Persistence and the Quest for Innovation Guided a Radiotherapy Pioneer

Herman D. Suit, MD, MSc, PhD

As he was growing up, Herman D. Suit, MD, MSc, PhD, took to heart his mother’s advice: “If you really want something, ask for it politely and repeatedly.” When he was recruited to Massachusetts General Hospital in 1970, he added that the requests not only be polite and repeated, but in writing. By employing that strategy throughout his career—combined with his carefully planned work and the support of numerous friends—he obtained virtually everything he requested along the way to changing the course of radiation oncology.

During a career that has spanned more than 60 years, Suit helped launch proton therapy as a cancer treatment, introduced preoperative radiation and conservative surgery for patients with soft tissue sarcoma, and developed the intraoperative and preoperative use of electron beam irradiation as methods of reducing the scope of surgical resection.

Along the way, he managed the development of the world-class radiation oncology department at Mass General, was the principal founder of the Connective Tissue Oncology Society and a co-founder of the Particle Therapy Clinical Oncology Group, and served as president of the American Society of Radiation Oncology and the Radiation Research Society.

A Stellar Student

Throughout his career, Suit has been on a quest to deliver the best care possible to his patients, a mission that includes innovation. “Physicians should view our current best treatment as obsolete and use this as a provocation for active effort to develop superior management strategies,” he wrote in an essay published in Radiotherapy and Oncology in 2011.Born in Houston, Texas, in 1929, Suit distinguished himself academically as an honor student who accelerated his way through the public school system and went on to receive his bachelor of science from the University of Houston in about 2 years. There, he developed a deep interest in organic and biochemistry while taking a course given by Professor Eby Nell McElrath, whom he describes as the most impressive teacher he had—she made the subject truly stimulating to her students, Suit recalled. That led to Suit to plan a career in a medical specialty that was based heavily in science, preferably biochemistry. In 1948, at 19 years of age, he entered Baylor College of Medicine.

In that first year, Suit requested admission into the graduate program so that he could earn a master of science degree in biochemistry as a secondary goal to his studies as a medical student. The chair of biochemistry was not impressed with Suit’s résumé, which listed only freshman-level physics and math. Suit was informed that he would have to take a second year in math and physics at the University of Houston. During his second summer, he was to attend the University of Texas at Austin and take atomic and nuclear physics. Near the end of one of his textbooks, he latched on to a small section that discussed the use of radiation to treat patients with cancer with some impressive success.

“I read this and thought, ‘Golly, that is fantastic!’ I had seen patients who had had their larynx removed in its entirety as their treatment for laryngeal cancer with loss of a critical function—ie, their voice. Apparently, comparable cure results could be achieved by use of radiation alone with clearly superior functional and cosmetic results,” he said.

“So, I became intensely interested about this and rapidly learned more,” Suit said. “I decided to change my goal to a physics-based medical field, vis-à-vis radiation oncology. I was puzzled in that radiation therapy had not been mentioned in any lecture that I had attended at Baylor.”

In his fourth year at Baylor and confident of graduating with his medical and a master of science degrees, Suit faced another decision: where to study radiation oncology. Ever since childhood, he had believed the University of Oxford held one of the highest concentrations of intellect on the planet. The harsh reality, though, was that his family could not afford to send him to England. But a determined Suit applied for a funded position for graduate study, and—to his enormous surprise and pleasure—his request was granted. He was accepted.

Meanwhile, Suit wrapped up his time at Baylor. Less than 2 months into his rotating internship, he was assigned to administer anesthesia alone to surgical cases, an area in which he’d received minimal instruction. That made Suit extremely nervous. “I had no real training in anesthesia and was scared to death to even try, but had no real option!” he recalls. “Things were much different back then.”

One day early in his internship, while he was providing anesthesia for a thoracic surgical case, the operating room’s head nurse told Suit to go to her office to read a letter that had been sent to him. Suit learned that he was being drafted to serve in the US armed forces and had to report for duty in 2 months—an extremely disappointing development, he said: “I just couldn’t imagine what in the world to do, because I strongly wanted to do research at Oxford.”

He followed his mother’s early advice. “Well, my mother always told me, ‘If you want something, son, you ask for it politely.’ And so I got an appointment with the draft board,” he said. “I went there, and they really had an unfriendly approach toward me. I was just asking for something over which they had absolute control,” Suit said.

Suit stood before the board members to discuss a potential deferment, emphasizing that he wanted to learn about the biological effects of radiation and using it, instead of surgery, as a cancer treatment. He remembered to mention that he had a British fellowship that would cover all his room, board, and living costs. “At that point,” Suit recalls, “the chair of that draft board looked at me with disbelief and shouted, ‘Do you mean that the British are to pay all of the costs of graduate education of an American boy?’ I answered politely, ‘Yes,’ and he slammed his hand on the desk and yelled, ‘Deferment granted!’”

So, after completing his internship, followed by 6 months as a radiation oncology resident, Suit began his doctoral work at Oxford University on January 1, 1954. After several months in clinical residency, he focused on the study of the effects of ionizing radiation on iron metabolism in the blood-forming cells of bone marrow, in vivo and in vitro. He then spent a few months studying clinical radiation oncology before returning to the United States.

“That was one of the most intellectually stimulating times of my life,” said Suit, describing his time at Oxford University. “The chairman of the department would basically say, ‘You don’t believe me, and you don’t believe anybody, when they say something if they do not have supporting data. Otherwise, it’s merely their opinion.’ And opinion was not a complimentary term,” Suit says. “That was a highly challenging and exciting environment.”

Professional Journey

Suit anticipated that when he returned to the United States, he very likely would be drafted. Shortly before his departure, during a 3-day visit to the Royal Cancer Hospital in London, he met an American friend who asked, “Herman, why don’t you apply for a deferment and go to a research center like the National Cancer Institute [NCI]?”

“Well, my eyes just lit up at that idea,” Suit said. Once again, he didn’t hesitate to ask for what he wanted. “I applied to join the US Public Health “I lucked out, as there were not many applicants with interest in radiation biology. I enjoyed 2 years of research at the NCI.” Next, Suit was recruited by MD Anderson Cancer Center and stayed there 11 years, from 1959 to 1970. His clinical time was concentrated on patients who had cancer of the bone and connective tissue, assessing the efficacy of preoperative radiation treatment of patients with connective tissue sarcoma. This substantially reduced the need for large surgical margins for subclinical extensions because they could be eradicated by subradical radiation doses. This strategy substantially improved functional status and, in a number of instances, avoided amputation.

Finally, Suit found what might be called his professional home: Massachusetts General Hospital and Harvard Medical School. From 1970 Service and to be assigned to the NCI,”he says to 2000, he served as chief of the Department of Radiation Oncology at the hospital and is now the Andres Soriano Professor of Radiation Oncology, Emeritus, at the medical school. Suit taught and mentored more than 100 residents and research fellows, many of whom went on to chair academic departments.

During those 30 years, Suit was a pioneer both in his research and in advancing Mass General in radiation oncology. In 1973, he initiated the first program to evaluate proton beam radiation therapy as a cancer cure using multiple dose fractions, based at the Harvard Cyclotron Laboratory in Cambridge, Massachusetts. Their physics/engineering team combined with the hospital’s team of physicians and physicists from 1973 to 2001 to develop a proton therapy center in Boston.

All of their work, including the land and part of the cost of the building and machines, was supported by Mass General, combined with generous, sustained funding by grants from the NCI. In 2000, the year before the center went into clinical operation, Suit stepped down as chief at age 71. He was replaced by another faculty member, Jay S. Loeffler, MD.

Suit counts the proton therapy program among his top professional achievements, because it achieved spectacular results for many patients. Proton therapy centers now dot the globe and have treated more than 100,000 patients.

Personal Commitments

“When you see a patient 10 to 25 years after radiation treatment who is doing well with no cancer and near normal functional results, you can’t have anything except a deep sense of your and the patient’s good fortune,” Suit said. “That’s just natural. So that’s one thing [in my career] that I would put up as highly important.”When not working, Suit spends time with his wife, Joan, whom he married in 1960. Joan Suit is a Stanford University PhD graduate and retired Massachusetts Institute of Technology research scientist in microbial genetics.

The couple have been avid supporters of educational endeavors. In 2013, the University of Houston honored the couple with the President’s Medallion in recognition of their charitable support. Joan Suit has been a volunteer at the Museum of Science, Boston, where she remains an emeritus trustee.

Suit is confident that the field of radiation oncology will continue to advance and improve in years to come. His prediction for the next 5 to 10 years: “I think we’ll be able to genetically characterize the patient and their tumor so that there will be the ability to design a management strategy for the individual patient.”