In Memory of Dr Carlos A. Pérez

Dr Carlos A. Pérez has been a giant of international radiation oncology in the 5 decades of transition between the 20th and 21st centuries. In that time, interval radiation technology in its medical use was transformed. Medical care in oncology has generated a huge collective of cancer survivors. Social change has loomed with globalization and cycled with hyper-connected individualism. Carlos was a very special protagonist of his time. He was a prototypical medical specialist: his science was care based. It was impressive to observe how he controlled his own data (those of the department, those of his institution), with what exigency he updated them, and with what critical spirit he interacted with his own and other people's data. In his years of professional maturity, when he had the greatest responsibilities, Carlos displayed a strong character: fortunately, I coincided with him in many professional forums, and I know that he did not compromise with ambiguity either personally or professionally. Carlos was born in Pereira (November 10th, 1934), studied in Medellín, joined the Mallinckrodt Institute of Radiology as a resident (1966), and was appointed director of the Department of Radiation Oncology at Washington University, St. Louis, in 1976. He received multiple awards, including the gold medal from the American Society for Radiation Oncology (1992), American College of Radiology (1997), CRILA (Círculo Radioterapéutas Ibero-Latino-Americano) (2000), American Radium Society (2005), and ALATRO (Asociación Ibero-Latino-Americana de Terapia Radiante Oncológica) (2013). He was president of the American Society for Radiation Oncology (1982). He took part in intense research activity in the Radiation Therapy Oncology Group, engaging in studies on the radiotherapeutic approach to high-incidence cancers: prostate, gynecological, head and neck, breast, and lung. He belonged to a generation of wise oncologists: they promoted emerging concepts, very open, based on observable effects in health care practice, seeking to improve the therapeutic index with radiation therapy in all varieties of human cancer that could be treated with ionizing radiation. These were times of matching technological development and improvement with innovation in clinical practice—dose, volume, and fractionation defined the basic variables of clinical progress. Patterns of progression provided clues to biology and therapeutic opportunities. Toxicity set the acceptable limits of medical action. Patients deserved every care and to be cured at a well-measured and acceptable price. Two elements are particularly insistent in Carlos's publications: "local control is dose-dependent" (he recorded this in a variety of solid tumor studies) and "toxicity is dosimetry-dependent" (he embellished his presentations with details of dosimetric implementation to try to improve the tolerance of normal tissues; he was especially honest in describing toxicity). This need to accumulate knowledge, erudition, and polyvalence may have been the impetus behind his decision to embark on the adventure of writing a comprehensive treatise on radiation oncology as a medical specialty with a consolidated body of doctrine. It was the boldest international academic initiative of its time. He needed an strong partner, convinced that education and transmission of knowledge would transform clinical practice in a globalized world. He and Dr Luther W. Brady were a match made in heaven. Very different personally, very competitive in their hard work and critical spirit. Pérez-Brady Principles and Practice of Radiation Oncology1Perez CA Brady LW Principles and Practice of Radiation Oncology. 1st edition. JB Lippincott Company, Philadelphia1987Google Scholar established a before and after in radiation oncology. Its multiple reprints are living witnesses that he who is born and grows giant in the values of education and transmission of knowledge becomes even greater in old age. Carlos and Dr Brady were extraordinarily long-lived; fortunately, they always remained very lucid and reaped many fruits of kindness and admiration from generations with whom they connected through the permanence of a great book. Carlos was left-handed. He wrote with the charming gesture of the left-handed: left wrist bent to the limit, left shoulder forward, and head cocked to one side (always with the pen very distal between the fingers so as not to smear the ink). His handwriting gave away the fact that he went to school and was initially educated in Colombia. His handwriting was sharp and tightly intertwined, with no spaces. I remember him dedicating his book to young and mature colleagues in many countries around the world. He enjoyed it very much. He defended in public the demanding truth: I heard him say many times that suboptimal technology in radiation therapy could not generate optimal results (when he reached this point of controversy, he used to express himself in forums where to speak so openly, questioning results, was politically incorrect). In his personal dealings he was courteous and in his social performance he was a vitalist. Carlos knew Spain very well and enjoyed being with us. He participated in the inauguration course of the radiotherapy oncology service at the Clinica Universidad de Navarra in 1984, together with Dr Brady and Dr Julian Bloom from the Royal Marsden Hospital. He received in his department many Spaniards who requested rotations or periods of training at his side. He sowed in some of them the seed to become managers or highly accredited researchers. They know who they are. He participated in many educational and professional events in Spain. His generosity in traveling and his rigor in presenting and discussing data distinguished him. This style, cultured and learned, made him very attractive in terms of training, but let's not deceive ourselves—we were also very grateful that he expressed himself in Spanish, with technical terms in English (he was amused to hear the translations we made for clinical use in Spanish) and colloquial terms chosen in Spanish, slowly returning with some difficulty to his linguistic roots. In Latin America, Carlos was much loved and respected. He earned his prestige with intense dedication to our colleagues and with courage in advocating demanding work and technology to achieve valuable clinical results. Meanwhile, in Europe, he was awarded the SEOR (Sociedad Española de Oncología Radioterápica) Gold Medal (2013), and the GEC-ESTRO (European Group of Curietherapy - European Society of Radiotherapy and Oncology) (Marie Curie Medal (2011) and helped many years in the Educational Program for Italian radiation oncology residents at Gemelli Hospital. For those of you who have met him, I hope I have done justice to his mark among us. For those of you who have not met him, I recommend that you consult his book and his publications with the curiosity and respect of getting to know a thoroughbred oncologist, a citizen of the world, a hard worker in his profession, and a dear friend of Spain. Rest in peace Carlos A. (de Alberto) Pérez.