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Friday, February 28, 2014

Remembering Donald L. Morton, MD, Pioneering Surgical Oncologist and Sentinel Lymph Node Researcher







Surgical oncology pioneer  Donald L. Morton, MD, died in January of heart failure, at age 79. He played a leading role in developing and implementing sentinel lymph node (SLN) biopsy, which transformed the surgical management of many solid tumors, especially melanoma and breast cancer.


SLN biopsies today have been estimated to save the U.S. health system more than $3.8 billion per year in early cancer treatment, and averting numerous unnecessary surgeries.


Morton himself developed melanoma in the 1980s, but was able to recognize it early, and it was successfully treated.


For the last four decades of his life, he had been attempting to develop a therapeutic vaccine for melanoma, work that is being continued by his colleagues and other researchers.


"I think my greatest accomplishment,” he said at various times over the years, describing his childhood poverty, “was making it from rural West Virginia to the Westside of Los Angeles. I grew up during the Depression in a house that my dad built. We had no running water, no indoor plumbing, and no electricity."


At the time of his death, Morton was Chief of the Melanoma Program and Director of the Surgical Oncology Fellowship Program at John Wayne Cancer Institute at Saint John’s Health Center, in Santa Monica, Calif., and  Professor of Surgery Emeritus at UCLA.


Outside of the medical community, he gained public attention for treating John Wayne, who died of stomach cancer in 1979 and participated in an early immunogenic cancer vaccine study that Morton led.


The author of some 700 papers published in peer-reviewed journals, he was considered one of the most prolific researchers in the United States and received many national and international awards. Over the course of his professional career he served as President of several organizations, including the Society of Surgical Oncology, the World Federation of Surgical Oncology Societies, and the International Sentinel Node Society. In 2008, he received the prestigious Jacobson Innovation Award of the American College of Surgeons (ACS).


“Dr. Morton’s discoveries have profoundly changed the treatment of human cancer,” the ACS noted in making the award. “When he assumed the role of professor and chief of the Division of Surgical Oncology at UCLA School of Medicine in 1971, surgical oncology was not yet recognized as a specialty within general surgery. Dr. Morton’s division provided a model for other medical schools to duplicate.”


Regarding his SLN work, the ACS said, “His contribution has spared countless patients the morbidity of a complete regional lymph node dissection needlessly done in the absence of nodal metastasis. Intraoperative mapping of the sentinel node is a landmark achievement in surgical oncology.”


In 1991, Morton and John Wayne’s eldest son, Michael Wayne, founded the John Wayne Cancer Institute, where  Morton became Medical Director and Surgeon-in-Chief until his death.


In the late 1970s, he changed how melanoma surgery was then approached by introducing the use of cutaneous lymphoscintigraphy to identify the regional lymphatic basin receiving drainage from a primary cutaneous melanoma. During the 1980s, he further refined lymphatic mapping to identify the pathway of sequential metastasis from a primary tumor to tumor-draining nodes within the regional nodal basin.


He defined the sentinel lymph node as the first tumor-draining node and hence the most likely initial candidate target of nodal metastasis. Extensive studies have confirmed that the pathologic status of the SLN accurately predicts the status of all nodes in the same drainage basin. SLN biopsy thus eliminates the need for more extensive staging lymphadenectomy, and improves the accuracy of nodal assessment by allowing closer scrutiny of a smaller specimen.


His novel studies of sentinel node mapping resolved the debate on the value of prophylactic lymph node dissection for melanoma, and SLN biopsy has become the standard of care for patients with early-stage malignant melanoma and breast cancer. The technique has also been successfully adapted for staging of other solid malignancies that can often spread to regional lymph nodes.


Morton received his medical degree from the University of California, San Francisco in 1958. He interned at UCSF Medical Center and began a surgical residency in general surgery, and then a fellowship at the National Cancer Institute. He then joined NCI as Senior Surgeon in the Surgery Branch, eventually becoming head of the Tumor Immunology Section.


Educator, Mentor

Over the course of his long career, Donald Morton trained hundreds of surgical oncology students, many of whom have gone on to make significant contributions themselves. One of them, Robert Wascher, MD, is now Chief of Surgical Oncology at Cancer Treatment Centers of America’s Western Regional Medical Center, in Goodyear, Arizona.


Speaking to OT about his mentor, Wascher said, “If you look at the trajectory of his life, it is quite amazing. This man, who began as a child from an impoverished coal-mining community in West Virginia, grew up to become one of the founding titans of surgical oncology.


“As a clinician, research scientist, and educator he liked to think outside the box. He was possessed of a tenacity that was, undoubtedly, a product of his hardscrabble youth. He was a tireless clinical investigator, and I believe that he still holds the record for being the most prodigiously funded researcher in the U.S., if not the world.”


Morton was a true innovator, Wascher said, but above all remained interested and committed to the work of the students that he had trained: “What stands out in my mind is not only his amazing contribution to the care of cancer patients through his development of the sentinel lymph node hypothesis, and the techniques of sentinel lymph node mapping and biopsy, but also his lifelong commitment and generosity towards his students and colleagues.”


For all of the professional awards and recognition that Morton received in his life, Wascher said that he believes his greatest contribution was in educating and mentoring students.


“I am certain that Dr. Morton was most proud of the many young surgeons that he personally trained who went on to become successful and renowned surgical oncologists, research scientists, and department chairs in their own right. He was very paternalistic towards all of us. Although he could be very demanding of his fellows, he was always committed and caring towards us.


“Following my graduation, in 2003, from the surgical oncology fellowship that he founded, and that he sustained until literally a few days before his passing, he continued to regularly check in with me regarding my professional progress, as well as my family and me. For those of us who were fortunate enough to have had Dr. Morton as our mentor and teacher, his passing leaves an enormous void in our hearts and in our lives.”