Charting a Career in Brachytherapy While Preparing to Lead ASTRO

Beth Erickson, MD, FACR, FASTRO, FABS, never set out to become a radiation oncologist. Like many medical students, she had never been told the specialty existed until a summer externship supported by the American Cancer Society placed her in a radiation oncology department at the Medical College of Wisconsin (MCW).

“I slipped into it, presumably out of good fortune, and grew to love it,” Erickson said. “The physicians there were wonderful mentors [and are] now very historic figures. You couldn’t have asked for a more robust group of mentors for a medical student to come upon, and it certainly determined my career path.”

Those mentors included James Cox, MD, FASTRO; Ritsuko Komaki, MD, FASTRO; J. Frank Wilson, MD, FASTRO; and Larry Kun, MD, FASTRO. Decades later, Erickson is the J. Frank and Vera B. Wilson Professor of Radiation Oncology at MCW, where she serves as chief of brachytherapy services and specializes in gynecologic, gastrointestinal, and eye/orbital cancers. On September 29, 2026, she will take office as president-elect of the American Society for Radiation Oncology (ASTRO) at the society’s 68th Annual Meeting in Boston before assuming the presidency in September 2027.¹

Ahead of the meeting, Erickson spoke with CancerNetwork® about the innovations that shaped her clinical career, the guideline work she considers a pinnacle, and the priorities she is bringing into ASTRO leadership.

Bringing Image-Guided Brachytherapy to Wisconsin

Erickson earned her medical degree, completed her residency, and built her entire clinical career at MCW. She credits much of that to her training and the 3 months she spent in France as a senior resident learning brachytherapy under Monique Pernot, MD, whom she described as “an amazingly innovative brachytherapist.”

At the time, European centers were pioneering CT-based imaging during brachytherapy for gynecologic cancers. Erickson brought those techniques back to MCW, where she was hired to contribute to both the gynecologic and gastrointestinal programs. With support from Wilson, then her chairman, she developed the gynecologic and brachytherapy arms of the department, including a high-dose-rate brachytherapy program that allowed patients to be sedated and treated as outpatients rather than stay in the hospital for their treatments.

Through collaboration with diagnostic radiologists, magnetic resonance physicists, and the gynecologic oncology team, the program eventually moved to MRI-based brachytherapy, which Erickson called “the highlight of my career here at MCW.”

“There’s nothing more gratifying than seeing a tumor shrink, go away, and stay away [while] having a patient survive a very, very difficult cancer,” she said. “It’s been very rewarding, and it’s kept me going for many decades to perfect our techniques.”

That work continues. MCW’s physics group, led by Eric Paulson, PhD, along with Jason Rownd, MS, has pioneered MRI-guided brachytherapy, and the team is now performing brachytherapy inside the MRI scanner, with Erickson inserting catheters and applicators while the MRI is being acquired.

“That’s the crown jewel of what we hoped to do over these many years,” she said. “[We are able] to know that we have a good implant before we leave the scanner and to afford a cure for many things that come to us that others struggle [with], saying, ‘Well, what do I do now?’ It’s been a very rewarding career, not just because of me, but all my wonderful colleagues.”

Defining a Target

Asked about the most significant shift in image-based treatment planning she has witnessed, Erickson pointed to the early 2000s, when an international group gathered to define a target using an MRI in gynecologic cancers. That effort became the Gynaecological GEC-ESTRO Working Group recommendations, published in 2005 and 2006, the latter of which Erickson is a coauthor.^2,3

As a younger attending, she and members of MCW’s physics team were invited to Europe on numerous occasions to contribute to the development of the guidelines. She and colleagues in the US, including Akila Viswanathan, MD, MPH, director of Johns Hopkins Radiation Oncology and Molecular Radiation Sciences, and director of Johns Hopkins Gynecological Radiation Oncology, then helped teach the approach through the efforts of ASTRO, the American Brachytherapy Society, and the Radiological Society of North America.

“This has now become the standard of care for women with cervical cancer, vaginal cancers, and inoperable endometrial cancers,” Erickson said. “It makes me extremely happy and proud to know that we were able to develop a concept, share it, and have it grow and improve with the wonderful innovations that others have brought to it so that our female patients have been given something even better as they struggle with these cancers that leaves them whole, rather than combating a lot of regrowth of tumor and a lot of toxicity. I’d say that’s a pinnacle for me.”

Lessons From Guideline Development

Erickson chaired the task force behind ASTRO’s updated clinical practice guideline on radiation therapy for endometrial cancer, serving as senior author alongside first author and task force vice chair Matthew M. Harkenrider, MD, professor and vice chair of clinical operations and education, medical director, and director of brachytherapy of Loyola University Chicago.⁴

She said the process deepened her appreciation for the clinical trials conducted across the world, noting that much of the endometrial guideline draws on the European PORTEC trials. “Clinical trials are what move the progress in cancer forward,” she said.

It also underscored the value of collaboration. Canadian and European colleagues contributed to the endometrial guideline, and Erickson noted that, beyond published protocols, much of what a guideline claims comes from its members' expert opinion.

“I’m obviously the senior person on it, but my equal is Dr Matt Harkenrider, who is my coauthor of the guidelines,” she said. “Working with Matt has been an exceptional privilege, and [I] couldn’t have done any of this without him and all the members of that team, the ASTRO staff, who helped to guide this process. We cannot do guideline creation without our wonderful ASTRO staff. It’s the starting place and the ending place for all these guidelines.”

Advice for Early-Career Radiation Oncologists

Having held numerous leadership roles, Erickson offers residents and young attendings a simple, consistent piece of advice: Volunteer.

“There’s nothing more admirable and sought after than a resident or a younger attending who wants to get involved,” she said. “It’s so easy to mentor them if they’re wanting to be a part of something.”

She described watching trainees who are willing to work hard and follow through on responsibilities grow from feeling unworthy of a position to feeling enabled, becoming equal members of the team, and eventually leading others.

“Put yourself out there, be willing to work hard, and never underestimate your value,” she said. “Even though you may not have much experience, you have fresh ideas. You’re a very meaningful part of that team.”

Looking Toward ASTRO Leadership

Erickson is clear-eyed about what her first year on ASTRO’s leadership track will look like. As president-elect, she said, she will spend a year watching how her colleagues operate as president, past president, and chair of the board.

“[In] your first year, you’re not leading; you’re watching, you’re absorbing, and you’re becoming part of that executive team,” she said. Her top priority is to determine ASTRO’s priorities and the society’s needs before helping advance and complete those initiatives. “My job as I transition through these leadership opportunities is to make sure it’s ASTRO No. 1, and whatever I have to do to help will be my best role.”

On payer friction, prior authorization hurdles, and reimbursement cuts, Erickson said these are not challenges that 1 person can combat alone, citing ASTRO’s health policy and government relations teams. She described the burden of peer-to-peer reviews, in which a busy clinician must arrange an appointment and may wait on the phone for 20 minutes to get a CT or MRI approved that they know their patient needs, sometimes without success.

“That is a ridiculous way for physicians to be spending their valuable time,” she said. “Whatever we can do to make those interactions fewer and farther between, I would appreciate. Again, that’s not something that I will be able to do directly. I will serve as support, encouragement, and let our wonderful health policy and government relations leaders help guide the way.”

A Welcoming Society

Making ASTRO a welcoming society for every member of the care team was part of Erickson’s vision, and she said work is already underway. A current priority is increasing physicists’ participation by making membership terms favorable so that it is financially feasible for them to become full members.

“We cannot do what we do without our wonderful physicists,” she said.

The society is also looking at how to create a niche for nurse practitioners and physician assistants, whose numbers are growing, and how to bring dosimetrists and radiation therapists, many of whom currently attend meetings that run parallel to ASTRO, into more of the society’s activities. Academic, private practice, and hybrid physicians are all welcome, she added.

“One of my great hopes is that people feel that way, rather than just hoping that they’ll feel that way,” Erickson said.

Asked what she hopes her legacy will be once her term is complete, Erickson said she is not looking for one.

“I’m looking for ASTRO to flourish,” she said. “If people reflect on my leadership, hopefully it will be a successful leadership, that I was somebody who cared deeply about our profession and did things that were for the good of all. That I was always a welcoming presence and someone who could be approached and help in many different areas. That I was a team player for the right things.”

References

1. Dr. Beth Erickson elected president of the American Society for Radiation Oncology (ASTRO). News release. ASTRO. July 29, 2026. Accessed September 16, 2026. https://tinyurl.com/5ypmtwwa
2. Haie-Meder C, Pötter R, Van Limbergen E, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image–based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol. 2005;74(3):235-245. doi:10.1016/j.radonc.2004.12.015
3. Pötter R, Haie-Meder C, Van Limbergen E, et al. Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol. 2006;78(1):67-77. doi:10.1016/j.radonc.2005.11.014
4. Harkenrider MM, Abu-Rustum N, Albuquerque K, et al. Radiation therapy for endometrial cancer: an American Society for Radiation Oncology clinical practice guideline. Pract Radiat Oncol. 2023;13(1):41-65. doi:10.1016/j.prro.2022.09.002