Trailblazers in Radiation Oncology Awarded Society’s Most Prestigious Award
2023 ASTRO Gold Medal Recipients
By Jennifer Jang and Diane Kean, ASTRO Communications
Congratulations to the 2023 ASTRO Gold Medal recipients, Najeeb Mohideen, MD, FASTRO, Simon Powell, MD, PhD, FASTRO, and Randall K. Ten Haken, PhD, FASTRO, who join the revered class in receiving ASTRO’s highest honor. Awarded annually, ASTRO Gold Medal winners represent a premium class of leaders who contributed to the field through their clinical patient care, research, teaching, mentorship and service.
Najeeb Mohideen, MD, FASTRO, is a radiation oncologist at Northwest Community Hospital in Arlington Heights, Illinois. A long-standing active member of ASTRO, much of his work occurs behind the scenes. Whether advocating for fair compensation or planning the Practical Radiation Oncology track for the Annual Meeting or brainstorming the next topic for ASTROnews, Dr. Mohideen’s influence on the field is monumental. As one of his peers put it, “Never was so much owed by so many (our entire specialty) to an individual.”
Dr. Mohideen grew up in Kerala, India, where encouragement from his mother pointed him in the direction of a career in medicine. He earned his MBBS from the Armed Forces Medical College in Pune, India. A family history of cancers diverted his interest to the field, and he spent two years as a Post Graduate Resident in Radiotherapy and Oncology at the Regional Cancer Center, Government Medical College, Trivandrum, under the mentorship of Dr. M. Krishnan Nair, “a doyen of cancer care.” Dr. Nair started the department in Trivandrum after training at Christie Hospital in Manchester, United Kingdom (UK). Dr. Mohideen followed Dr. Nair’s path to the UK to further study oncology in Cardiff and Leeds, acquiring his fellowship in Clinical Oncology (FRCR).
Dr. Mohideen then moved to the United States to pursue research opportunities. He completed a residency in radiation oncology at Loyola University and joined the faculty there for eight years, rising to Associate Professor, before joining Northwest Community Hospital in 2005, where he continues to practice. “I truly love my job and the challenges that it gives me. I like to help people and have the privilege to meet and get to know some incredibly brave people at a challenging time in their lives. We are so fortunate to have the training to use some really powerful tools to help cure or palliate their disease.”
Dr. Mohideen was integral in helping shape the fiscal status of radiation oncology. Much of his work in the early 2000s was behind the scenes through his role as the radiation oncology advisor for the AMA’s Relative Value Update Committee (RUC). As a peer stated, “[Dr. Mohideen’s] ability to negotiate without appearing pretentious or sanctimonious…led to an admiration that bordered on reverence at the RUC table.” Another describes his “tireless efforts and talents as a skillful negotiator and ambassador for our field.” A partial list of accomplishments at the RUC include bringing to the specialty SBRT treatment management and delivery, 4-D simulation, and revaluation of IMRT, bringing stabilization to the compensation platform. Never one to take credit without first acknowledging the team he works alongside, Dr. Mohideen reflected on one of the highlights of his time on the RUC: “It’s the teamwork involved in creating and valuing the SBRT codes, including physician management. Like IMRT, it has transformed our field and enabled access to this technology across the nation to help many patients. It’s rewarding when you have research, clinical trials, advocacy and health policy come together to positively impact patient care.”
Dr. Mohideen served on the RUC in this all-encompassing role for a record 10 years and continues to advise on and be an active member of many health policy committees for ASTRO. He was chair of the ASTRO Health Committee and then the Health Policy Council, serving on the ASTRO Board of Directors from 2009 to 2013. “I always had an interest in health equity and policy. The two go together — when you have good health policy, health care is available for more people and there is better health and quality overall.”
In addition to his many roles within ASTRO, he is current chairman and long-time member of the Board of Directors at The Radiosurgery Society, served as Economic Committee Chair of the Commission on Radiation Oncology for the American College of Radiology, is an active member of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) at the Centers for Medicare and Medicaid Services (CMS) and, since 2016, has served as the Senior Editor of ASTROnews.
As senior editor, Dr. Mohideen set out to address key issues impacting the field “through the lens of very different perspectives to generate a discussion on the progress and future of our specialty.” He’s been applauded by peers for leading the charge for inclusiveness and equity long before high-profile tragedies raised the collective awareness of racial inequities with the proactive, forward-thinking 2018 issue, “Thoughts and Reflections on Diversity in Radiation Oncology.” He expanded the editorial board to be more diverse, including international representation, and sought authors from varying backgrounds to bring different perspectives. “It has been so rewarding to get feedback on many of these issues both positive and negative; it tells me that we are a vibrant, thoughtful specialty who care deeply about our patients and the society we all live in.”
Another long-lasting impact was leading the development of the Practical Radiation Oncology track at the ASTRO Annual Meeting. Dr. Mohideen served as inaugural chair of the task force from 2018 to 2020. Now in its sixth year, this weekend program for community-based practitioners and academicians who cannot attend the full meeting has created a sense of camaraderie and engagement.
Dr. Mohideen has received many accolades: two-time recipient of ARRO’s Teacher of the Year award, ASTRO Fellow in 2014 and Fellow of the American College of Radiology in 2015, among others. He has mentored countless students and made a lasting impact on colleagues.
“I love working with the next generation. I am excited about the future of our field and the amazing talent that we have,” Dr. Mohideen remarked when discussing what’s next. “Both technology and biology will advance to help us treat patients more effectively and safely and there will be increasing use of AI and big data. We need to underscore the need for radiation oncologists to be central to multidisciplinary care.” He’s concerned cancer will pose an enormous and growing challenge to health care systems worldwide. Disparities need to be addressed and diversity needs to be promoted. Leaders like Dr. Mohideen influence the next generation, especially through the humble and visionary perspective by which he helps shape the future.
Simon Powell, MD, PhD, FASTRO, chair of the Department of Radiation Oncology and an attending radiation oncologist at Memorial Sloan Kettering in New York City, is a world-renowned physician-scientist, internationally recognized for his research in the genetics and molecular biology of DNA repair and the application of this to clinical radiation oncology. Dr. Powell is also a highly respected leader and representative of the specialty, mentor to many and an active volunteer to ASTRO.
Dr. Powell originally hails from Manchester, England. He received his undergraduate and master’s from the University of Oxford followed by his MBBS from the University of London, where he also went on to receive a PhD in cell and molecular radiation biology. Under the tutelage of Michael Peckham, a professor of oncology at the Royal Marsden Hospital, Dr. Powell decided to shift his initial focus of neuroscience to oncology. “My medical student elective with Michael Peckham was undoubtedly the turning point,” said Dr. Powell. “Although he was head of an academic department of radiotherapy, there was an extensive component of chemotherapy in the department’s work, since the specialized practice of the group grew from treating testicular tumors and lymphomas.”
After completing his PhD, Dr. Powell was recruited by the late Herman Suit, MD, FASTRO, to complete a fellowship in radiation oncology at Massachusetts General Hospital and Harvard Medical School. He secured an R01 and over the course of 12 years, established his research laboratory in DNA repair and moved up the faculty ranks to associate professor. In 2004, Dr. Powell became professor and head of radiation oncology at the Washington University School of Medicine in St. Louis. In 2008, Dr. Powell was recruited as professor and to lead the Department of Radiation Oncology at Memorial Sloan Kettering Cancer Center, where he continues to practice and teach today.
Dr. Powell is lauded as a preeminent physician-scientist and his portfolio includes more than 240 publications on DNA repair, cell-cycle control and radiation therapy. His research provides a direct link to the basic sciences and the translational research that impacts patients daily. When looking back at the years, he summarizes: “In the 1980s, the detailed biology of how radiation killed cancer cells was still quite limited, and while radiosensitive cells had been identified, the reason for their sensitivity was still largely unsolved. The 1990s led to an explosion of gene cloning and understanding the mechanisms of DNA double-strand break repair, which has been the focus of my laboratory and translational research for more than 30 years. DNA double-strand break repair is not limited to radiation repair. It is a relevant mechanism of carcinogenesis, exemplified by BRCA1/BRCA2 genes, as well as required in the repair of a number of cytotoxic drugs (e.g., cisplatin, etoposide, doxorubicin).”
More specifically, Dr. Powell’s translational studies revealed a number of early observations on the role of BRCA1 and BRCA2 in modulating DNA repair induced by radiation. These findings have been translated from the lab into clinical trials for women with breast cancer, including ongoing evaluations of DNA repair as a marker of response in women with triple negative breast cancer. His work influences not just radiation oncology, but all cancer research and has influenced the design of clinical trials at multiple institutions. Dr. Powell’s leadership in the field is demonstrated in his role as the Principal Investigator (PI) of the NCI’s Specialized Programs of Research Excellence (SPORE) grant in breast cancer. As a peer remarked, it is rare to have a radiation oncologist as PI on a SPORE grant and “a visible reflection of the key role our field plays in oncologic research and the accomplishments our researchers can provide.” Dr. Powell’s reputation as both a researcher and respected leader in oncology led to this accomplishment.
Inside and out of the lab, Dr. Powell has mentored countless trainees, influencing the next generation of radiation oncologists. Many of his mentees now lead their own departments and programs, contributing to both research and clinical disciplines in radiation oncology. When considering the future, he believes much improvement remains in the delivery of radiation therapy — to make each radiation plan more precise to the individual tumor of the patient. Combinations of radiation therapy with cytotoxic chemotherapy or biological therapy or immunotherapy can be fine-tuned to genotype and phenotype of the tumor, which includes the tumor microenvironment. Improved precision radiation oncology will enlarge the therapeutic ratio: better tumor control and less side effects. He views another exciting and growing research area in the increasing role of radionuclides conjugated to antibody or ligand-based targeting. As he mentors, he encourages radiation oncologists to be involved, since they are the only specialists who understand radiobiology, an area of increasing importance to optimize effectiveness.
He has been heavily involved in modernizing board exams through his role on the Radiation Biology Section with the ABR and increasing the scientific footprint of ASTRO’s Annual Meetings and specialty meetings and workshops.
Dr. Powell is described by ASTRO peers as “a clinical leader in our own community, a scientific leader in the broader oncologic community, and a mentor to a whole new generation of investigators.” Not surprisingly, he views the Gold Medal as “a wonderful culmination to [his] career in radiation oncology.” He was honored to be linked to all the previous awardees of the Gold Medal and hopes to continue to spread the mindset that “asking important questions is the best way to move the field forward.” This inquisitive spirit is present in his many other involvements, including as a long-standing volunteer both within ASTRO and many other professional organizations, including the Royal College of Physicians of the United Kingdom, ESTRO, and the Radiation Research Society. He is a Fellow of the Royal College of Radiologists of the United Kingdom and received ASTRO Fellow designation in 2014. He is also an active member of the ASTROnews Editorial Board, helping shape each issue by providing insights and guidance on topics relevant to the field.
Dr. Powell’s influence has raised the profile of radiation oncology, whether through his leadership at MSKCC, his work in the lab or with his many mentees, his impact is felt throughout the specialty.
A Wisconsin native, from the outset Randall K. Ten Haken, PhD, FASTRO, always had an enthusiasm for science, as evinced by an undergraduate degree in applied math and engineering physics at the University of Wisconsin, followed by a PhD in experimental nuclear physics. An accelerator was located in the lab where he did experiments in nuclear physics, and another physicist spent time there making PET isotopes for his nuclear medicine studies. The two started to discuss their work, and Dr. Ten Haken learned more about the medical physics field, something that was intriguing for its more applied nature. As one who always enjoyed the hands-on aspects of experimental nuclear physics, his initial plan was to do a post doc in nuclear medicine and build and work with PET scanners. However, digging further, he learned about radiation oncology, and appreciated the immediate positive impact he could make in the clinic by treating patients.
While making inroads in the field, Dr. Ten Haken’s work has touched all aspects from teaching at the University of Michigan, to research in the lab, to practicing in the clinic. Following his post doc in medical physics at Tufts-New England Medical Center in Boston, he spent four years at Fermi National Accelerator Laboratory in Illinois, where neutron therapy was the focus. Dr. Ten Haken noted this was a particularly fruitful time in his career, as he and his colleagues spent several days a week treating patients and several doing research, all the while bumping into Nobel Laureates in the cafeteria and enjoying the intellectual richness of that environment.
Around that time Dr. Ten Haken attended an American Association of Physicists in Medicine Meeting, and met Benedick Fraass, PhD, FASTRO, another medical physicist who came from a similar background of experimental physics. They hit it off, having similar thoughts and backgrounds, and some months later, Dr. Fraass asked him if he’d be interested in joining him, Allen Lichter, MD, FASTRO, and Daniel McShan, PhD, at the University of Michigan. Reflecting on this time, Dr. Ten Haken remarked, “I knew I had to get back into the mainstream of medical physics and radiation oncology. This seemed like a good chance to join the jet stream.” Together, in 1984, they started the Radiation Oncology Department at the University of Michigan and introduced 3-D treatment planning to the clinic.
As a team, they checked each other’s work, did research on building 3-D treatment planning and making it work in the clinical setting. They started out with the 3-D treatment planning systems, but at that time, they were used for research and not widely used in the clinic. The Department was among the first to make the systems clinically useful. “When I think of what I’m proud of, in the earliest studies that we did, we looked at patient motion and set uncertainties and their impact on treatment outcomes.”
Dr. Ten Haken and his colleagues also were among the first to discuss the dosimetric impact of prostate motion due to differential filling of the rectum and bladder, a factor rarely considered at the time. This discovery was followed by more studies and the impact of breathing on the design of treatment, especially for tumors in the lungs and liver. They published these findings, and they learned that treatment teams needed to incorporate patient-specific anatomy and setups certainties and organ motion into the treatment planning process.
This led to a career of integrating these findings into clinical practice, and to the development of phase one dose escalation methodologies. Initially a one-size-fits-all approach was the standard for radiation treatments. But Dr. Ten Haken was the primary innovator for a more customized method, incorporating a dose escalation scheme that led to clinical trials demonstrating the ability to safely deliver higher doses of radiation to tumors in the liver and lung that had been deemed not possible prior to that work.
Dr. Ten Haken and his colleagues shared their discoveries at AAPM and ASTRO meetings and were often initially met with skepticism. Attendees commented that they had nice pictures, but Dr. Ten Haken and colleagues were persistent and kept their findings at the forefront of important conversations. The liver and lung in particular revealed themselves to be “volume effect” organs, where the dose escalation scheme they devised for treatment of tumors located in them allowed the team to give higher doses than had been attempted prior. They made outcomes models for complications, and designed treatments that took the dosage up to a tolerable level of toxicity for each patient, allowing for the individualization of tumor treatments and, ultimately, the optimization of treatment plans. Dr. Ten Haken and the team also noticed the impact of motion and started to include that factor in the models for individualized treatment. Most recently, he noted that they have used physiological imaging and treatment response assessment for both tumors and normal tissues to individualize patient treatments. Looking ahead, he is excited about the continued individualization of treatments, and the ability to better adapt during the course of therapy.
Dr. Ten Haken noted that one of the advantages of radiation oncology is the opportunity to see the patient over several treatments, and the chance to see how the tumor and normal tissues are responding to the radiation and change the course of therapy if need be — termed “response-based adaptive therapy.” This ability can be attributed to the answers provided in particular imaging of anatomy and physiological changes. Furthermore, machine learning and artificial intelligence applications will contribute to more personalized treatments and ultimately better outcomes.
Dr. Ten Haken remarked that the Gold Medal award is a team effort, brought about by working for decades with physicists, physicians, dosimetrists, therapists, computer scientists, and the entire patient support team, and an honor to be shared.
The Gold Medal Award will be presented to Dr. Mohideen, Dr. Powell and Dr. Ten Haken on October 3, during the Awards Ceremony at ASTRO's 65th Annual Meeting in San Diego.
