October 2009 Archives

Toad Venom May Help Treat Cancer

Huachansu, a Chinese medicine that comes from venom secreted by the skin glands of toads, may slow the growth of cancer in some patients and do so without significant side effects.

Researchers at M. D. Anderson and Fudan University Cancer Hospital in Shanghai, China, reported their Phase I clinical trial findings Aug. 21 in the online Early View feature of the journal Cancer.

Stereotactic Radiosurgery Preferred for Brain Metastases

Cancer patients who receive stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) to treat 1-3 metastatic brain tumors have more than twice the risk of developing learning and memory problems than those treated with SRS alone.

Findings from a Phase III randomized study led by M. D. Anderson researchers were published in the Oct. 5 online edition of The Lancet Oncology.

Cancer Newsline Podcast Series

New Breast Cancer Screening Guidelines
Therese B. Bevers, M.D., Professor in the Department of Clinical Cancer Prevention explains the newly released breast cancer screening guidelines.  Dr. Bevers discusses how the new guidelines address women at higher risk of being diagnosed with breast cancer and when and how often they should be tested by mammogram or breast MRI.

By Dawn Dorsey, Staff Writer

RestlessLegs_edit1.jpgGetting a good night's sleep when you have cancer can be a challenge. In addition to treatment side effects and anxiety, a condition known as restless leg syndrome (RLS) gives some sleepers fits.

As many as one-tenth of adults are affected by RLS, according to the American Academy of Sleep Medicine. It's likely that figure is even higher among cancer patients.

What is RLS?

RLS, which happens most frequently at night when a person is at rest, causes a strong, undeniable urge to move the legs. Many people with RLS also have paresthesia,  uncomfortable feelings deep in the legs that often are described as burning, tingling or prickling.

Many people with RLS also have periodic limb movements, in which muscles tighten, twitch or flex when they are resting. These movements may wake them or another person sleeping nearby.

RLS and its accompanying conditions are roadblocks to sleep quality and quantity, which is so important to the health of cancer patients. Among other dangers, sleep disruption may affect the immune system and endocrine (hormonal) function, since hormones are produced during certain levels of sleep.

Triggers are varied

RLS causes may include:

•    Iron deficiency
•    Medications including:
•    Nonprescription allergy and cold medicine like Benadryl®
•    Antidepressants like Elavil® and Prozac®
•    Major tranquilizers like Haldol®, Mellaril®, Thorazine®
•    Family history of RLS

Solutions depend on severity

For mild cases of RLS, try:

•    Establishing a regular daytime exercise program
•    Taking hot baths
•    Getting leg massages
•    Using a heating pad
•    Avoiding alcohol
•    Doing stretching exercises like yoga or Pilates late in the day

If your iron levels are low, talk to your doctor about oral or intravenous iron treatments.
More severe RLS may be treated with drugs including:

•    Requip® (ropinirole) or other dopaminergic agents
•    Benzodiazepines, such as Valium® or Xanax®
•    Opiates, such as Vicodin®

If you experience RLS symptoms, tell your doctor or health care provider.

Related article:

Cancer Patients Need to Treat Sleep Disorders

By Laura Sussman, Staff Writer

While older women with early invasive breast cancer are increasingly undergoing breast conserving surgery (BCS), commonly known as lumpectomy, significant socioeconomic and geographic disparities still preclude some from receiving the therapy, according to a study published in the Journal of the American College of Surgeons.

Led by Grace Li Smith, M.D., Ph.D., a postdoctoral fellow in M. D. Anderson's Department of Radiation Oncology, the study compares the use of lumpectomy to that of the other surgical option available to women with early invasive disease, mastectomy.

Combined with radiation, lumpectomy has proven to be as effective as a mastectomy for the treatment of early invasive breast cancer, yet previous studies have reported that less than half of all patients eligible receive this option, said Smith.

"Treatment of nonmetastatic invasive breast cancer has improved significantly over the past several decades, but we continue to fall short of the goal to treat every woman with the highest quality of care," said Smith.  "Our study suggests that barriers exist that may prevent may women with breast cancer - especially those in poorer areas, areas with low education levels, rural communities and counties with few radiation oncologists - from being offered every treatment that should be available to them."

For the retrospective study, Smith and her M. D. Anderson colleagues used Medicare claims to examine the treatment history of women 65 and older who were surgically treated for invasive breast cancer in 2003.

Of the 56,725 women identified, 59 percent underwent a lumpectomy, compared to 41 percent who received mastectomy. BCS was used most frequently in women younger than 70 and had no lymph node involvement. In contrast to mastectomy, the study also found BCS more prevalent in areas with low poverty, high education, a high population of treating radiation oncologists and/or in larger metropolitan areas. Looking at geographic regions, the researchers found that women in the Northeast and Pacific West were most likely to receive the procedure, while the South and parts of the Midwest were the least likely.

Smith hopes that results from the study may prompt physicians and patients to work together to overcome some of the barriers to treatment.

"Physicians may be able to help women identify specific barriers to their care and be influential in helping patients overcome such obstacles," suggested Smith. "Or, if there are concerns or misconceptions about surgical options, patients themselves may play a role by becoming educated about the value of lumpectomy as an appropriate therapy, and helping to disseminate this information into their communities."

Sitting with the boys from Little League and their parents on Saturday night, a parent (and friend) surprised me when he said, "I know a lot about your Dad." He told me my Dad's name and he knew that his birthday was on Valentine's Day. It turns out that he had met the spouse of a former patient of mine, and she remembered me fondly and recalled this information that I had shared. I wondered ... what was the context for me sharing this about my Dad and was that appropriate?

The next morning, I read the front page article in the New York Times about M. D. Anderson Cancer Center. The question on my mind after reading this article is whether or not the story captured the essence of our top-ranked institution. 

There are many perspectives on the story, depending on whether you talk to faculty and staff or patients familiar with M. D. Anderson, or other people who are mesmerized by the story but unfamiliar with our center. To me, of the images and various vignettes in the story, the most striking was that of a singular mission -- to eliminate cancer in Texas, the nation and the world -- and an ambitious and compassionate approach.

The nurse (Cindy Davis) and the physicians (Marty Raber and Patrick Hwu) featured were all intimately connected to their patients, striving to do everything in their power and professional scope to understand their patients in all possible dimensions, and most of all to help. The mission was personal to each of them, and this is how things go around here.

feelingsman.jpgI wrote in an earlier post about the concept of buoyancy (the force that keeps us afloat) and some of the factors that this force has in each of us. To me, compassion is derived from the combination of our own buoyancy plus empathy (the process of understanding and being sensitive to the experience and feelings of another). As such, it's important to bring something of ourselves in order to be fully compassionate.

The idea of sharing something intimate, as a physician, can be humanizing and helpful to our patients. This was discussed in the New York Times wellness blog, and there was a strong acknowledgement that it can be an important and useful feature in caring for patients (as long as the intent and ultimate focus is squarely with the patient).

As I sit in my office and watch the storms approach here in Houston, I think I understand a bit better why I might have shared something intimate with a patient about my Dad. 


Younes10_06final.jpgEvery October, scientists and the public from around the world eagerly await the announcement of the winners of the Nobel Prize in Medicine. This year, the prize was given to three U.S. scientists for the discovery and identification of telomeres and telomerase, a process that seals off the tips of chromosomes like the cap on the end of shoelaces, and is a key to understanding both aging and cancer.

Telomeres are essentially caps that protect the ends of chromosomes. The telomerase enzyme determines the length of the caps. The longer the caps, the more frequent the chromosomes can be copied, therefore, controlling how often the cell divides.

The potential impact of this discovery is obvious. Inhibiting the enzyme activity can reduce the cell capacity to divide, a hallmark of cancer. In aging cells, the caps, or telomeres, become shorter. Thus, maintaining telomerase activity may prevent aging.

The Nobel Committee cited the scientists' work that was published approximately 30 years ago (telomeres in 1978 and telomerase in 1985). This means that two of the recipients were in their 30s and one was in her 20s when they made these discoveries.

Intriguing selection process
The secretive nomination and selection process of the committee remains intriguing, and continuously generates rumors and fascinating stories. According to Alfred Nobel's instructions in his will, the committee members should always be selected from the Karolinska Institute faculty in Stockholm.  In 1901, the committee included 19 members. Today, it includes 50. A total of 195 individuals have received the Nobel Prize in Medicine.

I visited Karolinska Institute in 1999, and had the opportunity to meet with its president, Dr. Hans Wigzell. At the time, Dr. Wigzell was the chairman of the Nobel Assembly that awards the prize in medicine. The following year I invited him to visit M. D. Anderson and to give a lecture on his scientific work in immunology. However, my hidden agenda was to get him to meet with our young medical oncology fellows, to discuss the award and to inspire them. He graciously accepted the invitation.

As planned, Dr. Wigzell met with our fellows in a small conference room over coffee and bagels. The informal meeting lasted 90 minutes, and the discussion spanned many interesting topics and anecdotes regarding the Nobel Prize. Although he couldn't reveal any secrets, he provided very important facts and insights.

The first fact was that nominations are kept very secretive and are not released to the public. You know that you got the prize when someone calls you from Stockholm early in the morning, shortly before the announcement is made public. So this is not like the Oscars. Although several investigators are nominated on a short list, the names remain secret and, therefore, there is no reward or even an acknowledgement for being nominated. Nothing to write about in your C.V.

The second fact was that no matter how important the discovery might be, the award is given only to a living scientist. No award is given after death.

The third, and most important observation that I recall from our meeting with Hans Wigzell, was that the majority of awards were given to scientists for discoveries that they made when they were young, mostly when they were in their 30s. A remarkable observation that strongly endorses the notion than many creative ideas come from young, unestablished investigators.

However, these discoveries have to be validated over time, and thus the awards are frequently given 20-30 years after their discoveries. This year's award was no exception.

Funding the young still critical
As research funds continue to decrease, a debate in the scientific community is focusing on who should get more research support: established senior investigators or new junior investigators. No one argues that established senior investigators should continue to receive research funding. However, a quick look at the history of the Nobel Prize and its laureates should convince everyone that funding young investigators is also critical for the continued progress through major discoveries that will have the greatest impact on humanity.

You would have to be living on a deserted island these days not to hear about health care reform. Reforming the American health care system was a key aspect of President Obama's domestic agenda and Congress is moving this initiative forward.

 But advocacy and industry groups, the public and elected officials, and even policy wonks have been talking about the need to make reforms to our nation's health care system for years. While one group's interest may be slightly different than the next, all are voicing their opinions on what's working and what's not working. One voice that needs to be heard is that of cancer survivors.

So as health care discussions continue this fall, be sure to let your family and friends know your perspective about what's important. Attend any health reform town hall sessions scheduled in your area and voice your opinion. Talk with or write to your elected officials and let them know to consider cancer survivors' needs as they set about reforming the system.

This is the story of one cancer survivor's effort to ensure her voice was heard.

At a loss of what to say? Most of the time, our elected officials just need to hear our stories. But if you want to say more than that, an advocacy group for cancer survivors, the National Coalition for Cancer Survivors, has posted Lance Armstrong foundation posted its cancer policy platform. Also read the National Conference of State Legislatures Cancer Survivorship: State Policy Issues

Cancer screening examinations are medical tests performed when you're healthy and you don't have any symptoms. They help ensure that any existing cancers are identified at their earliest, most treatable stages.

M. D. Anderson has released updated guidelines for colorectal, cervical and breast cancers. The new recommendations are based on how likely you are to develop a certain kind of cancer. Therese Bevers, M.D., professor in the Department of Clinical Cancer Prevention, explains the basis for these important updates.

Visit our website to review the new cancer screening guidelines.

Do you get tests to check for cancer, such as a mammogram or colonoscopy? Did you know that you can make an appointment at the Cancer Prevention Center at M. D. Anderson for these and other preventative cancer screenings. 

What do you think about the new screening guidelines?

Maurie Markman, M.D., vice president for clinical research at M. D. Anderson, talks about a study in Japan with Paclitaxel and Carboplatin, a standard regimen for the treatment of ovarian cancer.

The study results, published in The Lancet on Sept. 20, indicate that dose-dense weekly Paclitaxel plus Carboplatin improved survival of women with epithelial ovarian cancer and may represent a new treatment option.

Markman says, "Here's an example of where we take an established drug and simply learn how to give it better, and we have an important impact on our patients' lives."

Related Articles

Read the article in The Lancet
New Chemo Regimen May Benefit Ovarian Cancer Patients (U.S. News & World Report)


M. D. Anderson Cancer Center is taking action to safeguard its patients, their families and the health care teams from added exposure to H1N1 and seasonal flu. 

Effective Monday, Oct. 19, M. D. Anderson will not allow visitors 12 years and under in any of its campus buildings or common areas.  For teens or adults who are experiencing flu-like symptoms of runny nose, fever or sore throat, M. D. Anderson will be actively screening patients and visitors at the front desks of all clinics, centers or upon arrival to inpatient areas. Patients showing flu-like illness will be given masks, while visitors experiencing similar symptoms will be asked to leave the institution. 

The change to the visitor policy takes effect Monday, Oct. 19, and will remain in effect until M. D. Anderson determines that the H1N1 and seasonal flu is no longer a threat to the safety of patients, their families and the staff.

In keeping with this policy change, M. D. Anderson's Child Visitation Rooms will not be available for child care.

The only exceptions to this policy will be children who are patients in active treatment or who have appointments at M. D. Anderson Children's Cancer Hospital.

M. D. Anderson urges visitors, family members and staff to remain at home for at least seven days after the onset of influenza-like symptoms or fever or 24 hours without fever (without medication), whichever is longer. Throughout this emerging flu season, M. D. Anderson encourages visitors and staff to wash their hands thoroughly and frequently, cover coughs and sneezes, get a flu shot and stay at home when ill.

M. D. Anderson apologizes for any inconveniences this interim policy causes, but for the safety of the thousands of patients who seek the best cancer care in a safe environment, we appreciate your understanding. 

For more information on H1N1 flu, prevention tips and its impact on patients with weakened immune systems, please see

Questionmark.jpgBecause a cancer diagnosis spurs a raft of questions for patients and caregivers, Anderson Network has arranged week-long online sessions with many of our experts in specific types of cancer.   

The current forum addresses bladder cancer, its new treatment options and results. The fourth most common type of cancer in men and the eighth most common in women, it is diagnosed in 38,000 men and 15,000 women in the United States every year.

Find out more about bladder cancer Oct. 12-16 from three of M. D. Anderson's experts: Colin Dinney, M.D., professor; Barton Grossman, M.D., professor; and Ashish Kamat, M.D., associate professor, Department of Urology.

Visit to submit questions or e-mail for more information.

If ever there was a breast cancer in need of increased awareness, it's inflammatory breast cancer. IBC, also known as the silent killer, is a quickly spreading cancer that starts on the skin. Most of the time, there's no lump. This post is short and sweet with one take-home message -- know the signs of IBC.

Why the urgency?
Inflammatory breast cancer is a killer cancer. Caught early, treatment has a better chance. IBC is a "master metastasizer". For many women, IBC has already spread to lymph nodes and beyond by the time of diagnosis.

Signs and symptoms:

  • • Increase in breast size, increasing to 2-3 times the size of the normal breast in a matter of a week or two.
  • • Redness, rash or blotchiness of the breast. Some women report that it looks like a bug bite.
  • • Pain and/or soreness of the breast. 
  • • Lump, thickening or dimpling of the skin of the breast. 
  • • Warmth or tenderness of the breast.
  • • Lymph node swelling under the arm.
  • • Flattening of the nipple or discharge from the nipple.

You don't have to have all the symptoms. If you see some of these signs, contact your doctor. If your doctor prescribes a round of antibiotics and the symptoms do not resolve, don't wait. Ask for a referral to a specialist who knows inflammatory breast cancer. Help fight this silent killer by knowing the signs. Knowledge is power.

Inflammatory Breast Cancer Toolkit (PDF)
Podcast: Inflammatory breast cancer -- Know the symptoms (Mayo Clinic)

CancerGenomeAtlas.jpgIt takes some imagination to grasp the raw computational challenge researchers face trying to understand the molecular causes of cancer. John Weinstein, M.D., Ph.D., professor and chair of M. D. Anderson's Department of Bioinformatics and Computational Biology, likes to start with this imagery.

"If you unpacked the DNA in every cell of a single person and stretched it end to end, it would circle the equator 917,000 times -- the equivalent of 120 round trips to the sun. One error in replicating the genome in one unlucky place -- over a length of 120 trips to the sun and back -- can lead to cancer. Our challenges are to understand how that happens, and to know what to do about it if we can't prevent it in the first place."  

Now, consider that there are usually many more errors spread across that expanse and that they tend to interact with each other in a maze of complexity. Add current techniques to profile genetic expression and variation that capture a galaxy of data, and you have enough information to choke traditional methods of analysis.

The Cancer Genome Atlas, a federally funded project to make sense of the genetics that drive 20 different cancers, has enlisted Weinstein and colleagues at M. D. Anderson to help with this problem. A five-year, $8.3 million grant will allow the team to apply cutting-edge approaches to find the right buckets of information in an ocean of data.

They will blend agile software development, Bayesian statistics, and a flexible and efficient database infrastructure called semantic web with M. D. Anderson's expertise in clinical and translational research to compile the most meaningful data in a tumor's tangled molecular profile.

Success will mean better treatment choices, improved risk assessment, diagnosis and prognosis. "The bottom line is personalizing cancer medicine," Weinstein says.

A Romp in Our Shadow Garden

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It's been 10 years since the Children's Art Project at M. D. Anderson Cancer Center published a story book, but this year they're at it again with "Our Shadow Garden."

The latest story book is both educational and an interesting read. The storyline focuses on a grandmother who loves to garden, but has been prohibited from being in the sunlight. Her young grandchild and husband conspire to make her happy again, coming up with a special garden that blooms at night.

Hence, "Our Shadow Garden" is planted. In the book there are sidebars where young readers can learn about special plants that thrive in the nighttime, and nocturnal birds, bats and bugs. There's even a gardening glossary and instructions on how to plant a seed.

The text, which is written by certified Texas Master Gardener Cherie Foster Colburn, is based on Colburn's own issues with a disease that kept her out of the sunlight for a time. Colburn is a landscape designer and owner of Nature's Tapestry. In addition, she is also a freelance garden writer and has been a garden/feature writer for numerous publications. Colburn is owner/developer of, a site for Texas gardening info and a frequent speaker for various organizations, including garden clubs and community groups. "Our Shadow Garden" is her gift to the children of the M. D. Anderson Cancer Center's Children's Art Project, to show the love and healing power inherent in gardening.

The artwork in the book has all been created by young patients in the Children's Cancer Hospital at M. D. Anderson. While some of the art is new, inspired by the Children's Art Project's educational classroom curriculum in the Children's Cancer Hospital, other art has been previously published before finding a new use in "Our Shadow Garden." 

The Children's Art Project at M. D. Anderson began in 1973 with a mission of making life better for children with cancer. This volunteer-driven project blends business and caring to do just that. Through worldwide sales of young cancer patients' artwork featured on seasonal note cards and gifts, the project has funded educational programs, college scholarships, summer camps, ski trips, the Child Life program and other exciting activities that benefit cancer patients and their families.

Each child with art in the book is a current or former cancer patient at M. D. Anderson. The artwork they create is often featured on the products produced and sold by the Children's Art Project. Since CAP began, more than $26 million has been returned to M. D. Anderson to support many psychosocial programs.

"Our Shadow Garden," which retails for $20, and other CAP products are available through the Children's Art Project at its Uptown Park retail store in Houston, online at or by calling (800) 231-1580 to place an order or receive a free catalog.

What I didn't know on April 1 when this cruel April Fool's Day joke (I wish!) was played on me, is that the State of Texas has a law that prohibits anyone who has had a seizure from driving for six months or until they are seizure free.

GBG_post1.jpgOn that day, April 1, I did have a seizure. Actually, what happened is that I stopped talking, which is pretty unusual for someone like me. When I didn't respond to a colleague's urging to leave for a meeting, when all I did was smile, she knew that something wasn't right. Lucky for me that she called an ambulance. Unlucky for me that I was diagnosed with a brain tumor. Lucky for me that I work at M. D. Anderson.

It didn't take long for me to be lined up with a team - a surgeon with "golden hands" and a well-respected oncologist. Individually, they met with me and my enormous family support team, each for over an hour. By the time the day was done, it was determined that I did indeed have a brain tumor and that the first thing to do was to get it out of my head.

So what does one do when faced with something like that? Well, in good M. D. Anderson style, I continued to work up until two days before the scheduled surgery. I wasn't frightened. I have been drinking this M. D. Anderson Kool-Aid for almost 10 years and I knew I was in good hands. The aspect of being operated on in our state-of-the-art BrainSUITE was exciting and at least I didn't have to be awake.

The people who were frightened were all the members of my family. My husband, my children, my parents, my sisters, well, everyone. My colleagues at work couldn't believe it. All my other friends were shocked, too. Six months out, I think I can also say that I was surprised - I never expected anything like this to happen to me.

But today, October 1, is a really good day. I've turned some kind of invisible corner in the last few days. I feel good. I can work. I have goals to accomplish. Best of all, I can drive!

 Read more about Gail and her treatment on GBG is a Brainiac

By Susan Kelly M. D., Assistant Professor, Department of Pediatrics

What is cord blood?
When a baby is born, there are a high number of stem cells circulating in the blood that are generally discarded with the placenta. The primary responsibility of these stem cells (what we refer to as umbilical cord blood or cord blood) is to make components of blood -- red blood cells, white blood cells and platelets.

Cord blood can be collected and stored in liquid nitrogen for years and later used for transplants. There are public banks, where mothers can donate the cord blood for use by anyone who needs a transplant (at no charge). There also are private cord blood banks that allow a family to store their baby's cord blood for use by someone in the family (the family pays for its collection and storage). The cord blood units stored in public banks are searchable through a computer registry that's accessible throughout the world.

Cord blood transplants
The first transplant using umbilical cord blood was done in 1988. Since then, thousands of transplants have been performed using cord blood as the source of stem cells.

Why is this important? The first choice for a stem cell donor is usually a perfectly matched sibling (or other matched family member). We look at markers on the cells called HLA types (different than blood type) to see how closely a patient and potential donor match. Matched cells from a family member have a higher chance of taking (engrafting) and cause fewer side effects, such as graft-versus-host disease (GVHD), where the transplanted cells attack their new "host." 

However, as families are changing and getting much smaller, the chance of having a fully matched sibling is quite low. Only one in four full siblings will be a match, and half- and step-siblings are almost never a match. The other options for stem cell transplants include finding an unrelated stem cell donor or receiving stem cells from cord blood.

While the bone marrow registry is expanding, the chance of finding a match is less than 50% and much lower for minority patients or patients with mixed ethnicity. Cord blood doesn't need to be matched as closely as other stem cells because they're more naïve immunologically, causing less GVHD. Therefore, a match can be found for a much higher percentage of people.

In addition, cord blood is stored and readily available. For volunteer bone marrow or peripheral blood donors, it often takes two to four months from the start of a search to getting cells donated for transplant. For patients with very aggressive cancers, or in children with certain metabolic disease, waiting that long may not be an option. In those cases, the fact that you can get cord blood so quickly is a big advantage. 

In children, the results from cord blood transplants are very promising. Recently, cord blood has been used more for unrelated transplants then either bone marrow or peripheral blood in the United States. Historically, cord blood transplants have been used primarily for children, because the number of stem cells available in a cord blood unit is too low to remake an adult's blood and immune system. This also has recently changed, as researchers are finding ways of expanding cord blood cells and making cord blood transplants available to patients of all ages.

What's new in cord blood transplants?
At M. D. Anderson, researchers are working on ways to make cord blood transplants available for more people and safer with better results. Some of these studies involve:

•    Using novel combinations of chemotherapy given right before the cord blood transplant

•    Combining two cord blood units to give higher numbers of cells, and therefore possibly a better chance for cells to take and to grow faster

•    "Expanding" cord blood in the lab, making the stem cells duplicate themselves to provide higher numbers of cells for transplant

•    Combining cord blood with other types of transplants to try and improve the cancer-fighting ability of the transplant

•    Developing other cell therapies; In the basic science labs, cells are being made from cord blood that are engineered to specifically attack B cell leukemias or lymphomas

New trials are opening constantly. Cord blood transplants aren't a perfect solution and have their own set of drawbacks. However, they offer hope to many patients -- more each day.

By Dawn Dorsey, Staff Writer

Cancer has been playing hide-and-seek with Patsy Lofton for 17 years, traveling from her breast to her lung, spine and brain.

Over the years she's tried many treatments, some more successful than others. Now, she's hoping a recent Gamma Knife radiosurgery procedure at M. D. Anderson will help slow the growth of the cancer in her brain.

patsy lofton_final.jpgBreast cancer began the saga
In 1992, Lofton, who lives in central Mississippi, was diagnosed with stage 1 breast cancer. She had a lumpectomy (surgical removal of the tumor and some of the surrounding tissue), radiation and chemotherapy and felt lucky she had caught the cancer before it spread.

But three years later, she began to have a pain in her back, just under her shoulder blade.

"I had a feeling the cancer was back," Lofton says. "But after you've had cancer, you think every little pain is cancer."

Cancer reappears in lung, spine
Unfortunately she was right; the cancer had reappeared in her lung. The tumor was surgically removed, and Lofton had two bone marrow transplants.

For nine years, she was free of cancer. Then it reared its head again, this time in her spine. Her radiologist referred her to M. D. Anderson.

"Since I was 50, still young the doctor said, he thought we might be able to just remove the two vertebrae where the cancer was," she says. "But to do that, we first had to treat the spine with radiation."

Surgeries take their toll
After the radiation, surgeons removed T3 and T4, two vertebrae in the middle of her back.

"It's been a pretty tough adjustment, and it still affects me," says Lofton, who's now 55. "I can't do very much, and my shoulders hurt a lot. Everything below and above the vertebrae that were removed has to work extra hard to compensate."

Before she was completely healed from the surgery, Lofton slipped and fell as she was leaving a restaurant. She broke her ankle and heel and was in a wheelchair for four months, requiring two surgeries.

Procedure hones in on tumor
Last year, a PET (positron emission tomography) scan revealed several small spots on Lofton's brain and lung. Doctors treated the spots on her brain with radiation, but 10 months later another PET scan revealed two new spots. That's when they decided to try Gamma Knife.

A Gamma Knife procedure is neither a knife nor surgery. It's a type of radiation treatment that delivers highly focused, high-intensity rays to a tumor with little damage to healthy tissue.

Gamma Knife causes little pain
Although the procedure might sound scary, Lofton explains it calmly. She says she felt only minor discomfort.

"They drilled two little holes in my skull: two in front and two in back," she explains. "Then they fitted a metal, locking mechanism called a halo on my head to keep it straight and still during the procedure. First they did an MRI, then the procedure, which lasted about 40 minutes."

Lofton was awake during the procedure, but she was lightly sedated.

"After they removed the halo, I had to sit for about an hour, and then I was dismissed," she says. "They asked me to stay in town overnight, and I went home the next day."

"The only side effect has been a little discomfort and two small knots where they drilled the holes to fit the halo."

Treatment continues for lung cancer
Lofton returns to M. D. Anderson every three months for MRIs of her brain, and the tumors seem to have stopped growing. She still receives chemotherapy for lung cancer, but she's able to do that at a facility about two hours from her home.

Recently, a small spot appeared on her liver.

"The doctor says that's the least of my worries," Lofton says. "But we're keeping an eye on it."

Battle influences her attitude
How does Lofton keep going? She attributes it in large part to family, including her husband of 30 years and a grandchild who lives a little over an hour away.

After fighting a formidable enemy for so many years, Lofton has developed a fairly easygoing attitude.

"I ask a lot of questions and learn what I can," she says. "But, in the end, the cancer's either going to come back or it's not."

Related articles:
Q&A: Gamma Knife® Radiosurgery for Brain Tumors

M. D. Anderson resources:

Breast cancer

Lung cancer

Brain cancer

Division of Radiation Oncology

Additional resources:

Detailed Guide: Brain/CNS Tumors in Adults (American Cancer Society)

Brain Tumor (National Cancer Institute)

Patient Information - North America (Elekta)

Gamma Knife® is a major advance in the field of stereotactic radiosurgery for certain brain cancer patients. It offers a non-invasive procedure that can be performed in one session and with extreme precision.

Answering questions about this procedure at M. D. Anderson is Eric Chang, M.D., associate professor in the Department of Radiation Oncology.

What is a Gamma Knife?
The Gamma Knife is a 30-ton machine that contains a cylindrical cone made of the world's largest piece of tungsten with lead shielding. The machine has 192 Cobalt-60 radiation sources that are shaped by eight sectors that surround the patient's head.

GammaKnife.jpgThere is a theoretical possibility of choosing from 65,000 combinations of highly focused radiation beams.These can be used to create customized shots that target a particular brain tumor, allowing each shot to be tailored to the shape of the patient's tumor.

In addition, the current Gamma Knife model can treat a larger volume of brain area than previous models, which allows greater cranial reach of tumors located in extreme anatomical locations. It has great accuracy to one-tenth of a millimeter and can reach deep-seated targets.

What is Gamma Knife radiosurgery?
Gamma Knife surgery is actually a form of radiation therapy invented in 1967 by Lars Leksell, a Swedish neurosurgeon. The latest model, Perfexion, has been redesigned and re-engineered, and it is the first fully automated Gamma Knife at M. D. Anderson.

For the one-day procedure, the patient first has a brain MRI with a head frame placed by a neurosurgeon. Then the Gamma Knife team creates a customized treatment plan, which is  delivered to the patient who lies on a sophisticated and highly accurate patient positioning system (PPS). The patient's head is inserted into the cone-shaped tungsten cylinder that delivers highly focused gamma rays around the head.

While the contribution of each ray is relatively small -- allowing for less damage to surrounding healthy cells -- when the multiple rays converge on the tumor, they have great intensity. The Gamma Knife unit also has an audio/visual connection so the patient can be seen and also communicate with the treatment team.

Who is eligible for Gamma Knife radiosurgery?

The brain radiosurgery tumor board is a multidisciplinary team of radiation oncologists, neurosurgeons, neuron-radiologists, a radiation physicist and a nurse. At tumor board meetings, each case is discussed to decide if Gamma Knife radiosurgery is the best option. Radiosurgery is especially important for patients who have no other treatment options, including those not eligible for standard surgical techniques due to illness or advanced age.

The Gamma Knife is considered most effective in the treatment of intracranial tumors (within the cranium and the skull base below the brain) such as:

•    Brain metastases (cancer that has spread to the brain from other parts of the body)
•    Acoustic neuromas
•    Pituitary adenomas
•    Craniopharyngiomas
•    Meningiomas
•    Gilial tumors
•    Skull base tumors
•    Upper cervical spine tumor

What is the process?
Generally an outpatient treatment, the surgery consists of four steps:

1.    Early morning placement of the Leksell stereotactic coordinate frame, which will hold the patient's head in place during imaging and treatment
2.    MRI of the brain, which accurately locates and visualizes the tumor
3.    Planning of treatment using a Gamma Planning Computer  
4.    Treatment, followed by observation in the Post-Anesthesia Care Unit

Depending on the number and complexity of the tumors, the delivery of radiation treatment can take from 15 minutes to several hours. A patient usually can return to a normal routine and activities after 24 hours.  

What are the advantages of Gamma Knife surgery?
Because it is non-invasive and no surgical incision is required, the physical trauma and the majority of risks associated with open neurosurgical procedures are avoided. The procedure is recognized worldwide and supported by more than 2,500 peer-reviewed research articles. In addition, more than 50,000 patients are treated with Gamma Knife every year by the approximately 250 machines in use around the world.

Related article:
Gamma Knife® Radiosurgery Targets Brain Cancer

M. D. Anderson resources:

Brain Cancer

Eric Chang, M.D.

Division of Radiation Oncology

Additional resources:

Detailed Guide: Brain/CNS Tumors in Adults (American Cancer Society)

Brain Tumors (National Cancer Institute)

Gamma Knife

Patient Information - North America (Elekta)

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