Within two years, we have collected enough funding to get an architect who created “ AB Children’s’ statue in the center of the peace memorial park in Hiroshima which was the hypo-center of AB.

Sadako’s death had a very strong influence on me. I was very sad but had a definitive idea that I had a mission to not let the world forget her death and to not let the world repeat a war that destroyed so many lives both immediately and afterwards. I was very curious about the effects of the AB, since my grandmother was in Hiroshima when the AB was dropped and her house collapsed because of the suction effect from the AB.

She was underneath of her house, but was saved from her collapsed house and taken away outside of the city. The following few months, she had every side effect of total body radiation, e.g., loss of all her hair, sever diarrhea, anorexia and bone marrow suppression. But she recovered from the acute total body radiation effects and came to live almost a normal life without having leukemia or any malignancy. My grandmother died of severe senile dementia and osteoporosis at age of 72. I always puzzled by a question why my grandmother did not develop leukemia like Sadako. Now I do understand much better by learning higher susceptibility to carcinogens in dividing cells or younger generation.

I decided to go to a medical school and my parents wanted me to stay in Hiroshima, since it would take six years to graduate. My parents did not want me to separate from them. While I was a medical student, I volunteered to perform physical examinations for people who were exposed to AB at the Atomic Bomb Casualty Commission (ABCC), now is called Radiation Effect Research Foundation (RERF) during summer vacation.

I became very interested in hematology and chromosome abnormality while I was working at the RERF where I met Dr. Awa who was one of world experts in the chromosome abnormality caused by Radiation. Also, I met Dr. Bloom who was a hematologist and Dr. Bell who was a thyroid specialist. Dr. Robert was a cardiologist who was checking cardiac effects on human beings from exposure of AB.

I had a great opportunity to meet with great scientists and clinicians at the RERF who were interested in Radiation effects on human being .

When I graduated from the medical school, our Hiroshima University Hospital was as well as all university hospitals, since all interns and medical students decided to go on strike. We wereprotesting the governmentto pay internship and improve medical system at the University Hospitals and Medical School Curriculums. We had to go outside of University Hospitals to get postgraduate education by ourselves. I went back to RERF and worked one year and came to the United States to continue my postgraduate education.

I started my internship at the St. Mary’s Hospital where I met Dr. Guenninger who had double specialties, one Internal Medicine and the other Radiation Oncology. He was well respected by Surgeons and Medical Oncologists whom I was working with.

I started to think about the Radiation Oncology, but because of my original interest in Hematology Oncology, I started work at VA hospital as a Hematology Oncology fellow. However, the results of patients treated by chemotherapy around that time were not great. Most of the time I had to deal with anemic patients at the VA hospital. When I saw some patients who were cured by radiotherapy for their early laryngeal cancer or Hodgkin’s disease, I decided to go toe Radiation Oncology Residency program. From my back ground in Hiroshima, the Radiation Oncology was fascinating area for me. I have learned so much about surgical oncology from Dr. William Donagen, about Gynecologic Oncology from Dr. Richard Mattingly, Pathology Dr. Lawry Clowry, Pediatric Oncology from Dr. Larry Kun and Dr. Donald Pinkel, Lung, Head /Neck, GU and Lymphoma from Dr. James D. Cox, Roger Byhardt, and Dr. Donald Eisert,  BreastandBrachytherapy from J. Frank Wilson and Physic from Dr. Michael Gillin. I was the first and only resident when I started the residency program under thenew Chairman of Dr. James D. Cox. I was well taught by the famous Radiation Oncologistswho were all interested in multidisciplinary approach and teaching. When I came to MDACC as an observer for three month in 1980, Dr. Gilbert H. Fletcher was still chairman at the Department of Radiation Oncology at MDACC.  

I wanted to be expert of GYN and came to follow Dr. Fletcher’s clinic.  His knowledge in the Head/ Neck and GYN was truly impressive. Again, I met so many great Radiation Oncologists (Drs.Gilbert Fletcher, David Hussy, Nora Tapley, Eleanor Montague, Lillian Fuller, Luis Delclos, Thomas Berkley, Robert Lindberg, Rodney Withers) GYN and Head/ Neck Oncologists at the MDACC.

I never imagined working such a prestigious institution such as the MDACC at that time, but now I have been here almost twenty years. I have completed my Radiation Oncology Residency program at the Medical College of Wisconsin (MCW) in 1979 and did my fellowship in 1980. I stayed at the MCW and became to an associate professor of Radiation Oncology. My specialty was GYN oncology and was interested in predictors of the GYN malignancies including histological grading, ploidy, DNA index, anemia and other factors.

I have taught medical students during summer and many of them now became professors of Radiation Oncology at the MCW including Beth Erickson Colleen Lawton, and Chris Shultz.

Because of Dr. Eric Hall’s reputation on Radiation Effects on human being and persistent recruitment by Dr. Chu Chang who was one of the kindest physicians we have met in NYC.  Dr. James D. Cox took a chairman position of the Radiation Oncology Department at the Columbia Presbyterian Medical Center in 1985. This new department was created 40 years after the last Department of Anesthgiology. I tagged along with him, since we have been married in 1980.

I got a position as clinical chief and associate professor of Radiation Oncology at the Columbia Presbyterian Medical Center. I treated many Breast Cancer patients, GYN and Lung Cancer patients. I introduced conservative surgery followed by Radiotherapy for early Breast Cancer, which was not routine there at that time. Dr. Gump was one of open-minded Breast Cancer surgeons and became very collaborative with us.

Jim and I worked so hard to make the Radiation Oncology department better. We met great people there, but clinical trials and studies were very difficult to accomplish. We decided to move to MDACC when Jim was offered a vice president patient care and physician in chief of MDACC in 1988. Dr.Peter Peters Division Head of the Radiation Oncology at that timerecruited me as a section chief of Thoracic Radiation Oncology and an Associate Professor of Radiation Oncology. I have learned so much about Radiation Pneumonitis from Dr. Elizabeth Travis, Radiation Time/ Fractionation on the Head/ Neck Cancer from Drs. Lester Peters and Kian Ang and Translational Research from Dr. Luca Milas.

Highlights in my life are to become president of American Association of Women Radiology (AAWR) in 2001, president of American Radium Society 2007-2008, receiving Award from Texas Women Business in 2005, Marie Sklodowska-Curie Award in 2005, and receiving The Society in Tribute to Maria Sklodowska-Curie in Warsaw, Poland in 2006. I wish my mother were with us when I received the Marie Curie Award. She would have been so proud of me and hugged me saying “Ri-chan (my nick name), you have done a great job!”.

One more highlight for me with Jim Cox and others was opening Proton Center in May 2006. Proton treatment has been one of our dreams to reduce side effects to normal tissue especially for Children. After being raised in Hiroshima, I always felt that Radiation is double-edged sword, as Eric Hall said.

If low dose of Radiation was scattered over the body, incidence of the second malignancy will increase especially among children or long-term cancer survivors. On the other hand, Proton with active scanning to remove neutron, will give very sharp beam edge without scattering Radiation which will reduce the chance of the second malignancies.

In the personal life, my highlight was getting married with Jim Cox who has been my mentor, friend, advisor, supporter and a wonderful husband. My hobbies are traveling ,Japanese gardens, Orchid and flower arrangement. Also I love to talk to children about Sadako and how to make Origami Cranes. I would like to let them know how terrible the nuclear war to be which must be prevented.

There were many sad memories in my life including my brother’s illness, Sadako’s death, my parents’ deaths due to cancer, Valerie Cox’s death due to automobile accident when she was 18 years old.

Whenever I faced those tragedies, Marie Curie words encouraged me.                               

As Marie Curie said” Life is not easy to anybody. But what of that? We must have our perseverance and above all confidence in ourselves. We must believe that we are gifted for something and this must be attained.” ,“Nothing in life is to be feared. It is only to be understood.” and “ One never notices what has been done; one can only see what remains to be done.”.

At the end, I thank all great clinicians, managers, nurses, therapists, physicists dosimetrists, dietitians to care patients, scientists, and educators to take care of tranees and fellows at the MDACC. I will continue to learn science, care patients, teach others and give messages from Sadako, Marie-Curie , my mother and my patients who all still live in my mind always.