One of the major tenets of the NWTS is “cure is not enough,” a dedication to reducing the duration and intensity of treatment in order to minimize late effects. It was Dr. Giulio D’Angio, co-founder of the NWTS in 1969, who first articulated this important goal and who, through the years, kept it as a major objective of our study.
Born in 1922, the second son of an Italian family, he was also the first family member born in the U.S. He attended public schools in Brooklyn and Mount Vernon, New York, and to this day he recalls the excellent education he received. Following high school graduation he attended Columbia College then Harvard Medical School, graduating in 1945.
Dr. D’Angio did his internship at the Boston Children’s Hospital, training under Chief Surgeon Dr. Robert E Gross, a pioneering giant in surgery. In 1946 he served with the U.S. Army Air Corps in Japan at the 49th General Hospital in Tokyo and at the airbase in Kanoya on the southern island of Kyushu.
Before returning to medical training he spent several months in Florence, Italy studying cultural courses in art and Renaissance history. “I decided this was the time to indulge those interests since I was unmarried. The next opportunity would come in the distant future when I would be wheeled about in a wheelchair.”
After discharge from the Army he started his radiology training at Boston City Hospital. In 1956 he returned to BCH as radiation therapist there, starting a 50 year career in pediatric oncology. At that time, when only surgery could cure some cancers, exciting innovations in treatment began to be studied: chemotherapy and radiation therapy. Dr. D’Angio began working in the laboratory and was the first to observe that radiotherapy enhanced the effect of actinomycin D (dactinomycin) in mice. He was also a member of an oncology team in the trial of newly developing chemotherapy drugs. One of the most exciting was when a single course of dactinomycin for a young boy caused multiple metastatic Wilms tumors to disappear.
In the 1960s two chemotherapy drugs, dactinomycin and vincristine, proved to be effective in treating Wilms tumor. At the time patients would be treated with one or the other, and the medical community began to discuss combining them, and possibly reducing the use of radiotherapy. Dr. D’Angio was approached by members of three independent pediatric cancer cooperative groups to chair the first intergroup study and thus began the National Wilms Tumor Study Group. With time the NWTS eventually enrolled nearly all Wilms tumor patients in North America. The study’s success was ensured by Dr. D’Angio’s leadership and mentoring. Staff in Seattle have long appreciated his compassion for participants and his inclusion of us as members of a team that includes physicians and other scientists. Thirty years of study results include the publication of more than 250 articles on treatments, schedules, pathology, genetics and even on the cost and efficiency of different schedules of chemotherapy.
His NWTS experience led to his participation in organizing committees for studies of childhood Hodgkins disease and soft tissue sarcomas. With his long-term collaborator Dr. Audrey Evans he made the first observations about the biology and clinical evolution of neuroblastoma, another childhood cancer. Dr. D’Angio has long been interested in and concerned about the late effects of therapy in children. He organized and chaired the first National Institutes of Health conference on this topic, having already founded the Late Effects Study Group devoted to cured cancer patients.
Dr. D’Angio has been honored widely by national and international pediatric and radiology societies for these trail-blazing accomplishments. A past president of the International Society of Pediatric Oncology, he has also held responsible elected and appointed positions in learned societies at home and abroad.
He is a prolific author, having written more than 500 articles, books, book chapters, editorials and commentaries. Several of his papers are “firsts”.
Since his retirement as Chairman of the study, he continued as Editor-in-Chief of Medical and Pediatric Oncology for several years and remains active giving lectures and attending meetings of the several societies to which he belongs. On a more personal note, he recently married Dr. Audrey Evans, the coordinator of the NWTS since its inception. They have been partners in Science and Medicine for decades. Now they are partners for life.
Dr. D’Angio has long maintained a strong personal interest and concern for participants of the National Wilms Tumor Study. Not only do the staff of the DSC hold him as a “father figure”, he is also a warm and concerned “grandfather” to those of you who have sought his advice over the years.