N E S W

Children’s Cancer Hospital
NEWSLETTER
FROM THE DIVISION OF PEDIATRICS AT THE UNIVERSITY OF TEXAS M. D. ANDERSON CANCER CENTER • • • • • SUMMER • 2006
Children’s Cancer Hospital
at The University of Texas
M. D. Anderson Cancer Center:
The George Foreman Pediatric
and Adolescent Inpatient Unit
Robin Bush Child and
Adolescent Clinic
Kim’s Place
R. E. (Bob) Smith
Research Facility
Our Mission
is to treat the whole child,
not just the cancer.
Each patient has a team of treatment
specialists to address any cancerrelated issues, whether they are
medical, psychological or developmental. Treatments are designed for
minimal interference to your child’s
normal routine. Because a familiar
face means so much to a child,
they will see the same physician
throughout their treatment. Patients
and families always know who “their”
doctor is. We also make sure that
life after cancer is the best it can be.
Follow-up programs monitor and
manage any side effects of cancer
or its treatments. Counseling and
support groups help the parents and
the child overcome any fears and
concerns.
At the Children’s Cancer
Hospital, kids rule–not cancer.
We wouldn’t have it any other way.
Contact us at 713-792-5410
8 a.m. – 5 p.m. (M–F)
and after hours at 713-792-7090
Request the On-Call
Pediatric Oncology Attending
We’re on the Web!
www.mdanderson.org/children
Treating Solid Tumors
at the Children’s Cancer Hospital...a Team Approach
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
Physicians and nurses in the solid tumor group at the Children’s Cancer Hospital at M. D. Anderson
take a team approach to treating their young sarcoma patients. Team members share advances
and innovative approaches such as PET-CT fusion imaging in treating sarcomas. This improved
visual method of monitoring therapy helps physicians communicate with families about decisions
concerning treatment interventions.
With the PET-CT fusion imaging, Peter
Anderson, M.D., Ph.D., routinely uses
MIMvista, a program that generates color
fusion images of PET and CT scans on the
same day that scans are done. For patients
with complicated situations, the PET-CT
fusion images serve as tie-breakers,
helping Dr. Anderson to facilitate
resolution of “analysis-paralysis” and
to develop treatment strategies using
M. D. Anderson resources.
Winston Huh, M.D., checks on his patient to monitor the
child’s side effects from treatment. Huh is involved in
studies of long-term side effects of treatment in children.
Communication
between doctor
and patient is
important when
determining the
best treatment plan.
Peter Anderson,
M.D.,Ph.D., takes
time to discuss the
novel therapies
at M. D. Anderson
for pediatric patients
with osteosarcoma.
According to Dr. Anderson, MIMvista PET-CT
fusion is an important advance in several
respects including:
•PET-CT provides pictures of the tumor that make
it easier to communicate local control strategies
“at-a-glance” with patients, families, referring
physicians, surgeons, radiation therapists and
interventional radiologists.
•PET-CT offers rapid standard uptake value data
concerning location and intensity of tumor activity.
•Before and follow-up scans can show continuing
response and help decide treatment effectiveness.
Recently, a publication by Dr. Anderson and Peggy
Pearson, pediatric advanced practice nurse,
highlighted solid tumor treatment principles and
some innovative new approaches in treating
sarcomas at M. D. Anderson. (“Novel Therapeutic
continued
Treating Solid Tumors continued from page 1
Peggy Pearson, P.N.P, checks in with a patient completing her last round of
chemotherapy.
Approaches in Pediatric and Young Adult Sarcomas,” Current Oncology
Reports 2006; 8:310-315. To request a PDF of the article, e-mail Pete
Anderson, [email protected], or Peggy Pearson, [email protected]
mdanderson.org.)
Another member of the solid tumor team,
Andrea Hayes-Jordan, M.D., uses an
improved surgical treatment paradigm for
cancers in the abdomen. The treatment
involves aggressive surgery, then continuous
hyperthermic peritoneal perfusion (CHPP)
of chemotherapy. This “shake and bake”
procedure eradicates microscopic disease
and offers hope for patients with desmoplastic small round cell tumors. She has seen
success with the surgery, with a recent
patient out of the hospital within a week after
the operation. This fall, the child will enroll in
the first grade with no evidence of disease.
Doctors and researchers at the Children’s
Cancer Hospital continuously seek out novel
therapies that will improve outcomes for pediatric
patients. Andrea Hayes-Jordan, M.D., has been
successful in redeveloping an aggressive
adult surgery for treatment of young patients.
Representing the Children’s Cancer
Hospital, Dennis Hughes, M.D., Ph.D.,
left, gave two talks in Heidelberg,
Germany in June. One, a basic science
talk, “Protein Lysate Array Assessment
of Therapeutic Targets in Sarcoma,”
was presented at the 2nd International
Congress on the Molecular Staging
Dennis Hughes, M.D., Ph.D., takes
his job seriously, but isn’t afraid to
roll up his sleeves and meet
patients on their level.
of Cancer. In addition, he gave a clinical
presentation, “Advanced Care and Research in
Relapsed and Refractory Pediatric Sarcomas:
The M. D. Anderson Experience,” to the
pediatric oncology group at the University of
Heidelberg. The clinical presentation highlighted current efforts to use specific boneseeking therapy for osteosarcoma bone
metastases with samarium; use of proton therapy to improve radiation
treatment of young people; interventional radiology to “cook” tumors in
the liver, bones, or chest wall using radiofrequency ablation; and novel
agents such as Imm-Ther in Ewing’s sarcoma; and targeted treatments
such as Avastin, and aerosol L9NC.
Cynthia Herzog, M.D., uses an aerosol L9NC with temozolomide protocol
offering a number of novel and patient-friendly features. In this protocol,
the patient receives instruction at M. D. Anderson about nebulization and
lung function testing. The first treatment supervision is actually done
outside in the gazebo next to the M. D. Anderson Faculty Center.
Monitoring of lung function is done daily using a small device
(Spirotel)that records
pulmonary function test
parameters and then
sends the data directly to
the hospital over the
telephone. L9NC study
patients can get aerosol
chemotherapy at home,
which results in fewer
pediatric oncology visits.
The treatment paradigm
is completely compatible
with attending school
full time.
Winston Huh, M.D., and
Louise Strong, M.D., are
participating in national
studies of long-term side effects of cancer therapy in children. This is an
important effort since one of every 900 adults are currently survivors of
childhood cancer. Dr. Huh also will become the team point person for
developing combined modality treatment plans involving proton therapy
in combination with chemotherapy for rhabdomyosarcoma and other soft
tissue sarcomas in young people. Since proton radiation has minimal
entrance and exit doses, a higher dose can be given to the tumor with
fewer areas of growth in children getting unnecessary radiation and
undesirable long-term effects.
Maritza Salazar-Abshire, R.N., works closely with
patient and doctor to oversee the daily administration
of treatment and monitor its side effects.
Additionally, there are a number of current efforts to make cancer
therapy for children and young people at M. D. Anderson more effective,
predictable, with less hospitalization and fewer side effects.
These include outpatient high-dose methotrexate, continuous infusion
ifosfamide/mesna with portable pumps permitting school attendance,
and use of aerosol L9NC with temozolomide or irinotecan with
temozolomide for relapsed and high-risk Ewing’s sarcoma.
Although doxorubicin is a highly effective and commonly used drug in
oncology, there are several new improvements for patients getting the
drug. These include use of Zinecard for cardioprotection and outpatient
administration, substitution with Doxil to reduce cardiotoxicity risk (and
keep hair, too!), and prevention and/or reduction of mouth sores using
glutamine suspension. The glutamine suspension was invented by
Dr. Anderson and was submitted as the first electronic New Drug
Application (Saforis; MGI Pharma) to the FDA in May 2005. FDA
approval is anticipated in fall 2006.
Since patients, referring physicians and families are often overburdened with too much information,
Dr. Anderson’s solid tumor team works to organize complex care efficiently. A number of one-page
summary documents are available on flash drives or can be e-mailed to physicians, nurses and families
to ensure that everyone involved in the treatment stays on the same page. The treatment documents
include a one-page patient summary and an editable PDF calendar. Dr. Anderson shared his hands-on
approach in a recent article written with Maritza Salazar-Abshire, RN (“Improving Outcomes in Difficult
Bone Cancers Using Multimodality Therapy Including Radiation: Physician and Nursing Perspectives,”
Current Oncology Reports, 2006, in press).
For more information about non-neural
solid tumor treatment and other pediatric
cancers at the Children’s Cancer Hospital at
M. D. Anderson, go online to
www.mdanderson.org/children.
It’s cancer-free and back to college for
this patient of Cynthia Herzog, M.D.,
here for a follow-up appointment.
•••••••••••••••••••••••••••••••••••••••••••
How to
Approach a
Skin Lesion in
Children and
Adolescents
by Cynthia Herzog, M.D.
What is melanoma and skin cancer?
Melanoma, basal cell carcinoma and squamous carcinoma are
all types of skin cancer. Melanoma is a cancer of the pigmented
cells but is not always dark in color.
Who gets melanoma or skin cancer?
Melanoma is most commonly found in older adults, and the
incidence is increasing due to increased sun exposure. Melanoma is
rare in children but does occur and should be considered in the
diagnosis of skin lesions in children. If basal cell carcinoma is
diagnosed in a child, the child should be evaluated for basal cell
nevus syndrome (Gorlin syndrome).
What can one do to protect against melanoma or skin cancer?
Avoidance of sun exposure by staying out of the sun during the middle of the day, wearing
protective clothing and using sunscreen helps to prevent melanoma in adults and possibly even
adolescents. Except for rare cases, such as patients with Xeroderma pigmentosa, sun exposure
has not been shown to play a role in melanoma in young children.
What are the warning signs of melanoma or skin cancer in a child/adolescent?
The typical signs of melanoma in adults include skin lesions that change color, grow rapidly, have
irregular borders, bleed or itch. Although similar signs may be present in a child/adolescent, it is
not uncommon for the lesion to be amelanonotic and have a wart-like appearance.
How to treat skin cancer:
The preferred treatment for melanoma is surgical resection. Frequently the lesion is initially
removed with a small biopsy; a reexcision to obtain good margins is always needed. Depending on
the depth of the melanoma, biopsy of the sentinel lymph node(s) should also be performed. If the
melanoma has spread beyond the primary tumor, further therapy may be indicated, including
biologic agents (interferon, IL2), chemotherapy or vaccine therapy.
Pediatric Clinical Trials
To learn more about the many different clinical trials offered at the Children’s Cancer Hospital at
M. D. Anderson, check the “Clinical Trials” Web page at www.mdanderson.org/children.
Because other new trials and therapeutic options are always being developed, please contact
our physicians at the same Web site. Physicians and their specialties can be found at the same
Web site on the “Our Doctors & Staff” Web page.
DIVISION OF PEDIATRICS
Academic Office: 713-792-6620
Division Head
Eugenie Kleinerman, M.D.
Deputy Division Head
Robert Wells, M.D.
Adolescent/Young Adult
Michael Rytting, M.D.
Martha Askins, Ph.D.
Bone Marrow Transplantation
Laurence Cooper, M.D., Ph.D.
Laura Worth, M.D., Ph.D.
Demetrios Petropoulos, M.D.
Brain/Neural Tumors
Joann Ater, M.D.
Johannes Wolff, M.D.
Vidya Gopalakrishnan, Ph.D.
Peter Zage, M.D., Ph.D.
Endocrinology
Steven Waguespack, M.D.
Hematology
W. Keith Hoots, M.D.
Deborah Brown, M.D.
Nydra Rodriquez, M.D.
Late Effects
Alan Fields, M.D.
Winston Huh, M.D.
Leukemia/Lymphoma
Seth Corey, M.D., MPH
Joya Chandra, Ph.D.
Patrick Zweidler-McKay, M.D., Ph.D.
Cesar Nunez, M.D.
Irma Ramirez, M.D.
Michael Rytting, M.D.
Robert Wells, M.D.
Nephrology
Joshua Samuels, M.D., MPH
Neurology/Neurofibromatosis
Bartlett Moore, Ph.D.
John Slopis, M.D., MPH
Non-Neural Solid Tumors
Peter M. Anderson, M.D., Ph.D.
Cynthia Herzog, M.D.
Winston Huh, M.D.
Norman Jaffe, M.D.
Eugenie Kleinerman, M.D.
Dennis Hughes, M.D., Ph.D.
Critical Care
Alan Fields, M.D.
Rodrigo Mejia, M.D.
Carroll King, M.D., J.D.
Jose Cortes, M. D.
Pediatric Surgery
Richard Andrassy, M.D.
Kevin Lally, M.D.
Charles Cox, M.D.
Andrea Hayes-Jordan, M.D.
Neurosurgery
Raymond Sawaya, M.D.
Fred Lang, M.D.
Jeffrey Weinberg, M.D.
Psychology
Martha Askins, Ph.D.
Bartlett Moore, Ph.D.
Rhonda S. Robert, Ph.D.
New Patient Line: 713-792-5410
After Hours: 713-792-7090
Community Support for the Children’s Cancer Hospital
It’s been said that it takes a village to raise a child. In many ways, the Children’s Cancer Hospital is like that African
proverb — it takes a community to support this hospital and to help it grow and thrive. From large to small, donations
come to the Children’s Cancer Hospital, reminding us that there are many people out there encouraging our
institution and its physicians as they work to conquer cancer.
The team’s 2006 Pedal Partner, Emily Parker, 10, a neurofibromatosis
patient at M. D. Anderson who lives in Sugar Land, her physician, John
M. Slopis, M.D., and Leslie Christison, RN, who served on the team’s
support crew during their eight-day trek across the country, were also
part of the celebration.
Since 2005, Cheniere’s Making Cancer History team has raised
approximately $170,000 for neurofibramotosis research at M. D. Anderson.
The Hyundai Hope on Wheels program with Houston area
Huundai dealers donated $50,000 to the Children’s Cancer Hospital to
promote pediatric cancer research.
Representing the Jori Zemel Children’s Bone Cancer Foundation, Nina and Brook
Zemel (center) presented a check for $60,000 earmarked for pediatric osteosarcoma
research to (L to R) Eugenie Kleinerman, M.D.; Norman Jaffe, M.D.; Dennis Hughes,
M.D., Ph.D.; Pete Anderson, M. D., Ph.D.; and Laura Nelson, postdoctoral fellow.
Jori Zemel Children’s Bone Cancer Foundation recently donated
$60,000 toward childhood osteosarcoma research at M. D. Anderson. Nina
and Brook Zemel, began their grassroots effort to raise funds for this research
area after their daughter, Jori Zemel, died at age 14.
To date, the foundation has raised more than $230,000 through donations
and the annual Jori Zemel Festival and Cancer Walk to support childhood
bone cancer research at M. D. Anderson. In 2005 the foundation created
a fellowship to study the disease; fellow Laura Nelson, M.D., is working
under the supervision of Dennis Hughes, M.D., Ph.D.
Eagle Scout Project Benefits Pediatrics
Justin Hajek’s recent Eagle Scout project benefited pediatric patients at the
Children’s Cancer Hospital. Justin
collected PlayStation games and
DVDs, and raised over $1,000
through donations and a car wash.
He used these funds to purchase
additional games and DVDs,
doubling his original goal of 50
games and 100 DVDs.
Hajek is a Boy Scout with Troop
1424 in Missouri City and is the
son of Richard Hajek, Department
Eagle Scout Justin Hajek, who developed his Eagle service project to benefit pediatric patients at the Children’s of Health Disparities Research,
and Misty Hajek, Department of
Cancer Hospital, presents his donation to Renee Hunte
(R) and Mary Emiola (L) with the Child Life staff.
Immunology, at M. D. Anderson.
Race Across America
Cheneire’s Making Cancer History Race Across America (RAAM) team netted
more than $70,000 for neurofibromatosis research at the Children’s Cancer
Hospital after a 3,000-mile bike ride from San Diego, Calif., to Atlantic City, N.J.
To celebrate, RAAM team members Kirk Gentle and Chris Shaw hosted a
“Christmas in July” party for pediatric patients
and their families.
The Hoglund Foundation PediDome was
transformed into a winter wonderland complete
with a decorated Christmas tree, stockings filled
with goodies and a personal appearance by Santa
himself. As a special gift to the Children’s Cancer
Hospital, the team has donated MedWagons,
special IV stands to enhance mobility for pediatric
patients undergoing chemotherapy.
Patient Emily Parker with Santa
(L to R) Astrid Camacho, Brendon Farmer, Armani Artis, John Jacob Ramirez and
Lauren Henley, all patients at the Children’s Cancer Hospital, have their handprints
on this Hyundai Santa Fe SUV.
Since 1998, Hyundai dealers across the country, with Hyundai Motor
America, have supported pediatric cancer research through the Helping
Kids Fight Cancer program, donating more than $6 million nationally. This
year Hyundai aligned with CureSearch National Childhood Cancer Foundation.
In conjunction with their program, a Santa Fe SUV traveled the country
gathering handprints from kids who are battling and beating all types of
pediatric cancers.
Westside Tennis Club Events
Linda and Jim McIngvale of Westside Tennis Club put the fast serve on
philanthropy during the 2006 U.S. Men’s Clay Court Championships
April 10-16, scheduling a number of special events benefiting pediatric,
uterine and gastric cancer research at M. D. Anderson.
Special events for pediatrics included a dinner reception honoring
President George H.W. and Barbara Bush, which raised almost $20,000 for
the Robin Bush Child and Adolescent Clinic at the Children’s Cancer Hospital.
The clinic is named in memory of the daughter the Bushes lost to leukemia
in 1953, two months before her 4th birthday.
In the midst of the U.S. Tennis Association activities, M. D. Anderson’s
OR Nursing Tennis Team – Brian Jahrsdoerfer, Michel Lavoie, Peter Okpokpo
and Warner Tse – broke the Guinness World Record in doubles, playing for
48 hours, 15 minutes and raising approximately $15,000 for pediatric
cancer research at the Children’s Cancer Hospital.
M. D. Anderson’s
OR Nursing Tennis
Team – (L to R)
Brian Jahrsdoerfer,
Michel Lavoie,
Warner Tse and
Peter Okpokpo
– broke the Guinness World Record in playing tennis doubles and raised money for
pediatric cancer research at the Children’s Cancer Hospital at the same time.
“Retirement,” says Norman Jaffe, M.D., “is not for the fainthearted.” However, for Jaffe and his colleague Irma Ramirez, M.D.,
this fall retirement is a reality.
The two doctors have watched pediatric care at M. D. Anderson
grow from a small specialty into its own Children’s Cancer
Hospital. Jaffe, particularly, remembers a year without interns,
residents and Fellows
and only the pediatric
staff, which included
Ramirez, to carry the load. Long hours resulted in a unique esprit
de corps and left him with happy memories of collegial interaction.
As the two prepare for new adventures, they both feel a
sense of pride in the contributions they have made to pediatric
oncology and specifically to M. D. Anderson and its Children’s
Cancer Hospital.
Irma Ramirez, M.D., retires this fall after 30 years of service
in her chosen field of pediatric hematologyoncology with a concentration in childhood
lymphomas and leukemias.
Dr. Ramirez began her medical career at
University Hospital at the University of
Puerto Rico School of Medicine, San Juan,
Puerto Rico, having also completed her
post-graduate training at this institution
including a fellowship in pediatric
hematology-oncology. Dr. Ramirez then joined the faculty
of the University of Puerto Rico School of Medicine in the
Department of Pediatrics.
In June 1976, she came to M. D. Anderson for a yearlong
training in pediatric hematology-oncology. The year turned
into three and she was offered a faculty position. She has
RETIREMENT
enjoyed watching the small department that was pediatrics
become the Children’s Cancer Hospital and says that her memories
are numerous.
“I have not one or two special memories, but numerous ones
of the pure and lovely faces of the children who have been my
inspiration and strength,” she says. “Certainly, I will miss my
patients.” Dr. Ramirez looks forward to spending more time with
her family here and in Puerto Rico.
Norman Jaffe, M.D., has specialized in
pediatric hematology-oncology for 28 years,
coming to M. D. Anderson from the DanaFarber/Harvard Cancer Center in Boston and
assuming the titles of Chief, Outpatient Clinics;
Chief, Solid Tumor Section; Chief, Long Term
Surveillance Clinic; and Professor of Pediatrics.
Known to many osteosarcoma patients as the
leader of the annual rehabilitation ski trip to Park
City, Utah, Jaffe has provided hope and motivation for both patients
and their families who go on this trip. In its 25-year history, the ski
trip has expanded to include other disabilities such as blind and deaf
skiers, and all the children return to Houston knowing that they
have conquered the mountains.
Jaffe is appreciative that his therapeutic discoveries in the
treatment of bone tumors, particularly osteosarcoma, have been
recognized by his colleagues.
With his newfound free time, he expects that he will continue to
devote time to learning and teaching. He has been asked to write a
monograph on osteosarcoma and is hopeful to have the resources
to do this. But, most of all, he anticipates more time to be spent
traveling to exciting new places with his wife and visiting his
children and grandchildren more frequently.
•••
3 Check it Out
The Children’s Cancer Hospital Suspicion of Cancer Program
W
hen a physician suspects that a patient
might have cancer, a swift and accurate
diagnosis is important. When the patient is a
child, the stress level raises a notch and
increases the significance of both.
For that reason, the Children’s Cancer
Hospital has established a new service, the
Suspicion of Cancer Program, partnering
with community physicians to help with
early detection of pediatric cancer.
The Suspicion of Cancer Program is
designed to be a resource for physicians
to help detect evidence of cancer in young
patients. Although improvements in medical
technology now help diagnose the disease in
earlier stages, this differentiation is still
difficult.
Beginning Oct. 1, the new program will
provide access to Children’s Cancer Hospital
pediatric oncologists on a 24-hour basis
every day of the week. Immediate help is
usually available; if not, a specialist will
return the call within a brief time period.
As a result, a child will normally be seen
either the same day or the next day for
diagnostic consultation and help with
treatment planning if desired. In addition,
the patient access staff can work quickly
with the family for insurance authorization.
Physicians with questions about their
young patients can expect doctor-to-doctor
conversations with fast results to help
determine the existence or absence of the
disease and recommendations for the best
course of action for the type of cancer
diagnosed. If desired, patients may selfrefer or be referred by their primary care
physician to M. D. Anderson.
There is a team of experts for
each cancer type treated at the
Children’s Cancer Hospital:
leukemia, brain tumors and
other CNS neoplasms,
melanoma
and skin cancers, softtissue sarcomas,
germ-cell,
trophoblastic
and other
gonadal
tumors, malignant bone tumors, lymphomas
and reticuloendothelial neoplasms, neuroblastoma, renal tumors, retinoblastoma,
hepatic tumors and endocrine tumors. In
addition, M. D. Anderson physicians treat
non-cancerous conditions such as aplastic
anemia and neurofibromatosis. This diseasespecific focus means that a child will benefit
from the combined expertise in treating both
common and rare cancers.
At M. D. Anderson, the whole child is
treated, not just the cancer. In addition to
a team of specialists to address medical,
psychological and developmental issues
related to cancer or its treatments,
each patient has access to counseling
and support groups, an in-house
education program and follow-up
programs that monitor and
manage any long-term side effects.
To access the Suspicion of
Cancer Program at the
Children’s Cancer Hospital,
call 1-888-KIDCHEK
(1-888-543-2435).
The Drug Development Process
ust like children, drugs go through phases. Bringing a drug to market in
Jdynamic
the United States, a process that averages 12 years, is a complex and
procedure involving thousands of people and billions of dollars.
Once a molecular entity is discovered, it undergoes preclinical testing
(average length 3.5 years) in the laboratory
and in animals to determine what activity, if any,
exists against a particular disease. Following the
determination of an agent’s safety and therapeutic
potential, an Investigational New Drug Application
(IND) is filled with the FDA.
–Susannah Koontz,
Once an IND is approved, testing in humans
PharmD
begins with Phase I clinical trials (average length one
year). Typically, these trials involve 20-80 healthy
volunteers. However, in the setting of cancer, study subjects in Phase I trials
are often patients with active disease who have failed other conventional
treatment modalities. Objectives of Phase I testing are to determine the
drug’s safety profile, including the most appropriate dose, and to characterize
the drug’s pharmacokinetic profile. Phase II trials (average length 2 years)
Drug
Corner
Proton Therapy For Pediatric Cancer
are expanded to include approximately 100-300 patients. These studies
explore a drug’s effectiveness against a disease compared to a placebo or
other standard treatment, such as in the setting for cancer patients. Phase
III testing (average length 3 years) is an expansion of Phase II trials as it
increases patient participation by ten-fold and continues to monitor a
drug’s efficacy and safety on a larger scale.
Once clinical testing is completed, a New Drug Application (NDA),
which summarizes data collected in all phases of testing, can be submitted
to the FDA for review. The review process averages 2.5 years and is the
final step before drug commercialization commences. Finally, postmarketing surveillance, employed to identify adverse drug reactions,
and Phase IV studies, conducted to evaluate a drug’s long-term effects,
are performed. In the end, for approximately every 10,000 compounds
evaluated for therapeutic potential, only one makes it to market.
At the Children’s Cancer Hospital, we have a dedicated team of
researchers and clinicians working together to cure childhood cancer
by bringing new drugs to market as well as examining the utility of
currently approved agents.
••••••••••••••••••••••••••••••
M. D. Anderson takes a patient-centered approach to treating children with cancer.
R
adiation oncologists, surgeons, pediatric
oncologists, radiologists and pathologists
work together to plan a course of treatment
unique to each patient. The Radiation Oncology
team at M. D. Anderson now offers a new
treatment modality called proton beam therapy.
Cancer is the leading natural cause of
death among children in the United States
between the ages of 1 and 14 years. In 2001,
there were 8,600 new cases of cancer among
children and about 1,600 cancer deaths.
Approximately 40 percent of newly diagnosed
cancers are leukemias and lymphomas; the
rest are made up of various solid tumors such
as brain tumors, bone and soft tissue sarcomas
and kidney tumors.
Most solid tumors are treated with a
combination of surgery, radiation therapy and
chemotherapy. While conventional radiation
therapy with X-ray beams is an effective
treatment, it can produce certain long-term side
effects in some children, such as a decrease in
bone and soft tissue growth in the treated area,
hormonal deficiencies, intellectual impairment
and, occasionally, second tumors.
Proton therapy offers another way to deliver
a high radiation dose to a tumor. Protons deposit
their radiation differently than X-rays. Compared
to an X-ray beam, a proton beam has a low
“entrance dose” (the dose delivered from the
surface of the skin to the front of the tumor),
a high dose designed to cover the entire tumor
and no “exit dose” beyond the tumor.
This unique characteristic, combined with
sophisticated image guidance, gives proton
therapy the ability to deliver a radiation dose
in a precise manner, thus minimizing damage
to the surrounding normal tissue, and thereby
reducing the long-term side effects to many
critical structures. It is estimated that proton
The Children’s Cancer Hospital Newsletter is an
educational resource for physicians interested in the treatment, research
and prevention of pediatric cancers, produced quarterly from the Division
of Pediatrics at The University of Texas M. D. Anderson Cancer Center.
The University of Texas
M. D. Anderson Cancer Center
Division of Pediatrics
1515 Holcombe, Box 853
Houston, Texas 77030
therapy could also significantly reduce the risk
of second tumors, when compared to X-ray
therapy. This approach may translate into better
local control of the disease, higher survival
rates and improved quality of life as the treated
children grow to adulthood.
M. D. Anderson oncologists are world
leaders in the development of emerging
treatment strategies and technology. Our focus
has always been on providing the best care for
our patients, with an eye toward continued
improvements of this care for the future.
Because so much clinical research is conducted
here, M. D. Anderson patients are among the first
anywhere to benefit from emerging treatment
strategies and technology. M. D. Anderson
continues to be a leader in the care of children
with cancer. With the addition of proton therapy,
we have added another weapon in the fight
against this disease.
•••
David B. Coe, Division Administrator • Seth Corey, M.D., Medical Advisor
Gail Goodwin, Managing Editor
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