Interview with Raymond Sawaya, MD, FAANS
Raymond Sawaya, MD, FAANS, has been the chairman of the department of neurosurgery at The University of Texas MD Anderson Cancer Center in Houston since the department was established in 1990. He also serves as the director of the Brain Tumor Center at MD Anderson and from 2005-2014, served as professor and chairman of the department of neurosurgery at Baylor College of Medicine. Dr. Sawaya is the recipient of numerous awards, including the Anne C. Brooks & Anthony D. Bullock, III, Distinguished Chair in Neurosurgery. He is the past president of the American Radium Society, the past president of the Houston Neurological Society and the past chairman of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Tumors. Dr. Sawaya is a member of the editorial board of numerous medical journals. He is frequently requested as a national and international lecturer. He has published more than 270 peer-reviewed articles and written and edited more than 10 books. Dr. Sawaya is a noted leader in the field of neurosurgery, with particular expertise in primary and metastatic brain tumors. He is also renowned for his great strides in enhancing the accessibility and safety of brain tumor surgery. Andrew E. Sloan, MD, FAANS, recently interviewed him for AANS Neurosurgeon.
Andrew E. Sloan, MD, FAANS (AS): Why did you decide to become a neurosurgeon?
Raymond Sawaya, MD, FAANS (RS): I was going to medical school at St. Joseph’s Medical School in Lebanon, which is a French University. I met an American-trained neurosurgeon, Fuad S. Haddad, MD, who had trained at the Montreal Neurological Institute (MNI) with Wilder Penfield. I was assigned as his personal intern for a year. To me, he was an exemplary role model and taught me how exciting the field really is. He built the first neurosurgical institute in Middle East at the American University in Beirut. I started my training there, but as I progressed, I realized that I had to go to the U.S. because the technology, including intraoperative microscopy, was best developed there.
After graduating from medical school, I started my surgical internship at Beekman Downtown Hospital in Manhattan in 1974. Shortly thereafter, I was very fortunate to encounter Robert B. King, MD, at Syracuse University Medical Center. He was an outstanding academic and an acknowledged leader in neurosurgical education. He also served as the chair of the American Board of Neurological Surgery (ABNS) and the American Board of Medical Specialties (ABMS). He taught me the value of academic pursuit in neurosurgery. I spent a year with him from 1975 to 1976. Unfortunately, for the year I wanted to start my neurosurgical residency, in 1976, Dr. King had already committed to take another resident. However, he wrote to his friend, Robert L. McLaurin, MD, JD, FAANS(L), who accepted me into the residency at the University of Cincinnati, where he was a tremendous influence on me. I was also greatly influenced by Frank H. Mayfield, MD. He was an innovator who was able to accomplish a lot. He taught me the value of organized neurosurgery.
In 1980, Don Long had an opening at the chief resident level at Johns Hopkins, and I accepted the position. Hopkins, at that time, was a unique place. It was extremely busy with 70 neurosurgery beds, but it also had a tremendous emphasis on education. I learned to do microneurosurgery during my time at Johns Hopkins. In 1981, I had planned to go back to Lebanon, but civil war had been raging there since 1975, so it seemed a bad time to go back. Instead, I applied to the National Institutes of Health (NIH), where Paul L. Kornblith, MD, was head of the surgical neurology branch. He accepted me into the lab on a two-year International Fogerty Fellowship. This is when I first committed myself to focus on brain tumors. This was a wonderful and formative period. I focused my professional life on gliomas and how they invade the brain.
In 1982, I was recruited back to the University of Cincinnati where I worked under John M. Tew, Jr., MD, FAANS(L), who had taken over the chairmanship. I spent eight years at the University of Cincinnati building the brain tumor program. However, in 1990, The University of Texas MD Anderson Cancer Center recruited me as the chairman of neurosurgery. I immediately saw the tremendous potential there, and I have been there for 25 years building what I consider to be one of the strongest programs in neurosurgical oncology.
AS: What makes you unique is that you are a triple threat: Surgeon, researcher and teacher. You have also been unusually successful as a leader and an advocate for the field. How did you master these skills?
RS: It came gradually. I learned a lot over time with experience and exposure. All my mentors brought important aspects to my practice. Excellence exists at multiple levels. The more we learn, the better we become. Watching Dr. Mayfield work his way through a room was very inspiring at the time–even to a junior resident like me. One needs to keep an open mind and allow oneself to evolve. However, one also has to take on some responsibilities because you will never master such activities without doing them and making some mistakes along the way. I kept my mind open, I watched, I learned, and I tried to emulate those whom I respected.
AS: Which neurosurgeons most influenced you?
RS: Dr. Haddad was the catalyst for my becoming a neurosurgeon. He was a great clinician. Dr. King was a wonderful educator. Drs. Maclaurin and Long were also great influences, as was Dr. Mayfield, who showed me the importance of organized neurosurgery. And John Tew helped me appreciate the importance of technology in neurosurgery. However, they were all very different people.
AS: What advice would you give a neurosurgeon just beginning his career?
Work hard, read a lot and never stop asking questions. Knowledge is power. Learn everything you can, and continuously ask big questions. Become an expert, create novel ideas and give back.
AS: You are known for many things, but perhaps best for changing the way we treat brain metastasis. What made you focus on this issue? You shifted the paradigm.
RS: Whole-brain radiotherapy was the only treatment used for brain metastases for decades. Surgical mortality up into the 1950s was 25 percent. Memorial Sloan-Kettering first started operating on patients with single metastasis, but this was only in retrospective series. I came to MD Anderson in 1990 just after Patchell published his first clinical studies. I was fortunate that at MD Anderson, the medical oncologists approached me about patients with more than one metastasis. I eventually published a series of papers where we treated patients with two to three metastases. These patients generally had good outcomes, and as long as we treated all of the metastases, they did essentially as well as patients with a single brain metastasis. This was published in 1993 and is still among my most highly-cited papers, with over 300 citations, and I am invited all over the world to speak on this topic.
AS: If you were not a neurosurgeon, what career would you choose?
I had difficulty getting into the U. S. and later getting into a neurosurgical residency. I sent 300 letters to the U.S., but no one offered me a job initially, and many letters were not even answered — although a few were answered with “no.” Had I not become a neurosurgeon, I would have pursued a career in psychiatry. The mind is a fascinating thing.
AS: What do you consider to be your top professional accomplishments?
RS: Building and maintaining our comprehensive brain tumor program. The University of Texas MD Anderson Cancer Center has the largest brain tumor and neuro-oncology program in the country and is approximately twice as large as its nearest competitor. Our brain tumor program reaches more people than all my work on brain metastasis and glioma combined and has been extremely rewarding. Yet, while it was easy to build, it is hard to maintain.
AS: Thank you!
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