Florence CH Chu, MD, FASTRO

By Roger Robison, MD, and Ronald Dorn III, MD, FASTRO 

This conversation with Florence Chu, MD, FASTRO, Roger Robison, MD, and Ron Dorn, MD, took place on September 21, 2008, during ASTRO’s 50th Annual Meeting in Boston.

Question: We have the pleasure of interviewing Dr. Florence Chu and her husband who has accompanied her to the 50th anniversary meeting. Dr. Chu is one of the original founders, and we're so happy to have her here today. Dr. Chu, I believe you told me you were born about 1918.

Dr. Chu: Yes, I was born in 1918 in Shanghai, China

Question: And your husband, too?

Dr. Chu: Yes, in 1917.

Question: In Shanghai, okay. Our previous interviewee was also from that region. Was that area occupied by the Japanese during the Japanese War?

Dr. Chu: Yes, it was.

Question: And did you do your schooling in China, or here or both?

Dr. Chu: I graduated from the National College of Shanghai in 1942. During the War, the whole college moved to Chongqing because of the Japanese invasion and I spent several years there. Following that, I came back to Shanghai to intern and spent three years in training for radiology.

Question: And why were you interested in radiology? Any particular reason? Did your mom and dad or your husband or someone influence you? 

Dr. Chu: It was my own reason, a selfish one. I thought being married to my dear husband probably would require me to spend more time at home as well as at work, so I could not take surgery, for instance, which had many emergency calls. I thought diagnostic and therapeutic radiology would have fewer emergencies, so that was kind of a selfish reason.

Question: And the National University there, was that run by the Chinese government? Was there some foreign influence there? 

Dr. Chu: Oh, yes. This was a national medical school, and it was one of the best in China. Another famous medical school is the Peking Union Medical College, which was affiliated with the Rockefeller Institute. Our college was subsidized by the government.

Question: The Chinese government?

Dr. Chu: The Chinese government, yes.

Question: And then shortly after World War II, of course, the country underwent a Communist revolution. Were you involved? Did that cause you any difficulties?

Dr. Chu: Oh, yes. My husband and I were in the United States during that time, but our families back in China suffered a great deal from the communist revolution.

Question: Were you married at that time?

Dr. Chu: Yes.

Question: And when did you come to the United States?

Dr. Chu: After the war the Chinese government decided to send a group of students abroad for postgraduate training because for many years during the war no one could go overseas for instruction. The Chinese government issued a nationwide examination. Both of us took the examination and passed. The Chinese government then gave us fellowships to go to the United States for postgraduate study. We arrived in New York in 1947

Question: And what field was your husband in?

Dr. Chu: In anesthesiology.

Question: So, Dr. Chu, when you came to the United States, had you finished your training in radiology or did you come to the United States to do an additional fellowship?

Dr. Chu: I applied for a fellowship in diagnostic radiology at the City Hospital of New York. Professor Gottlieb was a very, very good professor. At the end of the training I was certified by the American Board of Radiology in diagnostic radiology.

Question: Then what did you do?

Dr. Chu: Then I decided to have training in therapy because I was thinking of going back to China to serve my country and would need both diagnostic training and therapeutic preparation. Following that, communists took over China, so we couldn't go back.

Question: This was 1950 or so?

Dr. Chu: This was 1948. I applied to three different hospitals for a therapy fellowship, and all three accepted me. I didn't know which one to choose, so I consulted my professor. Memorial Sloan-Kettering Cancer Center gave me no stipend; the other two hospitals offered a stipend. Dr. Gottlieb immediately said, “Go to Memorial.” No stipend.

Question: Yes, I think many of us can verify that the more prestigious the training program, the less they paid you in the old days.

Dr. Chu: Right, so I entered Memorial in January 1949 as a special fellow. This was a fateful decision because I spent 38 years there.

Question: Yes, about 1950 is when China fell to the communists, I guess.

Dr. Chu: Yes, that is right. And we couldn't go back.

Question: Dr. Chu, in Dr. Gottlieb's program, was there a mentor who interested you in therapy or was that an interest that you developed on your own? Did you have a therapy mentor?

Dr. Chu: I developed the interest because I had some training in therapy in China. The three years was combined diagnosis and therapy. I loved the patient contact in therapy.

Question: So tell us about your years at Memorial.

Dr. Chu: When I became a special fellow in radiation therapy in 1949, Dr. Ralph Phillips was the acting chairman. The department was very small. In addition to Dr. Phillips, there was only one radiation therapist and two special fellows, including me. Memorial had a wealth of radiation equipment, consisting of 12 treatment machines. These were 1 MeV X-ray unit, eight 250 KeV machines, two low voltage machines (130 KeV and 100 KEV) and a Phillips contact unit. Members of the radiation department treated very few patients with the 1 MeV unit. The great majority of patients were treated by surgeons and internists on 150 KeV machines. This was a long standing tradition of Memorial under the James Ewing Concept of training surgeons and internists to use radium, radon and X-rays for the treatment of cancer.

Question: 12 machines?

Dr. Chu: Yes.

Question: Surgeons and internists wrote the prescriptions?

Dr. Chu: Yes they did.

Question: Did they come down to the department?

Dr. Chu: Yes, they came down to see the patients; our 1 MeV was one of the first units in the U.S. Our surgeons did not use the 1 MeV because they were not trained to use it. We attended various medical conferences and expressed our opinions about advantages of good radiation therapy. Gradually, more and more patients were referred to our department for radiation therapy. It took many years for us to become independents, and it took one important step to do that. That was in 1967 that Memorial underwent renovation. The department was moved from the first floor of the main hospital to the second floor of the adjacent Firestone building to be near the betatron, where four new megavoltage machines were installed. The previous 12 machines were thrown out, putting a stop to the use of radiation therapy by the surgeons and internists. They did not know how to use more modern megavoltage machines.

Question: When did Dr. Nickson become the chairman?

Dr. Chu: Dr. James Nickson became the first chairman of the radiation therapy department in 1950. He expanded the department by increasing both staff members and equipment. He added a 2 MeV X-ray machine, a telecobalt unit and a 24 MeV betatron. He also established a radiobiology laboratory. Our betatron was the second installed for medical use in the U.S. The first was at the University of Illinois in Chicago. Dr. Lewis Haas in radiation therapy and Dr. John Laughlin in physics had started treating patients using high-energy electrons, but they treated a relatively small investigation of high-energy electron beam therapy.

Question: When did Dr. Laughlin come to Memorial?

Dr. Chu: Dr. Nickson recruited Dr. Laughlin to be in charge of medical physics. Dr. Laughlin came to Memorial in 1951 and became the first chairman of the newly formed department of medical physics in 1952. Dr. Laughlin and I collaborated in the program of developing high-energy electron beam therapy in the treatment of advanced breast cancer, particularly chest wall recurrences. For a 10-year period we treated more than 1,000 patients. Sophisticated treatment procedures were developed, and a number of papers were published. Dr. Laughlin and I also used to give refresher courses at the RSNA meetings.

Question: I just want to understand more about these surgeons. Did they take care of their own patients or did you have to take care of their patients?

Dr. Chu: They took care of their own patients.

Question: Their own patients?

Dr. Chu: Yes, they were cancer specialists trained to do everything at that time.

Question: So you finally got them out of there by late-50s or early-60s?

Dr. Chu: In 1967.

Question: Dr. Chu, tell us what you remember about the early days of ASTRO, the founding of the Club.

Dr. Chu: Dr. Nickson was one of a group of radiation therapists who, in the early 1950s, was actively planning to form an American club of radiation therapists. Through Dr. Nickson I met Dr. Juan del Regato, Dr. Gilbert Fletcher, Dr. Henry Kaplan and many other radiation therapists. Dr. del Regato was most active in soliciting full-time radiation therapists to join the Club. He was instrumental in organizing informal meetings for these radiation therapists to get together. I attended most of these meetings, which were usually held during the convenient times of RSNA meetings. Dr. Nickson was one of the radiation therapists who wrote the founders’ agreement. The American Club of Therapeutic Radiologists was formally established 50 years ago. There were 100 founding member, including me. The Club later became ASTRO.

Question: At Memorial, was that a residency training program in straight therapy? 

Dr. Chu: Yes.

Question: So the surgeons probably still did a lot of interstitial work. 

Dr. Chu: Yes, but together with a radiation oncologist. The surgeon does the operation, and the oncologist does the implantation of the tumor.

Question: You got them off the machines, but you couldn't keep them away from the needles and brachytherapy. 

Dr. Chu: That's right.

Question: So did you . . . I don't mean to belittle it, but it sounds a little bit like on-the-job training for your fellowship.

Dr. Chu: Yes.

Question: But did you take separate boards or did you bother taking any straight therapy boards?

Dr. Chu: I was certified in diagnostic radiology by the American Board of Radiology in 1948. In 1950, I took the board examination in radiation therapy and passed. The American Board of Radiology, therefore, replaced my 1948 certificate with a new certificate in radiology. This was because radiology included both diagnostics and therapy in those days.

Question: How many years were you practicing at Memorial?

Dr. Chu: 38 years.

Question: 38?

Dr. Chu: Yes, I started as a little special fellow and worked all the way to become the chairman of the department.

Question: Do you remember when you became the chair?

Dr. Chu: I became the acting chairman in 1976 and chairman in 1977.

Question: And you were chair until?

Dr. Chu: I retired from being chair in 1984 at the age of 65, remaining on staff for two more years. During my chairmanship we suffered from an acute shortage of treatment machines. In the duration of 1967 we threw out 12 old machines, including eight 250 KeV units. We installed four new megavoltage machines adjacent to the betatraon. Although, the move to all megavoltage machines solved the problem of prescription of radiation therapy by surgeons and internists, it created a new problem. The old site had a configuration of 12 machines, and the new location had only five unites, including the betatron, which was devoted to electron beam therapy. Thus, only four machines were available for photon beam treatment. Memorial was known to be surgically oriented at that time; it was difficult to get adequate funding for radiation therapy.

One of my first major tasks was to upgrade all five treatment units; they were old and overused. The funds allocated by the administration were sufficient only for equipment replacement, not for adding new machines. It took six years to replace these units one by one. During this period, only four units were available for treating an increasing number of patients from both Memorial and New York Hospital Cornell Medical Center. It was a difficult task to treat 200-250 patients a day on four units, one of which produced only electrons. New York Hospital did not have a radiation facility then, so their in-patients were transported through a tunnel to Memorial for treatments. We did our best to accommodate all patients by extending treatment hours to evenings and weekends. It was a great hardship on the staff of radiation oncology and medical physics as well as patients. Despite all of these difficulties, we ran the department smoothly, emphasizing good teaching, research and patient care.

Question: When did you quit working there? 

Dr. Chu: When I retired from the chairmanship in 1984, I was very happy because I thought I could have more time to do research and patient care. In 1986, the New York Hospital came and said, “Dr. Chu, we would like to invite you to be in charge of our radiation therapy facility.”

In the early 1980s, New York Hospital realized that they had to have their own radiation facility because of the overcrowding of patients at Memorial. The facility was completed in 1986. It was a beautiful building overlooking the East River. I accepted the invitation and became their chief of radiation oncology.

Question: Oh, that's wonderful.

Dr. Chu: I was their chief for 10 years; I retired in 1996 at the age of 78. I am now 90 years old (2008).

Question: Well, you certainly look good. So, New York Hospital waited until Memorial required you to retire and then they grabbed you.

Dr. Chu: That's right.

Husband: Dr. Chu was the first woman appointed as chairman of radiation oncology of a large institution.

Question: Oh, is that right? The first woman to be chairman?

Dr. Chu: A woman chairman of radiation oncology at a major institution, such as, the Memorial Sloan-Kettering Cancer Center.

Question: A wonderful honor. Was there anything in particular that you liked to specialize in? Any particular types of tumors?

Dr. Chu: I treasured my experience in the development of high-energy electron beam therapy. As far as my specialty was concerned, it was breast cancer. In my lifetime I had treated many thousands of patients with breast cancer.

Question: The equipment that you described wonderfully for us, the meager equipment that you had when you started, I love it – 12 treatment machines consisting of 1 MeV X-ray unit and 11 kilovoltage machinges. By the time that you left, things had changed, I guess, a little bit.

Dr. Chu: Oh, yes. When I was the chairman, we had only five megavoltage machines, including the betatron. My former chairmen and I could not convince the administration to add new machines. Things changed dramatically when Dr. Samuel Hellman became the physician-in-chief in 1983 and Dr. Zvi Fuks became the new chairman of radiation oncology in 1984. Dr. Hellman allocated a large sum of money to modernizing the Radiation Oncology Department, and Dr. Fuks expanded the department to house 10 megavoltage machines, along with other state-of-the-art equipment

Question: We serve at the mercy of these administrators, don't we? They control our lives.

Dr. Chu: Right, very right.

Question: You obviously saw and oversaw incredible changes at Memorial and for radiation oncology in general over the course of your career. Are there any particular important landmarks that you recall that had the biggest influence on your career or on radiation oncology in general?

Dr. Chu: I have to say that my most exciting experience was the investigation of the high-energy electron beam therapy. I am grateful to Dr. Nickson who gave me the assignment in 1953 when I was a young radiation oncologist. It was my privilege working with Dr. John Laughlin and his physics staff. Sophisticated treatment procedures were developed to give homogeneous radiation dose to the chest wall lesions with sparing of the underlying lung tissues.

Question: May I ask, were you and your husband blessed with children?

Dr. Chu: Yes. We have a daughter who is a surgeon.

Question: In the Memorial tradition. Does she practice in New York?

Dr. Chu: Yes, she's in New York.

Question: Well, I think it's been very gracious of you to wait so long for us to get organized this afternoon. It's been such a pleasure to hear about your career, which has just been fascinating. You were at a world-famous institution for those many years. Did Memorial move at all when you were there? Did they change buildings or locations? 

Dr. Chu: No. They didn't move. They just expanded peripherally to different areas, but Memorial itself is still on the same site.

Question: Did you folks live in Manhattan or out in the suburbs? 

Dr. Chu: Originally we lived in Manhattan. Then we moved to Long Island. Then finally we moved to New Jersey.

Question: Well, thank you so much for sharing this with us, and we're very grateful. We didn't touch much on your gender, but as your husband mentioned, you were the first full-time lady, and I guess we've seen a great deal of change in the number of women in medicine in general.

Dr. Chu: Oh, yes.

Question: And I think as you stated, the lifestyle would seem to be more attractive to women than surgery, say, but your daughter went into it anyway.

Dr. Chu: That's right.

Question: But we're blessed now with many women radiotherapists, and it may be due to your wonderful example, so we're very appreciative. Thank you very much.

Dr. Chu: You're very welcome.

Question: Is there anything you'd like to add, doctor?

Husband: She was very busy lecturing all over the world. She trained young physicians to become high-quality radiation oncologists and many of them later became chairmen of radiation oncology department in the U.S. and foreign countries.

Question: Oh, sure. At Memorial. Sure, big drawing.

Husband: Wherever we traveled, we usually met with a former trainee of hers. It was heartwarming.

Question: Do you have relations still back in China?

Dr. Chu: Oh, yes. My husband and I were honored by three institutions in September last year. They were the Shanghai Medical College, Zhong Shang Hospital and Fu Dan University. They kept us very busy attending all kinds of ceremonies. I have many relations in China, and we had a big family reunion.

Question: I think that's quite an honor, though, considering it's now a communist country, China is willing to acknowledge that you emigrated and were successful in a different culture and I think that's quite an honor to be recognized by your country.

Dr. Chu: Yeah, That was truly heartwarming. This current occasion of celebrating the 50th anniversary of ASTRO, honoring the founders, also made me feel great and excited. I was one of the 100 radiation oncologists who founded the Society 50 years ago. ASTRO is now the largest radiation oncology society in the world. I am extremely happy and proud to be one of the founders. This was a very rewarding experience for me in my life.

Question: And as your husband mentioned, it must be very gratifying to see your trainees all around the world.

Dr. Chu: Absolutely, most satisfying.

Question: In different programs?

Dr. Chu: Right.

Question: Well, we have your picture in the book, and I must say you don't look a great deal different.

Dr. Chu: Thank you. That's a nice compliment.

Question: Thank you, again.