Brian O’Sullivan: Advancing Radiation Medicine

THIS IS AN EXCERPT FROM THE 2015-2016 ANNUAL REPORT.

Dr. Brian O’Sullivan’s career spans a series of inspiring successes, but he will be the last person to tell you that. You may know him as the co-creator of one of the world’s leading sarcoma programs or heard him at one of his countless speaking engagements; you may have followed his 300-plus peer reviewed publications or his groundbreaking research on how to treat tonsillar cancer including frontier research on understanding clinical behavior and optimizing treatment for human papillomavirus (HPV)-related oropharyngeal cancer. However, Brian wants to be known first, as a physician working with patients in the clinic, and then as a researcher connecting the world through education.

Dr. Brian O’Sullivan is a Professor in the University of Toronto’s Departments of Radiation Oncology (UTDRO) and Otolaryngology. He is also a Radiation Oncologist at the Princess Margaret, where he leads the Radiation Oncology Sarcoma Site Group and the institute’s head and neck site team. He holds the Bartley-Smith/Wharton Chair at the Princess Margaret in addition to his Clinician-Scientist appointment with the Ontario Association of Radiation Oncologists.

Dr. Brian O’Sullivan’s career spans a series of inspiring successes, but he will be the last person to tell you that. You may know him as the co-creator of one of the world’s leading sarcoma programs or heard him at one of his countless speaking engagements; you may have followed his 300-plus peer reviewed publications or his groundbreaking research on how to treat tonsillar cancer including frontier research on understanding clinical behavior and optimizing treatment for human papillomavirus (HPV)-related oropharyngeal cancer. However, Brian wants to be known first, as a physician working with patients in the clinic, and then as a researcher connecting the world through education.

Dr. Brian O’Sullivan is a Professor in the University of Toronto’s Departments of Radiation Oncology (UTDRO) and Otolaryngology. He is also a Radiation Oncologist at the Princess Margaret, where he leads the Radiation Oncology Sarcoma Site Group and the institute’s head and neck site team. He holds the Bartley-Smith/Wharton Chair at the Princess Margaret in addition to his Clinician-Scientist appointment with the Ontario Association of Radiation Oncologists.

Growing up as the son of a diplomat, Brian had spent time in several places around the world before settling down to attend the Clongowes Wood College, a renowned Jesuit school in Ireland. In addition to rugby, he developed a passion for medicine which brought him to the medical school at the National University of Ireland, University College, Dublin. In 1975, while on an elective as a medical student, Brian visited the United States and met oncologists trained at the Princess Margaret. Intrigued by their profound knowledge base, Brian decided to visit the Princess Margaret later that year and subsequently enrolled in the medical oncology fellowship program there.

Over the years, a lot of opportunities came about because, I hope, I was a little observant and not too dogmatic. I try to instill this philosophy in approach to the residents and fellows.

During his medical oncology fellowship, radiation oncologists including UTDRO’s past chair, Dr. Bernard Cummings, encouraged Brian to pursue a career in radiation oncology. Thus, after completing his fellowship, Brian joined the radiation oncology residency program in 1980, and followed that up with a clinical fellowship in radiation oncology.

While he was working at McGill University in 1985, he received a phone call that would profoundly change his career. Brian was invited by an established and well-published radiation oncologist, Dr. Andy Harwood, to take over his practice in head & neck and sarcoma at the Princess Margaret. Even though Brian has taken on numerous projects and leadership roles since then, he has continued with his head & neck and sarcoma practices to this day. 

Dr. Bob Bell, the current Deputy Minister of Health at the Ontario Ministry of Health and Long-Term Care, worked closely with Brian in the 1980s. They focused on the lack of sarcoma academic and clinical programs and set out to enhance sarcoma programs across the province. Although the Princess Margaret Sarcoma Site Group already existed as a clinical program, Dr. Cummings established it as an academic program in 1986, with Brian as its head. It is now one of the leading sarcoma programs in the world. “We are quite proud of this program as it guides teaching and practice globally,” said Brian. “It focuses on multidisciplinary care that is underpinned by excellent collaboration in the clinic between surgical oncology, medical oncology, pathology and medical imaging. Through this program, we have published major papers and influenced sarcoma care in many areas.”

In the early 1990s, when funding for health care was drying up in Ontario, UTDRO was established at the University of Toronto. “Against all odds, Bernard was able to gather support and backing to establish UTDRO,” recalled Brian. As one of the first members of UTDRO, Brian noted that the Radiation Medicine team has come a long way in the last 25 years. “There have been a lot of changes, but we have continued to work as a group. The support, respect and collegiality have ensured that we continue to do brilliant work as a team.”

In 2008, Brian became the Head of the head & neck site group at the Princess Margaret. “Serendipity played a big role in my career trajectory,” he recalled. “I did not plot a straight path to this point. Over the years, a lot of opportunities came about because, I hope, I was a little observant and not too dogmatic. I try to instill this philosophy in approach to the residents and fellows.”

As the head of this team, Brian has led several important initiatives. As the Bartley-Smith/Wharton Chair, he developed the Head & Neck Anthology of Outcomes, now known as the Bio-Clinical Anthology of Outcomes (the Anthology). The anthology is a unique and sustained integrated effort from all the head & neck radiation oncologists at the Princess Margaret. It is assisted by pathologists, radiologists, surgeons and medical oncologists and maintained in collaboration with UTDRO Assistant Professor and radiation therapist, Sophie Huang. 

The anthology is the only data-collection system to have prospective point-of-care data collection with outcomes for every head & neck cancer patient treated with radiation therapy. Brian explained that the anthology has enabled several initiatives. “It allows us to link any case parameter to measurable treatment or outcome details. And it provides correlative data and outcomes for our laboratory and translational work.” In addition, the anthology has assisted in Quality Assurance initiatives and in the design of clinical trials at the cooperative group level.

During his time with the Head & Neck team, Brian noticed unusual disease and changing behaviour in patients with head & neck cancers. ”It was not as straightforward as we had traditionally thought,” he explained. “There was some unexpected disease behaviour in HPV-related oropharyngeal cancer patients. For example, we were noticing unusual disease spread, including almost unheard of brain metastases in head and neck patients. We also noticed favorable but more delayed responses in neck disease in this patient population.” Using the anthology, the team was able to cross-examine data on patients with HPV-related oropharyngeal cancer and link such risks and disease behavior in this patient population.

Brian is also known for his research on tonsillar cancer and other head & neck malignancies. In 2001, he published a landmark paper describing how to treat patients using only one side of the neck while sparing the contralateral tissue. The unilateral neck irradiation technique described in the paper has been validated by major centres around the world, and the iconic Figure 2 from this paper continues to be used in resident training programs and notable conferences around the world.

Several organizations around the world have recognized Brian for his contributions to Radiation Medicine. He is the only Canadian to receive the Juan Del Regato Gold Medal and Lectureship. He is also the only Canadian to deliver the Annual Radiation Oncology Oration at the Radiological Society of North America’s annual meeting. Earlier this year, Brian was invited to deliver the Inaugural Stiefel Lecture in Head & Neck Cancer at the MD Anderson Cancer Centre in Texas. He has also received numerous awards from the American Society of Radiation Oncology (ASTRO), Canadian Association of Radiation Oncology (CARO), and regional organizations such as Cancer Care Ontario. Brian has also received several education awards at UTDRO, and is particularly proud to have received the Residents’ Award for Excellence in Clinical Teaching. Many of his trainees, including residents, fellows, radiation therapists and nurses, have benefited from Brian’s holistic approach that considers the patient as a whole.

Despite the international recognition and accolades, Brian maintains that he is a clinician first. “It is very important to remember that we are here for our patients. I want to be remembered as a doctor in the clinic before anything else.” And that is how Brian’s patients will remember him. There is no better proof of his dedication to his patients than the fact that many of them have become involved in fundraising initiatives to support Brian’s research and cancer programs.

IMAGE CREDIT: HORST HERGET PHOTOGRAPHY

 

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