Pediatric Brain Tumor Studies Focus on Reducing Side Effects, Locating Biological Targets   Retinoid Chemoprevention Trial Aims to Reverse Genetic Changes Caused by Smoking   DiaLog: Surviving Cancer and Staying Healthy, by Rena Sellin, MD, Professor, Department of Internal Medicine Specialties   House Call: From Biopsy to Diagnosis: Understanding the Process   Protocols: Pediatric Brain Tumor Clinical Trials   Protocols: Chemoprevention Studies Feature a Variety of Agentshttps://openworks.mdanderson.org/oncolog/1081/thumbnail.jp

Chalaire, Dawn

Sellin, Rena, MD

Wright, Kerry L.

English

Pediatric Brain Tumor Studies Focus on Reducing Side Effects, Locating Biological Targets Retinoid Chemoprevention Trial Aims to Reverse Genetic Changes Caused by Smoking DiaLog: Surviving Cancer and Staying Healthy, by Rena Sellin, MD, Professor, Department of Internal Medicine Specialties House Call: From Biopsy to Diagnosis: Understanding the Process Protocols: Pediatric Brain Tumor Clinical Trials Protocols: Chemoprevention Studies Feature a Variety of Agentshttps://openworks.mdanderson.org/oncolog/1081/thumbnail.jp

OpenWorks @ MD Anderson

University of Texas MD Anderson Cancer Center OpenWorks @ MD Anderson OncoLog MD Anderson's Report to Physicians (All issues) OncoLog MD Anderson's Report to Physicians 1-2000 OncoLog Volume 45, Number 01, January 2000 Dawn Chalaire The University of Texas MD Anderson Cancer Center Kerry L. Wright The University of Texas MD Anderson Cancer Center Rena Sellin MD The University of Texas MD Anderson Cancer Center Follow this and additional works at: https://openworks.mdanderson.org/oncolog  Part of the History of Science, Technology, and Medicine Commons, and the Oncology Commons Recommended Citation Chalaire, Dawn; Wright, Kerry L.; and Sellin, Rena MD, "OncoLog Volume 45, Number 01, January 2000" (2000). OncoLog MD Anderson's Report to Physicians (All issues). 87. https://openworks.mdanderson.org/oncolog/87 This Newsletter is brought to you for free and open access by the OncoLog MD Anderson's Report to Physicians at OpenWorks @ MD Anderson. It has been accepted for inclusion in OncoLog MD Anderson's Report to Physicians (All issues) by an authorized administrator of OpenWorks @ MD Anderson. For more information, please contact rml-help@mdanderson.org. Pediatric Brain Tumor Studies ( ontinued from page 1 ) tip] approache and cooperation b tween several different  discipline . Whj] standard care for mo t type of p diatri brain tumors continues to b urgery, often fol low d by radia­tion therapy wi th or ·without h mo­therapy, there i i ncr a ing empha is on  trying to min imize the long-termef£ ts from the e treatments.'Th r are tumors that have a v ry poor prognosi that w ar treating very aggr -i · ly, but in  those i n  which th  progno is has improv d, w ar a lot more careful t balanc the long-term effects, " aid Joann ter, M.D. ,  chief of the Section of Pediatric euraJ Tumor at M. D. Ander on . "Acut ly and long-term , we worry about in t 1 1  c­tual and neurological d fici . " Patien ts younger than thre y ar old are mo t l i kely to experienc  neuropsychological defici ts because the i r  tumors tend to be larger and more aggre ive and because they ar much m r n it ive to the long-term effe ts of radiation therapy and chemotherapy, Dr. ter aid. "Even thos who go th rough urg ry and ini t ial tr atm nt inta t, if th y ar und r age thr e ,  w know that radiation therapy can au e a sign ificant drop in IQ over year , "  said Dr. ter, referr i ng to  studies conducted by Donna Copeland, Ph .D . ,  a prof< or in  the Department of P diatric wh do um nted the cau of int  I I  tual d fi i in  young chi ldr n .  Dr. Copeland' research led Dr. ter to organize a protocol in which children le s than three years old who have malignant brain tumors ar treat d wi th surgery and chemo-th rapy, but no radiation. The approach, Dr. At r said, has b n moderately ucce ful, ·p iaJly in pati nts with medulloblast ma, and th r ar I ng­term survivor who have never had radiation therapy-and therefore have no intellectual deficits resulting from radiation exposure. Thi and imi lar protocol hav timulated ' veral ooperative group trial thr ugh th h i ldren's  Cancer Gr up that are al o aimed at u·ying to r duce th am unt of radiation children ar xpo ·ed to by repla ing it with chem th rapy. While the e trial have yie ld d results comparable to standard u·eatments with radiation th rapy incertain tumors, chemotherapy han t uppl an ted rad iat ion th  rap atandard care in  the tr atm n t  ofchi ldho d bra in tum r . Moreover,in recent y ar , n w t hn iques inradiation therapy hav led to themore preci tr atrn n t  of pediatricbrain tumor and b tter sparing ofthe de eloping brain than conven­t ional rad iation therapy allows.The most importan t  of th s advanc i th ree-dim nsional nformal radiation th rapy, which invo lv high! pr i d de livery to a target volum that is defined with radiographic imaging. It  is not ------ PROTOCOLS ---;,-----Pediatric Brain Tumor Oinical Trials C l i n ical tria ls i n  progress at The Un ive r­sity of Texas M .  D .  Anderson Cance r Cente r i nc lude the fol lowing for ped iatric patients with brain tumors. • A phase I I  study of h i gh -dose cyclo­phosphamide ,  triethyle n eth iophos­phoramide (th iotepa) , and melphalanwith auto logous blood stem cel ltransplantati on for the treatment of h igh­ris k  embryonal bra in  tumors ( 1 098-032). Physician: Ka Wah Chan, M.D.Pat ients five to 50 years old with recu rrent o r  high-r isk embryonal bra in tumors wi l l  receive two courses of h igh­dose chemotherapy, each with stem cel l  rescue. • Phase I study of intrathecal mafosfamide(DM98-06 1 ) .  Physician: Kurt Jaeckle, M.D.Patients more than three years old 2 / M D  Ander on  OncoLo" with meningeal mal i gnancies that a re p rog ressive o r  refractory to convent ional therapy are e l i g i b le . • A phase I I  study of methotrexate , fo l in icacid ,  mech l o rethamine ( n itrogenmustard ) ,  procarbazine, and prednisone(MMOPP) as p r imary therapy fo r infantswith bra i n  tumors ( P88-006) . Physician:Joann Ater, M. D.I nfants and ch i l d ren fou r  years old o r  younger with pr im itive neuroectodermal tumors and h igh-grade astrocytomas who have not had prev ious therapy (othe r  than su rgery) are e l ig ib le .  I nfants and ch i l d ren  with low-g rade astrocyto­mas or optic tract tumors that are incompletely resected and have a progressive cou rse not amenab le to further su rgery may a lso be e l i g ib l e .  • A g roup-wide p i lot study of  concurrentcarbop lat i n ,  v incrist i ne ,  and rad iotherapyfo l lowed by adjuvant chemothe rapy i npatie nts with n ewly d iagnosed h igh - riskcentral nervous system embryonal tumors (PNET) (CCG98-99701 ) . Physician: John Kuttesch, M.D. , Ph.D. Patients three to 22 years old with h isto log ic ve r if ication of a PNET at d iagnosis and no pr ior  rad iati on therapy or chemotherapy are e l ig ib le . • Phase I I  study of temodal (SCH 52365 ;temozo lomide , I ND  #52797) i n  ch i ld renand adolescents with recurrent centra lnervous system (CNS) tumors(CCG98A09701 ) .  Physician: JohnKuttesch, M.D. ,  Ph.D.Pat ients younger than 21 years o ld  who have measurable d i sease o r  d isease that has relapsed or become refractory to conventiona l therapy are e l i g i b le . • Chemothe rapy fo r p rogressive low­g rade astrocytoma in ch i l d ren less than1 0  years o ld (CCG97-9952). Physician:Joann Ater, M.D.Pat ients who have clear rad io log ical o r  c l in ical evidence of p rog ressiveGeorganne Mansour, an advanced jJractice nurse in the Department of Neurosurgery, Dr. John Kuttesch, assistant professor in the Department of Pediatrics, pediatric · el ow Dr. Cesar Nunez, and Dr. Frederick Lang, assistant professor i n  the Department ,f Neurosurgery ( /,eft t o  right), discuss treatment options for a pediatric patient r.dth 1 brain tumor. yet known how such treatments affect outcomes, but it is hoped that they will allow physicians to reduce the long-term toxicities that can be associated with radiation therapy, said Eric L. Chang, M.D., assistant professor in the Department of Radiation Oncology. One approach to improve out­comes and limit side effects of therapy is the study of cytoprotective agents, in particular amifostine, used in combination with standard thera­pies. John Kuttesch, Ph.D., M.D., a neuro-oncologist and head of the Pediatric New Agents Program, leads a phase I trial of amifostine in children with recurrent solid tumors. Amifostine has already been shown to protect against renal toxicity of cisplatin in adult studies, and some data suggest that it may also protect against cisplatin-induced hearing loss. Its effectiveness as a bone mar­row protectant is also being studied. ( Continued on page 4) ----PROTOCOLS----disease following resection or patients who had an incomplete resection are eligible to receive oral administration of carboplatin and vincristine at home through this study. • A pediatric phase I study of intravenousdolastatin-1 o (NSC 376128) in patientswith refractory solid tumors (CCG98-09718). Physician: Cynthia Herzog, M.D.Patients 21 years old or younger with histologically verified malignancies that are refractory to conventional therapy and other therapies of higher priority are eligible. Adequate cardiac and pulmonary function are required. • A phase 11 study of continuous 21-dayinfusion of topotecan (NSC 609699) inchildren with relapsed solid tumors(CCG99-O9713). Physician: JohnKuttesch, M.O., Ph.D.Patients with brain tumors, sarcomas, or neuroblastomas that have relapsed or become refractory to conventional therapy will receive topotecan on an outpatient basis. • Phase II study of docetaxel (Taxotere)(NSC#6285O3) in children with recur­rent solid tumors (CCG97-O962).Physician: Cynthia Herzog, M.D.Eligible for this protocol are patients age 21 and younger with clinically or radiographically documented measur­able disease that has relapsed or become refractory to conventional therapy. • A phase Ill prospective randomizedstudy of craniospinal radiotherapyfollowed by one of two adjuvantchemotherapy regimens in children withnewly diagnosed average-risk medullo­blastoma (CCG97-A9961 ). Physician:Joann Ater, M.O.This protocol includes both inpatient and outpatient treatment of patients three to 21 years old with nondisseminated posterior fossa medulloblastoma. • Phase II group-wide trial of pre­irradiation vincristine, cyclophospha­mide, and etoposide chemotherapy forchildren aged three to 21 years withnewly diagnosed intracranial ependy­moma and radiologic evidence ofpostoperative residual tumor (CCG96-9942). Physician: Joann Ater, M.D.To be eligible for this study, patients must have histologically proven intracra­nial ependymoma that has not been previously treated with chemotherapy or radiation therapy.• FoR MORE INFORMATION about these clinical trials, physicians or patients may call the M. D. Anderson Information Line. Thosewi.thin the United States should call (800)392-1611; those in Houston or outsidethe United States shoul.d. call (713) 792-6161. Visit the M. D. Anderson CancerCenter clinical trials web site at http://www.dinicaltrials.org/or a l7roader listingof treatment research protocols.MD Anderson OncoLog / 3 PHYSICIANS: THIS PATIENT INFORMATION SHEET IS YOURS TO COPY AND PASS ON TO PATIENTS. From Biopsy to Diagnosis: Understanding the Process I t is never easy to hear that you or someone you wve may have cancer, and the thought of undergoing a biopsy to confirm a preliminary diagnosis can be frightening. Knowing what to expect from the b iopsy process and being familiar with the types of biopsies commonly used for diagnosis, however, can ease some of your worries and make the procedure less stressful. What is a biopsy? A biopsy is the removal and examination of a tissue sample from an area of suspected cancer. Physical examinations and laboratory tests can show if abnormati ties are present in your body, but a biopsy is the only definitive way to make a diagnosis of cancer. The decision as to what type of biopsy is performed depends on the location of a tumor, as well as its type, size, and growth characteristics .  Types of biopsies Core needle biopsy uses a large needle that is inserted into the tumor to withdraw cells for examination. A local anesthetic is usually adminis­tered at the insertion site. This method is often used for masses located in muscle or just under the skin, such as in the breast. Fine needle aspiration (FNA) is a more common type of needle biopsy. In FNA, a needle no wider than a normal injection needle is inserted into the tumor, and tumor cells are aspirated (removed from the tumor) into a syringe for examination. No anesthesia is necessary, and diagnosis can be made within hours. Endoscopic biopsy utilizes a thin flexible tube with a light or camera on one end (endoscope). The endoscope is inserted through an incision or natural opening, and forceps, a brush, or a needle attached to a cable within the endoscope are used to snip off, iopsy is the only ,�-·nitive way to make --.t"'Y .. _gnosis of cancer. • brush off, or aspirate tissue from a tumor. Depending on the endoscope insertion site, local anesthesia or a sedative is sometimes used. lncisional biopsy involves surgical incision and remova 1 of a larger segment of a tumor. It is often the biopsy of choice for extremely large masses and is most commonly used to remove sections of soft tissue tumors (in muscle, fat, and connective tissues). Excisional biopsy involves complete removal of a tumor or organ. Exci­sional biopsies are best suited for removal of very small tumors (such as skin tumors), or for situations where removal of the entire organ is necessary. Excisional and incisional biopsies are often performed "'�th local or regional anesthesia; however, tumors inside the chest or abdomen require the use of general anesthesia. Because needle biopsy removes individual cells, and may not effec­tively demonstrate how cancer cells relate to each other, incisional or excisional biopsy may be required even when needle biopsy is simpler and less painful. Examination and diagnosis After a tissue sample is removed, it is taken to a laboratory and exam­ined by a pathologist (a doctor who studies cells and tissues to identify disease). Pathologists place tiny layers of tumor cells onto small glass slides and stain them with chemicals that distinguish different parts of the cells. They cover each slide with a very thin pane of glass to protect the sample, and view the processed tissue under a microscope. Pathologists then write detailed reports of their observations and conclusions, and a report and diagnosis are given to the patient's oncologist. Information obtained from a biopsy includes whether the tumor is benign (noncancerous) or malignant (cancerous), what type of cancer may be present, and how the tumor may affect the patient's health. Will a biopsy cause cancer to spread? In almost all cases, a biopsy will not cause cancer to spread. The majority of cancers are safely sampled with a needle or incisional biopsy. For rare exceptions , experienced doctors troubleshoot beforehand and can per­form follow-up operations to remove more of the cancer if necessar y. Though patients may feel physically worse after biopsy or surgery, it does not mean their cancer has spread. It is normal to feel this way after any invasive procedure. • For more irif ornwtion, contact your fJhysician or contact the M. D. Anderson Information Line:({) (800) 392-1611 withinthe United States, or ({) (713) 792-6161 in Houston and outside the United States. January2000 Q2000 1'M Univmicy of1'exas M. D. ,\11derson Cancervnter 

OncoLog, Volume 45, Number 01, January 2000

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OncoLog Volume 45, Number 01, January 2000

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