Welcome to the interview landing page.
Scroll down this page to explore this interview in several ways.
An Interview Profile summarizes this individual’s role, specialization, and contributions to MD Anderson.
A Table of Contents shows the range of topics covered in each interview session: each chapter title links to a chapter summary.
Chapter Summaries describe the specific topics treated in each section; each summary links to the corresponding recording so you can listen to the chapter.
Here is a link to the full transcript so you may browse and search. (link)
Five sessions: 6 November 2018, 28 November 2018, 19 December 2018, 23 January 2019, 21 February 2019
Total approximate duration: 5.5 hrs
Interviewer: Tacey A. Rosolowski, Ph.D.
About the Interview Subject:
Radiation oncologist Dr. Ritsuko Ueno Komaki (b. 24 September 1943; Amagazaki, Japan) came to MD Anderson as Fellow in 1979-80. She was then was recruited from Radiation Oncology at Columbia Presbyterian to the faculty at MD Anderson in 1988 to serve as chief of the Thoracic Section in the Department of Radiation Oncology in the Division of Radiation Oncology. She served in this role until her retirement from full time clinical work in 2017. Retired completely in August of this year. Dr. Komaki held the Gloria Lupton Tennison Distinguished Professorship in Lung Cancer from 1998 to her retirement. She worked with her husband, James A. Cox, MD [oral history interview] to establish a proton therapy center at MD Anderson, and she is known for her research the uses of radiation therapy for lung and breast cancer and for studies comparing proton and conventional radiation to demonstrate effects on survival, secondary effects, and sparing of normal tissue. She received the Madame Curie Award from the American Association of Women in Radiology in 2005 and was given award by the Japanese Association of Radiation Oncology for her work supporting Japanese radiologist in developing a radiation oncology perspective.
Major Topics Covered:
Personal background: experiences in Hiroshima, Japan, in aftermath of the atomic bomb
Educational path: Japan, early experiences with US monitoring of bomb aftereffects
Japanese versus American attitudes about radiation: impact on evolution of radiation therapy, radiation oncology
Research: radiation dosage and fractionation and preservation of normal tissue, impact on breast and lung cancer, integration into multi-modal treatment;
Radiation oncology at MD Anderson: work with Gilbert Fletcher; evolution of radiation oncology; establishing the Proton Therapy Center
Impact of gender and culture on career, impact of marriage on career
Views of MD Anderson culture, institutional change; experiences of administrative shifts within the Division of Radiation Oncology; critique of division culture
About transcription and the transcript
This interview had been transcribed according to oral history best practices to preserve the conversational quality of spoken language (rather than editing it to written standards).
The interview subject has been given the opportunity to review the transcript and make changes: any substantial departures from the audio file are indicated with brackets [ ].
In addition, the Archives may have redacted portions of the transcript and audio file in compliance with HIPAA and/or interview subject requests.
The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
Interview Session One: 6 November 2018
A Family in Japan during World War II
Experiences in the Aftermath of the Atomic Bomb Become an Inspiration
A Park for Sadako and Thoughts on Radiation Research
Japanese Attitudes about Radiation and the Bomb;
Interview Session Two: 28 November 2018
Medical Education in Japan and Internship and Residency in the United States
Encountering a New View of Radiation and the Decision to Shift to Radiation Oncology
A Residency and Research on Fractionation to Preserve Normal Tissue
Mentors, Unusual Challenges, and Striving to Establish Credibility
A Difficult Exit from MD Anderson
Interview Session Three: 19 December 2018
A Fellowship at MD Anderson to Work with Gilbert Fletcher
As a Young Faculty Member: the Medical College of Wisconsin and Columbia Presbyterian
Returning to MD Anderson and a Focus on Lung Cancer
Studies of Concurrent Radiation and Chemotherapy in Lung Cancer
Interview Session Four: 23 January 2019
Bringing Proton Therapy to MD Anderson
Research to Compare Proton Therapy with Standard Radiation Treatment
Women at MD Anderson and in Radiation Oncology
Interview Session Five: 21 February 2019
An Impact on Japanese Radiation Oncology
A Future in Personalized Treatment
Thoughts on MD Anderson in a Period of Change
Interview Session One: (listen/read)
Interview Identifier (listen/read)
Chapter 01 (Personal Background)
A Family in Japan during World War II (listen/read)
In this chapter, Dr. Komaki talks about her childhood in Japan, focusing in particular on her experiences in Hiroshima after the Americans dropped the atomic bomb. She begins by sketching her family background, noting that her father (a banker) and her mother (a member of a samurai family) married across class boundaries. She talks about her mother's many talents and notes the lessons her mother taught her. She explains her mother's insistence that her three daughters focus on gaining technical expertise (stemming from her mother's experience having to provide for the family during WWII). She also talks about her father's difficult family background and the perseverance that he needed to become successful in business. Next, Dr. Komaki sketches the family's story after the atomic bomb was dropped on Hiroshima on 6 August 1945. Her family was living in Osaka, her father having been transferred there for work, but he returned to Hiroshima in the days after the bomb was dropped to search for family members. Dr. Komaki shares what she learned about the devastation in Hiroshima, as well as the health impact on her father and other family members.
Chapter 02 (Personal Background)
Experiences in the Aftermath of the Atomic Bomb Become an Inspiration (listen/read)
In this chapter, Dr. Komaki talks about her own early memories, first of life in Osaka and then in Hiroshima during the post-war period. She also discusses the effect it had on her, inspiring her interest in medicine, in research, and eventually in her focus on radiation treatments. She begins with very early childhood memories of "being always hungry." She talks about her mother's struggles to feed the family and a family separation, when she was sent to live with her mother's sister to ease the family burden. Next, she talks about her schooling and the role of the Atomic Bomb Casualty Commission [renamed, Radiation Effects Research Foundation], set up early after the war to monitor the effects of radiation on Japanese citizens. Dr. Komaki then talks about her friendship with fellow pupil, Sadako Sasaki, who would die from radiation-effect leukemia and who would inspire her own commitment to become a physician. [This story has been captured in several publications ADD LINKS; Miss Sadako's story has been told in the book, Sadako and the Thousand Paper Cranes.]
Chapter 03 (Personal Background)
A Park for Sadako and Thoughts on Radiation Research (listen/read)
Dr. Komaki begins this chapter by talking about how she became curious about how radiation had different effects on Sadako, who was young when the bomb was dropped and died young, versus the effect on her grandmother, who was much older and who did not die prematurely. She then tells the story of her commitment to make sure that her friend, Sadako was not forgotten. She explains that as president of her class at Noborichu Junior High School, she worked with her classmates first to raise money to create a monument, and then working with several key adults to organize space in a public park to erect a statue in an area that would be named "Peace Memorial Park." She recalls that almost 1000 people attended the opening reception. She also notes that every year around 6 August, the anniversary of the dropping of the bomb, teachers around the world arrange for activities so this event is not forgotten. Dr. Komaki talks about visits she has made in the last years to schools in Houston to talk about WWII and atomic weapons. In the final moments of this chapter, she shares her own message against creating nuclear weapons and the importance of communities educating the next generation about their power and danger.
Chapter 04 (Personal Background)
Japanese Attitudes about Radiation and the Bomb; (listen/read)
Dr. Komaki begins this chapter with observations about how teachers in her schools avoided negative comments about the United States' decision to drop the bomb. She notes that, in fact, they said that since the Japanese "started the war" with the attack on Pearl Harbor, "Japan deserved the bomb." Next she talks about her interest in how different people responded differently to radiation exposure, leading to her commitment to be a researcher. She also notes that her mother encouraged her to go to medical school: Hiroshima University School of Medicine, MD in medicine conferred in 1969. She notes that during medical school, she volunteered at the Atomic Bomb Casualty Commission. She did check ups, attended staff conferences, and heard about chromosomal abnormalities and second-generation effects of radiation. Dr. Komaki also met several mentors. Next, Dr. Komaki talks about medical school and her growing interest in hematology and leukemia patients. She also discusses the medical students' strike, in which she took part: the students objected to the educational hierarchy and medical culture in Japan. Dr. Komaki shared these objections, which motivated her to come to the United States for her internship, residency, and fellowships.
Chapter 05 (Educational Path)
Medical Education in Japan and Internship and Residency in the United States (listen/read)
Dr. Komaki begins this chapter by adding to the Chapter 04 discussion of the features of medical education in Japan that led to the student strikes and her own decision to pursue an internship and residency in the United States. She explains that through her volunteer work at the Atomic Bomb Casualty Commission, she met and married her first husband and also made a connection with Walter Russell, MD, who helped her secure an internship at the Medical College (1972). (Her husband also secured a fellowship, but later returned to Japan to practice and the couple divorced.) She intended to focus on hematology and leukemia. Dr. Komaki talks about the differences between medical education in the US and Japan.
Interview Session Two: 28 November 2018 (listen/read)
Chapter 06 (Professional Path)
Encountering a New View of Radiation and the Decision to Shift to Radiation Oncology (listen/read)
Dr. Komaki begins this chapter by summarizing Japanese attitudes about radiation and the lack of interest in Japan in researching the therapeutic potential of targeted radiation. She explains that she began to question this perspective when she encountered entirely different views during her internship and residency in the United States. Dr. Komaki then talks about key events during her fellowship in hematology at the Veteran's Administration Hospital in Milwaukee that motivated her to shift to radiation oncology. She also talks about work with patients and also the impact of seeing Anthony Guaninger, MD on rounds and hearing him speak about cancer. She talks about meeting Dr. James Cox [oral history interview], who came to Milwaukee as Chief of Radiation Oncology at the Medical College of Wisconsin (and who would become her second husband). She became the first resident in Radiation Oncology in the department he was building. Dr. Komaki then talks about making the intellectual shift from hematology to radiation oncology and the types of questions she was interested in exploring.
Chapter 07 (The Researcher)
A Residency and Research on Fractionation to Preserve Normal Tissue (listen/read)
In this chapter, Dr. Komaki talks about her residency in Radiation Oncology, an experience that gave exposed her to the noted radiation oncologists being recruited to the new program. As the sole resident, she had unusual opportunities to present cases, which offered her learning opportunities. She also began to conduct research. Dr. Komaki begins the discussion of her research career by talking about the first research study she conducted while still in medical school. She notes that she was (and is) fascinated by basic research (and has some regrets that she focused on clinical research) and explains what led her to focus on clinical work. Next Dr. Komaki discusses her research during her residency program: fractionation of radiation dosages to preserve normal tissues. She discusses historical shifts in approaches to dosing and explains the concept of sub-lethal damage to tissue.
Chapter 08 (Professional Path)
Mentors, Unusual Challenges, and Striving to Establish Credibility (listen/read)
Dr. Komaki begins this chapter with discussions of James Cox, MD and others who influenced her career at that time. She then talks about an unusual situation of responsibility when she was a resident—explaining treatments to surgeons as the only available radiation oncologist. She explains that she became very good at working with surgeons and developing true multi-disciplinary treatment plans because of her close study of surgical procedures and their complications, as well as the details of treatments in her own field. Dr. Komaki touches on how being a foreign national and a woman led certain people to doubt her ability. This leads to a discussion first of how Dr. Komaki made a plan to develop her credibility. Dr. Komaki gives examples of how her credentials have been ignored or diminished over the course of her career.
Chapter 09 (Overview)
A Difficult Exit from MD Anderson (listen/read)
In this chapter, Dr. Komaki shares the story of how she came to retire from MD Anderson. She begins by explaining that Dr. Cox felt that attitudes toward him changed when he stepped down as Chair of Radiation Oncology and as Division Head. She reports that people began asking her why was not retiring and goes on to tell a series of stories about how she was treated in the Division under the new division head. She describes changes in division culture under the new division head. She then narrates a series of events that demonstrate that the department wished to push her out of her position. She describes her late husband's reaction to her treatment in the division and her own feelings now that her husband has passed away and she has left the institution.
Interview Session Three: 19 December 2018 (listen/read)
Chapter 10 (Professional Path)
A Fellowship at MD Anderson to Work with Gilbert Fletcher (listen/read)
In this chapter, Dr. Komaki talks about her fellowship at MD Anderson in Radiation Oncology [1/1977-1/1978]. She provides a portrait of Dr. Gilbert Fletcher: she attended his planning clinic every morning and discusses how these worked. She explains that Dr. Fletcher determined all aspects of treatment. She also tells a story about questioning his approach, which resulted in him changing a treatment plan. She explains that her mentors in the department taught her to think critically about cases rather than "follow the recipes." She shares her impressions of the faculty and staff in Radiation Oncology at that time and talks about a neutron treatment facility that MD Anderson used at College Station. Next, Dr. Komaki talks about Eleanor Montague and tells a story about inviting her to lecture in Radiation Oncology at Columbia Presbyterian in 1987 to encourage a less conservative approach to radiation treatment. She explains why the surgeons there were resistant, noting that positive results from studies conducted at MD Anderson were often discounted.
Chapter 11 (Professional Path)
As a Young Faculty Member: the Medical College of Wisconsin and Columbia Presbyterian (listen/read)
In this chapter, Dr. Komaki talks about two faculty positions she held prior to coming to MD Anderson. She first talks about her return to the Medical College of Wisconsin, Milwaukee. She talks about her shift to a focus on gynecologic cancers and applying what she learned about case management during her fellowship at MD Anderson. She also describes the challenges she confronted when advocating for this type of approach to the department chair and how she found a strategy to encourage buy-in from resistant clinicians. Next, Dr. Komaki notes that she married James Cox, MD [oral history interview] on 27 January 1987, explaining that she arranged her career to be independent of him, rather than attempting to benefit from marriage to someone at a higher administrative level. She talks about their move to New York City and the new Radiation Oncology department at Columbia Presbyterian, where she served as Clinical Chief and Program Director of the Residency Program ('85-'88), focusing on gynecologic malignancies, breast cancer, and lung cancer. Dr. Komaki next sketches how this was a "very difficult time" because the conservatism at Columbia Presbyterian did not offer an environment where she could conduct the type of research that would allow her to set up prospective trials. She notes that Dr. Cox was promised support to develop the new department, but these came to nothing.
Chapter 12 (The Researcher)
Returning to MD Anderson and a Focus on Lung Cancer (listen/read)
In this chapter, Dr. Komaki begins to discuss her faculty career when she returned to MD Anderson in 1988 to become Section Chief of Thoracic Oncology, as there was no position in gynecologic oncology. An initial project she took on with collaborator….? Was to focus on the use of radiation oncology for prevention. She describes how she became aware of the problem of lung cancer in Texas and the informational presentations she gave in many Texas communities to talk about speak against smoking, and discuss post-operative radiation treatments for lung cancer. She describes the events and what she believes they accomplished over the course of 2-3 years. She notes that she saw a decrease in the numbers of Texans coming to her service with advanced lung cancer. Dr. Komaki also talks about her involvement in a research group focusing on early detection and sketches other lung cancer studies she participated in examining combination treatments.
Chapter 13 (The Researcher)
Studies of Concurrent Radiation and Chemotherapy in Lung Cancer (listen/read)
In this chapter, Dr. Komaki talks about a series of studies she conducted with James Cox, MD between 1988 and 1999 to compare the effects of sequential versus (the more effective) concurrent treatment of small cell lung cancer with radiation at various frequencies and chemotherapy. She explains the various treatments studied and the significance of the results. She explains that the most effective concurrent treatment plan created side effects and these discouraged clinicians in private practice from accepting and prescribing this course of treatment, despite its improved outcomes for treating the cancer. She goes into detail describing the different dosages studied.
Interview Session Four: 23 January 2019 (listen/read)
Chapter 14 (Building the Institution)
Bringing Proton Therapy to MD Anderson (listen/read)
In this chapter, Dr. Komaki describes the first steps in the process of bringing a proton therapy center to MD Anderson. She first underscores that she supported such a center because it was her dream to have the best methods available to avoid radiation toxicities in normal tissue. She lists some of the secondary effects of conventional radiation treatment. She talks about the financial context in the late eighties and how Dr. James Cox, MD [oral history interview] was able to move on this project when he became Head of the Division of Radiation Oncology, securing fifty percent of the support from MD Anderson and the University of Texas system and the remainder from private funding. (The Proton Therapy Center opened in 2006.)Next, Dr. Komaki talks about the controversy over the value of proton therapy. She also describes efforts she and Dr. Cox made to find the best proton system available, eventually setting on Hitachi. Dr. Komaki then explains how she was able to intervene when contract negotiations with Hitachi broke down, using her fluent Japanese and her cultural knowledge to convince the CEO of Hitachi not to back out of the deal. She next sketches the slow increase in patients after the Proton Therapy Center opened in 2006, some problems confronted, and the difficulties of getting insurance reimbursement for proton therapies.
Chapter 15 (The Researcher)
Research to Compare Proton Therapy with Standard Radiation Treatment (listen/read)
In this chapter, Dr. Komaki discusses the clinical trials designed to study the value of proton therapy in comparison to standard radiation treatments. She notes that it was the goal that every patient treated at the Proton Therapy Center be involved in a clinical trial. She explains her reasoning: that there was no other way to establish standard of treatment with this relatively new therapy. She also explains that the lack of insurance reimbursement for treatment (with the bill to the patient being between 200 and 700 thousand dollars) was an obstacle to running trials. Dr. Komaki also recalls that both surgeons and medical oncologists had objections to proton therapy, and she explains her responses to them. She then explains that the results of clinical trials over the last thirteen years has helped convince clinicians to accept proton therapy. Dr. Komaki then talks about the results of a randomized phase 2 trial comparing proton therapy with IMRT. She notes that patients treated after 11 September 2011 did significantly better, and explains that this date marks the period when MD Anderson became compliant with National Cancer Center Network [NCCN] guidelines for dosage and volume for normal tissue. She comments briefly on the reorganization of regional radiation oncology groups and sketches a comparative study they are not collaborating on to determine overall survival rates. Dr. Komaki then notes that patients are requesting proton therapy as their tolerance of chemotherapy is better than with standard radiation therapy. She explains that she sees the difference in patients. Dr. Komaki then talks more about the increasing acceptance of proton therapy among medical oncologists, attributable to the fact that the treatment planning teams now include a radiation oncologist who can interpret and explain the proposed radiation treatment plans. Next, she talks about attempts to promote proton therapy, including an initiative to allow pediatric patients to be treated for free. She also explains that MD Anderson purchased the fifty percent share of the Center controlled by private investors and has plans to build a second center behind the first. This center will be equipped with special imaging to address problems of tumor motion during therapy. Finally, she explains some her concerns about carbon ion radiotherapy (and all special particle treatment), a treatment that is gaining in acceptance internationally, and which will also be studied at the new center.
Chapter 16 (Overview)
Women at MD Anderson and in Radiation Oncology (listen/read)
In this chapter, Dr. Komaki shares some of her own experiences as a woman in radiation oncology and observes some behavior of other women. First, she confirms that she participated in the Women Faculty Organization led by Elizabeth Travis, PhD [oral history interview] and others. Next she tells a story about a woman fellow in the Department of Radiation Oncology who was pregnant and who refused to come near the imaging equipment, convinced any contact would endanger her pregnancy. She talks about the importance of women being correctly informed about such risks and the messages they send to (male) colleagues when they act on incorrect information. [The recorder is paused] Dr. Komaki then talks about receiving the Madame Curie Award (2005) from the American Association of Women Radiologists and her work to convince women to join and enter leadership pipelines. She also talks about a regular lunch meeting held via that organization that gives women a chance to discuss issues. She explains that she emphasizes to women that they must think of themselves as oncologists, not just technicians. Dr. Komaki then discusses the challenges women from Japan and other countries face, given male-dominated hierarchies in their countries of origin. In response to a question about what would make a difference for women, Dr. Komaki responds that new leaders need to appreciate the contributions of senior women and not be intimidated by them. She reflects on her own situation as a senior women in a division and department with shifting leadership. She notes that she has seen incoming leaders of other divisions and departments at MD Anderson remove senior women.
Interview Session Five: 21 February 2019 (listen/read)
Chapter 17 (Contributions)
An Impact on Japanese Radiation Oncology (listen/read)
In this chapter, Dr. Komaki talks about her recent trip to Japan to receive the International Honorary Award of Japanese Society of Therapeutic Radiation Oncology (JASTRO), given to recognize the role she (and her husband, Dr. James Cox [oral history interview]) played in shifting Japanese attitudes about radiation oncology. She explains that because she had been living in the U.S. but understood Japanese culture and attitudes, she could speak up against tradition, and emphasize that radiation oncologist must think of themselves as much more than technicians and become an integral part of a multi-disciplinary team. She then talks about Japan's contributions to developing proton therapy and other technologies. She explains that surgery is still considered a primary treatment.
Chapter 18 (MDACC in the Future)
A Future in Personalized Treatment (listen/read)
Dr. Komaki begins this chapter by asserting the importance of MD Anderson's focus on personalized treatments for cancer, then sets radiation therapy in this context: radiation treatments should be determined by much more than anatomical features of the person and tumor. Advanced need to be made to determine exact histology, specific mutations, and dimensions of the patient's situation. She goes on to talk about her own work establishing criteria for treating tumors with prophylactic cranial irradiation.
Chapter 19 (Institutional Change)
Thoughts on MD Anderson in a Period of Change (listen/read)
In this chapter, Dr. Komaki talks about third president John Mendelsohn [oral history interview] and his successor Ronald DePinho [oral history interview], and discusses changes at the institution during the transition between them and since Dr. DePinho's resignation on 8 March 2018. She begins with a very positive portrait of Dr. Mendelsohn and the feeling of teamwork he was able to create among employees to take the institution to its number one position. Next she reflects on Dr. DePinho, noting that she respected him, but that his focus on basic since didn't ripple through the institution to generate a common feeling. She also explains that the focus on generating funds for the Moon Shots program created a mechanical, inhuman feel to the institution that had an impact on patient care. Next, Dr. Komaki explains that the transition team that assumed leadership after Dr. DePinho's resignation began to fire and "target" anyone who had been supported by Dr. DePinho. She says she counts herself in this category. After a few comments about Dr. Peter Pisters, MD, fifth president of MD Anderson, a close friend of hers and Dr. James Cox's [oral history interview], she explains that people were afraid during to speak up in support of people being fired during the interim period. She touches on her own experience, which she attributes to being targeted for removal. She laments the lack of respect for the faculty and leaders who were able to take the institution to its number one position and the fact that the incoming faculty do not know and respect the institution-builders who have come before. She cites some evidence that the Department of Radiation Oncology is losing ground. Dr. Komaki then speaks about how "blessed" she has been by seeing patients and her commitment to teaching residents the patient care mission. She talks about the lectureship she and Dr. Cox established in November 2017 and the individual who will be giving the lecture this year