Dr. Giulio J. D’Angio (1922–2018)

Abstract

On September 14th 2018 a true giant in pediatric oncology died peacefully at home at the age of 96, after a remarkably prolific academic career. Dr. Giulio J. D’Angio, affectively know as Dan to most around him, had a far-reaching impact on the lives of thousands of children with cancer because as a true visionary he recognized early on the importance of interdisciplinary multicenter research to advance the outcome of childhood cancer. In doing so, his efforts to improve the lives of children with cancer reached far beyond Philadelphia, the city he had moved to in the late 1960’s to practice medicine. Dan was an expert in diagnostic radiology, radiation oncology, pediatric oncology, and cancer survivorship. He contributed in a very significant way to the excellent survival rates that now exist for children affected by childhood kidney cancer, most notably Wilms tumor. Dr. D’Angio, the son of Italian immigrants, was raised in Brooklyn, earned an undergraduate degree at Columbia University and his medical degree from Harvard Medical School. World War II caused an interruption in his training as he served in the Pacific Ocean theatre. After he returned he felt fortunate to receive part of his training by giants in Medicine, like the surgeon William E. Ladd and the radiologist Martin “Dick” Wittenborg. At Boston Children’s Hospital he worked with the world renowned pathologist Sydney Farber and witnessed firsthand the introduction of chemotherapy for children with cancer, a highly controversial approach that according to its detractors only unnecessarily prolonged the suffering of children affected by cancer. But visionaries like Dr. Farber and Dr. D’Angio focused on the ‘prolongation of life’ as the first sign that cures were possible. And we owe it to their courage and perseverance in those early years for the successes that we take for granted in 2019. Dan’s contributions to pediatric medicine were many as exemplified by the over 500 manuscripts that he authored or co-authored. But above all he contributed by promoting and often help establish enduring and prolific collaborations, key in advancing the field of disorders with a low prevalence. And most, if not all, childhood cancers are indeed rare, making that any given institution would only see and treat a limited number of cases. To overcome this limitation, forging alliances was key. And so, the socalled ‘cooperative group system for clinical research’ began in 1955 with the establishment of the Acute Leukemia Chemotherapy Cooperative Study Group A (ALCCSGA), a consortium focused on childhood acute leukemia. Dan’s ability and enjoyment in working with others was instrumental in establishing another cooperative group: the National Wilms Tumor Study (NWTS) Group in 1969, which over the ensuing decades would become a model for interdisciplinary cooperation between oncologists, pathologist, surgeons, radiation oncologists, statisticians, and later on molecular biologists. Given his gentle character an readiness to share his talents with any person or organization that sought to improve the lives of children with cancer and their families, it should not have been surprising that 2 years later, Dan attended the first meeting of the Nephroblastoma Study Design Committee established by the Société Internationale d Oncologie Pédiatrique (SIOP), by many viewed as NWTS’s European counterpart. Their first study, SIOP-1, was designed to test whether preoperative radiation therapy would be better than primary surgery, forming the basis for future SIOP nephroblastoma studies, all designed around preoperative therapy in contrast to NWTS studies, all designed around upfront surgery. The friendly, but definitely real, competition between these two multidisciplinary study groups divided by the Atlantic ocean brought the best in each one of them, improving outcomes and decreasing long-term side effects for affected patients worldwide, and fundamentally enhancing our understanding of the biology and biologic behavior of Wilms tumor and the other pediatric kidney cancers. As survival started to improve, Dan as no other recognized the harmful effects of therapy, most notably of radiation therapy. Thus