Explore UAB

From our modest beginnings in the basement of the Jefferson Tower in 1969, the Department of Radiation Oncology at UAB has ascended to the technological vanguard of its field. An evolution ensued from our roots as a clinical-based unit to that of a world-recognized leader in clinical care, education, and research.

  • The 1960s: Beginnings
    While the field of radiation therapy has more than a century of history, its duration as a discipline at this campus is much shorter. In the 1930’s radiation therapy was simply a unit within the Department of Radiology, which consisted of both a diagnostic and a therapeutic section. This was the typical arrangement found at most facilities in the United States. While Radiation Oncology became recognized as its own discipline much earlier in Europe and Canada, it instead remained the therapeutic branch of radiology at UAB and much of the United States until decades later. With encouragement from then Radiology Chairman Robert E. Roth, MD, Dr. Clifton K. Meador, the Dean of the Medical College, finally agreed to separate the therapeutic portion from the remainder of the Department of Radiology in 1969. With this strategic action, the Department of Radiation Oncology was born. Dr. Roth, with fellow physicians Merle Salter, M.D. and Donn Brascho, M.D., medical physicist Benjamin Blackburn, and technical program manager Norbert Black, RT formed the foundation of our first Radiation Oncology staff. While together they were the foundation of a new organization in an emerging field, they were by no means inexperienced. The melding of their versatile skill sets quickly set the stage for brisk development and a period of swift advancement.
  • 1970s: Innovative Spirit

    The 1970s was a decade of rapid growth and change, for both the nation and for the newly formed department. Many clinical advances were achieved, and the groundwork was put in place for the development of our educational mission. Some cutting-edge technologies and methodologies were either created or furthered here, and this period brought the realization that it is was necessary for radiation oncology to expand as a field in the state of Alabama. UAB was going to be the organization that led the charge. A new facility was built and opened in 1976 in recognition of the regional void in essential cancer treatment facilities. Dr. Roth and Jill Caranto, RT (R)(T), CMD agreed that the current home to Radiation Oncology, the Lurleen B. Wallace Tumor Institute, was born out of Lurleen Wallace’s bout with cancer. “No one in the state had the facilities to provide her with necessary treatments at that time, and that kind of awakened legislators to the need to get new facilities in place in Alabama.” The city of Birmingham’s steel industry was waning and UAB was the new wunderkind. Funding was quickly available for the project. “We designed it (The Lurleen B. Wallace Tumor Institute) originally to house Radiation Oncology in the Basement and on the First Floor, with Medical Oncology up above,” recalls Dr. Brascho, a former department physician. Medical Oncology eventually outgrew the space, leading to the department’s move to The Kirklin Clinic when it opened in 1993. UAB also began providing traveling dosimetric services for brachytherapy patients at other facilities in Alabama. “We had an old Winnebago that we used to carry the tools of the trade around to other facilities. In fact, we had people traveling all over the state on a regular basis, helping other facilities help their cancer patients,” exclaimed Dr. Brascho. Many of the advancements in radiation oncology during the 1970’s were related to treatment planning. Dr. Brascho was a pioneer at using ultrasound for improving the accuracy of treatment planning. His revolutionary methods proved to be much more precise than utilizing wires for targeting. According to Ivan Brezovich, Ph.D., Dr. Brascho “was so respected for his contributions, he became one of the few MD’s to be inducted into the American Association of Physicists in Medicine (AAPM) as an honorary member.” Other advancements were made by other contributors. Said Dr. Brascho, “Ben Blackburn developed a 3-field, perineal technique using special compensators with the Cobalt unit. This technique allowed for more tolerable doses to be delivered to patients.” Some of Ben Blackburn’s ideas in the field were so ahead of their time that Dr. Spencer, detailing some early advances in our department, noted: “Ben Blackburn was a masters-trained physicist that was thirty years ahead of the field in some aspects.” Some very notable work on hyperthermia came from Dr. Brezovich, Ruby Meredith, M.D., Ph.D., John Durant, M.D. and Robert Kim, M.D. The goal was more effective cancer treatment, built upon the idea that combining heat with radiation provides a synergism that improves the rate of killing cancer cells. Most of the patients treated with these techniques were maxed out on conventional treatments. The UAB team measured success with this new treatment by the tumor’s shrinkage. They had many therapeutic techniques for heating a tumor, including externally applied electrodes, and implanted electrodes.

  • 1980s: New Horizons
    While clinical advances and educational efforts continued into the next decade, the eighties brought about an effort to transform UAB Radiation Oncology into a nationally-recognized program. Accordingly, a concerted effort to develop a notable and well-documented research program ensued. When Dr. Salter was hired into the Chair role, one of her directives was getting the department in human subjects’ research and then later, basic science research. Involvement in clinical trials was followed by key faculty hires. First, Ruby Meredith, MD, Ph.D., brought her experience with clinical trials to the department in the late 1980’s, and then Radiobiologist Donald Buchsbaum, Ph.D. established the Radiobiology unit at the turn of the decade. Grants and contracts gained in number and award amounts and the formal research effort was underway in earnest. The Eighties were also a period of rapid technological advancement in the Field. The department proved adept at acquiring the latest and greatest innovations. Jill Caranto explained that the challenges presented by these new technologies are perhaps what she has most enjoyed about working in the field of Radiation Oncology. Further, she specifically credits UAB for staying at the technological forefront of the field. “CT, MRI, high tech treatment planning systems, advances from film to digitizers and so on, serve to make this both a fascinating field and a fascinating place in which to work,” Caranto said. “We have always kept up well with new technology, and we’ve often been one of the first facilities to have new technologies.” The leadership of the department underwent a change as Dr. Roth retired from Practice in 1985 and his first medical resident, Dr. Salter, assumed the Chair position. In the Interim between Dr. Roth’s retirement and Dr. Salter accepting the Chair role, Albert Lobelia, M.D., provided leadership to the department in addition to his regular Responsibilities as Chair of the Comprehensive Cancer Center. He was also pivotal in the future, leading the hiring efforts of James A. Bonner, M.D. and in the development of Dr. Meredith’s research activities. He also aided the collaborative research efforts between the UAB Comprehensive Cancer Center and the department.
  • 1990s: Foundation for the Future
    The Nineties were characterized by the continued growth in of radiation oncology, helped in part by advances in physics and also by research innovations with roots in the Comprehensive Cancer Center Act. At the same time, another kind of growth was appearing in the department; growth from increasing patient loads, a larger faculty and support staff, and an increasing residency program. New capital equipment purchases escalated, bringing new technologies into operation, benefitting from several treatment planning system advancements. The department became a national program in Gamma Knife radiosurgery mid-decade and began treating with IMRT in 1999. Multidisciplinary cancer clinics became a staple of the department, highlighted by the Interdisciplinary Breast Clinic. As a result of this success, many other multidisciplinary clinics, including Head & Neck, Urology, and Neuro-oncology, became commonplace. The Radiobiology program came into its own in the early part of the decade. The program was led by Dr. Buchsbaum, who was recruited as Division Director to develop an experimental radiation biology and immunotherapy program using unlabeled and radiolabeled antibodies that bind to antigens expressed on the surface of cancer cells. The Division grew to include four additional Ph.D. faculty, two postdoctoral fellows, and a group of talented technicians. The Division also played a central role in the evaluation of death receptor antibodies for cancer therapy, and carried out research on antibody drug conjugates for targeted cancer therapy and the use of adenoviral vectors to produce single chain antibodies against epidermal growth factor receptor as radiosensitizing agents. Additional studies with novel radiosensitizers continued. Hand-in-Paw became a regular partner in care and could be seen in the unit on an almost daily basis. Their highly trained therapy dogs and caring volunteer-owners brought much joy to patients of all ages during their visits. The Hand-in-Paw organization’s relationship with our core facility continues today, and the therapy dogs and their owners still visit nearly every day. A change in leadership also occurred in 1998, as Dr. Salter retired and Dr. Bonner became the third Chair in our department’s history.
  • 2000s: International Acclaim

    When Dr. Bonner was hired as the department’s third chair, those that hired him had aspirations that he’d elevate the program to an international level. During this ascent, several grand achievements highlighted the decade, but Dr. Bonner’s own Cetuximab research has been recognized worldwide, changing the standard of care in treating head & neck cancers. After his research was published in the New England Journal of Medicine, it was cited as one of the top six most important cancer discoveries for 2006. New therapeutic devices and radioimmunotherapy (RIT) agents advanced from clinical trials and into clinical use, including Zevalin and Bexxar. The efforts of Dr. Meredith were instrumental in gaining the FDA-approval of both agents. Dr. Bonner was interested in providing patients with a facility that combined medical oncology care and radiation oncology care in the same location. John Brinkerhoff, R.Ph., MBA, then-current Executive Administrator of the department, worked with Dr. Bonner to take The Kirklin Clinic at Acton Road from dream to reality. The facility opened in 2002 and quickly became a popular destination for cancer care for patients throughout the region. Initially equipped with both a Varian linear accelerator and a Tomotherapy unit, this facility also provided patients with ample parking and outside-the-city convenience, with the same high-quality care offered at the core facility. While many other medical disciplines also practice in this facility, cancer care is still the primary activity here. The Tomotherapy unit was the first FDA-approved IGRT device. Jennifer De Los Santos is the primary Radiation Oncologist on site, but many other faculty members from the core facility at UAB also regularly see patients here. Kay Honeycutt led the administrative effort to open this facility and Ginna Blaylock acts as director of operations today. The department’s medical residency program continued its growth in both size and stature, and began accepting two new residents each year, and by mid-decade, yielding a total of eight in the program at any given time. Besides attracting some of the nation’s top medical school talent, the UAB residency program has yielded excellent rankings and board scores. “We’ve consistently ranked among the top ten percentile among all training programs in board scores,” noted John Fiveash, M.D. We continue to be one of the few programs to offer post-residency fellowships. The program also had the nation’s top-ranked score on the physics portion of the exam in 2000. Additionally, the UAB Radiation Therapist training program continued to grow. All therapists-in-training began regular rotations through both our core and The Kirklin Clinic at Acton Road facilities. RapidArc™ was another first in the department’s history. Richard Popple, Ph.D., led the effort to take this new technology from Varian Medical Systems into direct patient care. In April 2008, the UAB Department of Radiation Oncology became the first site in the United States to treat a patient with this technology. The clinical implications of RapidArc™ include improved speed of treatment, which improves a patient’s level of comfort, and potentially improved targeting, which can lead to improved outcomes. In all, three new Varian linear accelerators and one Tomotherapy unit were commissioned into operation during the decade, in addition to many other state-of-the-art technologies. Stereotactic radiosurgery procedures are performed regularly by our physicians in a collaborative effort at the UAB Highlands facility. A number of other therapies are also offered, including High-Dose Rate (HDR) and Low Dose Rate (LDR) treatments, and treatments with a number of experimental agents as well. UAB Radiation Oncology installed the Aria Treatment Planning platform upon its initial release. The pediatrics program, which is the only such program in the state, continued to expand during the decade and future growth is anticipated into the next decade.

  • A Look into the Future
    New Facilities
    Several facility projects are on the drawing board, under construction, in various stages of evaluation, or completed and in operation. Each future project is assessed for its continuity with the missions of the department. According to Dr. Bonner, “strategic and programmatic decisions will be made with the translational mission in mind.” Opened in 2010, the Hazelrig-Salter Radiation Oncology Facility is now home to the UAB Department of Radiation Oncology. The new 50,000-square-foot radiation center is among the most technologically advanced radiation centers in the country, with a radiosurgery program that can handle every aspect of treatment planning and delivery. It offers the full spectrum of radiation oncology services through the UAB Comprehensive Cancer Center. The Hazelrig-Salter Radiation Oncology Center is a departure from most academic medical center architecture. It was designed, first and foremost, to be patient-friendly and family-centered. It features glass-walled waiting areas, spacious treatment rooms and illuminated ceiling art designed to relieve patient and caregiver anxiety. There is a children’s play area, plush furniture in the lobby and changing rooms, and a patient-resource library. The new center has specialty evaluation rooms for pediatric, gynecologic and head-and-neck cancer patients. Spacious treatment rooms feature state-of-the-art linear accelerators, and the imaging suite has a 16-slice computed tomography (CT) scanner to aid in accurate treatment planning. The center is also among the first in the nation to begin using a new radiation-treatment system called TrueBeam, by Varian Medical Systems Inc., to deliver image-guided radiation therapy and radiosurgery with unmet speed and accuracy. To encourage both partnership and expansion in 2012, UAB Radiation Oncology entered into a new joint venture with Russell Medical Center in Alexander City, Alabama to enhance oncology services in the Lake Martin and surrounding areas. This partnership (UAB Medicine – The Cancer Center at RMC) is the first relationship of its type for both parties. In order to strengthen and diversify our education efforts, radiation oncology has begun a new series of training programs for stereotactic treatment. Physicians with access to the necessary stereotactic treatment technology are now able to attend a 2.5 day course on the therapy, taught by Drs. Fiveash and Popple. The department also continued its Tours of Excellence program by hosting 12 visiting cancer centers this year. These tours provide visiting cancer centers an opportunity to preview treatment techniques on the TrueBeam linear accelerator. These visitors represent the community hospitals, universities, and medical centers from across the western hemisphere. The Tours and training programs continue to increase our medical presence on a local, regional, and international scale.

    The Next Decade and Novel Agents
    “The next ten years should be some very exciting times,” stated Dr. Bonner. “There are many new agents in the pipeline now, which are a payoff from the past thirty-plus years of the National Cancer Act legislation. The question now is how do we appropriately integrate the many new agents with conventional therapies? New pathways are being targeted by new agents, and how do we implement them? Not only will the next decade prove exciting, it will likely be the most important decade in cancer therapy history.” Stay tuned.