Three Questions with Dr. Bill Mendenhall

What year did you first treat someone who had head and neck cancer with radiation?  

1979

Since that time, how have radiation therapy techniques and technology evolved to care for people who have head and neck cancer?

We (the UF College of Medicine Radiation Oncology Department) were treating some patients without simulation and setting the fields up based on surface anatomy. We had two cobalt machines that I could use myself without help (today’s standard has licensed radiation therapists operating the equipment). Our first simulator was homemade by our physicists and did not have fluoroscopy (real-time imaging). Nurses learned on the job to run the machines. Films were hard copy (today, everything is digital). CT (computed tomography) was recently created, and MR (magnetic resonance imaging) and PET (positron emission tomography) did not exist. We got our first linear accelerator in about 1978. We hired radiation therapists to run the machines around 1983 and progressed to 3D treatment planning and then to IMRT (intensity-modulated radiation therapy) in the late 1990s. We sent the occasional patient with skull base chordomas to the Harvard cyclotron for proton therapy, which was a physics facility. We started doing outcome studies in about 1970 to improve our cure rates and reduce complications. And now we have protons, which was unimaginable in 1978. Remarkably, we did pretty well with some of the older techniques.

With over 40 years of radiation oncology experience, what advice would you give a person who is newly diagnosed with head and neck cancer and needs radiation?

Go to a tertiary (specialized) care center that has a strong head and neck program and has access to both protons and photons. Preferably, one that does outcomes studies and publishes its data. Go to Pubmed.gov and search for your physician's last name and initials. If the last name is Smith or Jones, you'll get a useless tsunami; otherwise, you can find every paper in the English language that they have authored or coauthored.