Moody Wharam came to Johns Hopkins in 1975, as was one of the early radiation oncologists. At that time, just 50 percent of children diagnosed with cancer survived. Cancer, and particularly pediatric cancer, was a troublesome problem, and Wharam was among a group of cancer clinicians who ushered in an era that offered the first glimmer of hope.
The National Cancer Institute appointed four study groups to investigate common childhood tumors, and Wharam received the unusual distinction and honor to be named to two of these groups. From 1980 to 1990, he served as director of the radiation oncology committee of the Pediatric Oncology Group, a U.S. and Canadian collaborative group that studied childhood cancers. His roles in these premier groups made him an active participant in all of the pivotal pediatric cancer research of the time. It was this research that led to dramatic increases in pediatric cancer survival rates.
The four separate groups have since merged into one, known as the Children’s Oncology Group. The merger, Wharam says, was a marker of the success that had been made against these cancers. He could have hung is career on these impressive advances, but to Wharam, it wasn’t good enough.
Taking on Toxicity
Wharam says a pediatric patient he treated for Hodgkin’s lymphoma highlights the paradox of these early radiation therapies in children. The patient survived the lymphoma but died of a second cancer when she was 48. “That cancer was probably caused by the treatment I gave her as a child,” he says. It is a cruel irony that is particularly problematic for pediatric cancer patients. The same treatment that saves their young lives can also set into motion genetic alterations that manifest decade’s later as new cancers.
“Knowing that the therapies we give children for their cancers could cause other problems for them was one of the most difficult aspects of our job,” says Wharam. This inspired a new mission, and Wharam became a leader of research to scale back treatment for many childhood cancers. “I had two goals,” he says. “We were having great success in certain cancers, so we had to see if we could back off in the amount of radiation we were giving these patients. At the same time, kids were still dying, so we also had to figure out how we could do a better job of treating them.”
In addition to the risk of second cancers decades later, radiation to growing bones and organs could impede normal development, and radiation to the brain, a common site of pediatric cancers, often resulted in impairments to learning and other cognitive brain functions.
Still, scaling back therapies was a risky endeavor. The primary indicator that therapy could be reined in was increased survival. Go too far in reducing treatment and children would likely suffer deadly cancer recurrences. Few were willing to take on the challenge, but Wharam became one of the first when he collaborated with Johns Hopkins pediatric medical oncologist Brigid Leventhal in a groundbreaking study of treatment reduction in Hodgkin’s lymphoma. Their research led to refinements in therapy that allowed certain patients, based on specific characteristics, to receive less radiation or forgo it altogether without increased risk of recurrence.
A Special Patient
Wharam’s commitment to his patients transcended every aspect of his long and accomplished career. Theodore DeWeese, M.D., Director of Radiation Oncology and Molecular Radiation Sciences, was hired by Wharam. Several months ago, Wharam showed him a photo that a former patient had sent. The patient, who was just a toddler when the two treated him in the early 1990’s for retinoblastoma, cancer of the retina, had the cancer in both eyes. Now a young man, the photo showed him standing with his parents in his college graduation robe. This patient had particular significance to DeWeese and Wharam. It was DeWeese’s first patient as a resident in Radiation Oncology working under Wharam. It is rare to have the cancer in both eyes, and without extraordinary measures, the patient would have lost his vision. Wharam was determined to preserve the function of one eye. The only way to do that would be to deliver radiation so precisely that it would destroy the cancer with out harming the anatomy of his eye.
“The treatment was so complicated that we had to do it in off hours, and Moody tasked me to come in at 6 every morning to set up for the patient,” recalls DeWeese. “It required anesthesia and a special device for the patient’s eye. We did this everyday for weeks.”
In reality, the procedure Wharam devised was stereotactic radiosurgery, a precisely targeted and technically sophisticated way to deliver high-dose radiation to cancer. This was years before advanced radiosurgery equipment had been developed.
“Moody’s treatment worked, and because of his ingenuity and dedication, this patient was now graduating with an engineering degree,” says DeWeese. “He would have been blind without this therapy. There are not many doctors that would have gone the extra lengths that Moody did to save this child’s eye,” he says. DeWeese wondered how different that family photo might have been without their efforts decades earlier. “It shows the impact one person can have on an entire family,” he says.
DeWeese says Wharam’s pioneering influence earned the department the distinction as one of just a select few in the nation with a long history of expertise in treating pediatric patients.
“Moody also forged how rhabdomyosarcoma is managed in kids, and not just radiation therapy but how radiation is intertwined with chemotherapy. It remains the standard of care today,” says DeWeese. Rhabdomyosarcoma is a childhood cancer of the connective tissue that attaches muscles to bones. “The way we manage children with rhabdomyosarcoma today is based on what he did through all those years of tireless work in the Pediatric Oncology Group. Kids survive this now because of the work Moody did, and that’s why we do research,” says DeWeese.
This reputation of excellence was instrumental in helping the department earn approval for a proton beam facility, he says. Proton beam therapy is state-of-the-art technology that very precisely zeroes in on tumors and increases the damage to cancer cells without harming normal tissue. Its precision and safety makes it desirable for treatment of pediatric tumors and particularly tumors of the brain, spine, eye, lung, head and neck, and bone. The facility, which will be located at the Sibley Memorial Hospital on the Kimmel Cancer Center’s National Capital Region campus, is scheduled for completion in 2019 and will include space and staff for treating pediatric patients.
“Proton beam is another major advance in managing late effects of radiation therapy,” says Wharam. “It allows us to control the depth of the beam and stops it from passing through and harming critical structures like the pituitary gland and brain stem.” The department’s history of strength in treating pediatric cancers also led to a collaboration with Children’s National Medical Center Hospital. Under the direction of pediatric radiation oncologist Stephanie Terezakis, the Kimmel Cancer Center will become the primary provider of radiation therapy, including proton therapy, to its pediatric cancer patients. The merger creates one of the largest pediatric radiation oncology programs in the country, and the increase in patient volume promises to speed clinical discovery.
A History of Innovation
Wharam’s lengthy and accomplished career makes him the historian of the department, and DeWeese says, proton therapy falls in line with a constant theme among many milestones—patient-centered innovation.
In the beginning, Wharam was a member of a small team working in the basement of the Halsted Building waiting to move to state-of-the-art facilities in the new comprehensive cancer center. Wharam’s work began before there was a Department of Radiation Oncology and Molecular Radiation Sciences. Computer technology was limited at the time, as were the machines that delivered radiation to patients. Like the current generation of radiation oncologists, however, Wharam and colleagues were focused on advancing clinical research and improving the standard of care for patients, albeit at a time when the technology and radiation-delivering machinery had not quite caught up with their forward-thinking ideas. “We had state-of-the-art knowledge and with the comprehensive cancer center in planning, state-of-the-art facilities were coming,” says Wharam.
Radiation oncology broke off from the Department of Radiology and Radiological Sciences and joined forces with the Department of Oncology to tackle a cancer epidemic.
When the comprehensive cancer center opened in 1977, it had all of the technical aspects needed for cutting-edge radiation therapy. “We are the only specialty that makes its own medicine,” says Wharam. “We retired the old cobalt machines and replaced them with linear accelerators, and we hired physicists to make sure the machines were doing what they were supposed to.” Johns Hopkins was one of just a handful of strong academic programs in radiation oncology in the U.S. at the time, and Wharam recalls that when the center opened, they were immediately inundated with cancer patients. The radiation oncology clinic had to expand to twice its original size to accommodate the growing patient load. Years later, Wharam oversaw two additional expansions, one with the opening of the Kimmel Cancer Center’s Harry and Jeanette Weinberg Building and another with a satellite facility at Green Spring Station.
Wharam treated all types of cancer, but as the clinic expanded and more radiation oncologists were recruited, he made pediatric cancers his primary focus. The photographs around his office were a silent testimony to his pioneering contribution to advancing the care of children with cancer.
His face lights up when he speaks of his patients, and his detailed memories of them are remarkable. It is clear that they are his fondest memories from a long and impressive career.
The Future
Wharam retired from seeing patients in 2015. He quips that today’s patients are in even better hands. “Knowing and working with some of the founders of the oncology center has brought me great joy. Those of us who were there in the beginning were right for the time, but Ted DeWeese’s leadership is moving the field forward in ways we couldn’t even imagine then,” says Wharam. “Our program has grown into the best one in the country. We have first class scientists and clinicians and the finest physicists, residents, nurses, radiation therapists, and dosimetrists in the business. Our future is looking good.”
To honor Dr. Wharam’s unparalleled contribution to the field of radiation oncology and ensure this spirit of innovation and dedication continues, DeWeese initiated a campaign to establish the Moody Wharam Professorship.
An endowed professorship is considered the highest honor in academic medicine and recognizes extraordinary talent in research, clinical care and teaching, and it provides solid and sustaining funding to an accomplished faculty member to support his or her continued focus on radiation oncology research and its clinical translation.
“I can’t think of anymore more deserving of a professorship named in his honor,” says DeWeese. “When you think of the characteristics that make a great doctor, that is Moody Wharam—wickedly smart, totally dedicated, professional in every interaction and kind. Moody has the attributes that we would all hope to aspire to.”
Even in retirement, Wharam’s clinical research and innovative thinking continues to influence cancer care.
“This is a tangible example of how clinical research and thoughtful medicine goes on well beyond what we do. Moody’s work is a great example of what we do. That’s about all that any one of us could hope to achieve—to have your work impact people while you are doing it and remain impactful,” says DeWeese. “The Moody Wharam Professorship will continue this legacy.”
To make a contribution or obtain more information, contact Marie Jo Corry at 410-361-6391 or [email protected]