Carl Mansfield, MD, ScD, FACR, FASTRO (1928-2018)

Abstract

“If we [sic] can see further, it is by standing on the shoulders of giants.”Sir Isaac Newton On January 11, 2018, the field of radiation oncology lost a giant; Dr Carl Mansfield passed away peacefully at his home, at the age of 89. Dr Mansfield's impact on the field of radiation oncology has been extraordinary and wide ranging. Born in Philadelphia in 1928 to a single mother who worked as a housekeeper and raised with the help of his maternal grandparents, he overcame significant barriers to realize his goal of becoming a physician. He attended the Howard University School of Medicine, one of the few medical schools open to African-American students in the 1950s. At that time, the field of radiation oncology was in its infancy and still functioned in most institutions as a subspecialty of diagnostic radiology, as reflected in the name therapeutic radiology. Dr Mansfield was fortunate to receive early postgraduate training from Simon Kramer, MD, a pioneer in radiation oncology as a separate academic specialty, who introduced the concept of cooperative group-based clinical trials in radiation therapy. At what was then the Thomas Jefferson University Hospital and the Episcopal Hospital in Philadelphia, Dr Mansfield completed residencies in radiology and radiation therapy/nuclear medicine. He was awarded a number of prestigious fellowships, including a National Institutes of Health postdoctoral fellowship in radiation therapy (completed at the Middlesex Hospital and Medical School, London, UK), the Chernicoff fellowship in pediatric radiation therapy at Jefferson Hospital, and an advanced clinical fellowship in cancer by the American Cancer Society. He was certified by both the American Board of Radiology and the American Board of Nuclear Medicine. Throughout the 1960s, he continued his work with Dr Kramer at Jefferson Hospital, where he pioneered a number of innovative techniques in radiation treatment. In 1974, he became the first African-American full professor at Jefferson University and also served as chief of the division of nuclear medicine and of the section of ultrasound. He eventually went on to successfully lead 3 departments as chairman over a nearly 3-decade span. He was chairman of the department of radiation therapy at the University of Kansas from 1977 to 1983. He went on to become chairman of the nationally recognized radiation oncology department of Thomas Jefferson University from 1983 to 1994. From 1995 to 1997, he served as the associate director of the division of cancer treatment diagnosis and centers for the radiation research program at the National Cancer Institute until his departure in 1997. From 1997 to 2002, he served as the chairman of radiation oncology at the University of Maryland before his retirement. Throughout his career, Dr Mansfield balanced scientific and academic work with a prominent role as a national leader in the emerging field of radiation oncology. In 1988, he became the first African-American president of a major national radiological society, the American Radium Society. He achieved prominent roles in the American Society for Therapeutic Radiology and Oncology (now the American Society for Radiation Oncology [ASTRO]) and the American Cancer Society and also served in local chapters of national organizations. His academic achievements were prodigious, with the publication of >130 peer-reviewed articles and 2 textbooks, cooperative authorship of hundreds of scientific abstracts at national meetings, and presentation of hundreds of lectures, grand rounds, and other invited talks. His investigative work on treating breast cancer (among other clinical and research foci) contributed significantly to our current understanding of highly targeted, tissue-sparing therapy. He was also an early and vociferous advocate for interdisciplinary care models to identify the best strategy for each patient. Dr Mansfield is considered a pioneer in intraoperative radiation therapy for early-stage breast cancer and performed many of the early trials of partial breast irradiation. In 1983, he produced a seminal report comparing perioperative and intraoperative iridium-192 breast implants, which laid the groundwork for continuing research and clinical work in this field today. His work also led to the paradigm shifting concepts of conservative management of breast cancer through breast irradiation and local brachytherapy. In addition to his impressive academic credentials, Dr Mansfield was noted for his character, dignity, discipline, and strength. He took his positions of leadership with tremendous gravity and worked tirelessly to ensure that future members in the field learned, were challenged, and understood that the “patient first” focus could serve as a guiding and organizing principle for all aspects of work in the field. His famous mantras were “the only reason we do research is to better treat the patients” and “the only reason we train residents is to better treat the patients.” Dr Mansfield mentored hundreds of medical and postdoctoral students, residents, and junior faculty. During his 7 years as department chair at the University of Kansas, he developed the state's first school of radiation oncology technology and its first radiation oncology residency program. He expanded on this work as chair at Jefferson, where for 11 years he tutored and mentored hundreds of clinicians and staff, many of whom went on to lead and train future leaders in our specialty. In addition to his clinical academic output, he worked with his team of faculty medical physicists to advance dosimetry and treatment planning, with contributions that were, in many cases, ahead of their time. His effectiveness in faculty mentoring is reflected by the large number of protégés who are now internationally recognized leaders in the field of radiation oncology. His dedication and service on local, state, and national societies and committees in radiation oncology led to many other recognitions and honors, including receiving the Volunteer Award and Distinguished Service Award from the American Cancer Society, Philadelphia Division; the American Cancer Society Bronze Medal for outstanding work in leading the effort against RJ Reynolds' marketing of tobacco products designed to increase cigarette consumption in African-American communities; and the Lifetime Achievement Award from the Association of Black Radiation Oncologists. His service and leadership have been acknowledged by fellowship awards in organizations such as ASTRO, the American College of Radiology, the American College of Nuclear Medicine, and the College of Physicians of Philadelphia. In recognition for his outstanding lifetime contributions to the discipline of radiation oncology in research, clinical care, teaching, and service, Dr Mansfield was awarded the 2015 ASTRO Gold Medal, becoming the first African American to garner this prestigious award. Dr Mansfield's contributions over an illustrious career spanning 50 years in medicine cannot be overstated. He will be missed but his legacy will continue on in the many lives he has touched. It is a direct result of a lifetime of clinical investigation, mentorship, and advocacy of this gentle giant, Dr Mansfield, that we are able to see further and make a difference in the lives of the patients we treat today.