Roswellness. for Doctors. In This Issue. In the Business to Save Lives. through Research, Prevention and Innovative Treatment

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1 Roswellness for Doctors Updates on Cancer Advances and Patient Care In This Issue A2 Three Powerful Tools Boost RPCI s Brain Power In the Business to Save Lives through Research, Prevention and Innovative Treatment A4 Six Months In and Looking Forward RPCI s New President & CEO Shares His Vision and Goals A6 RPCI Headliners A7 RPCI Case Study: Brain Mass

2 The treatment of brain tumors, both benign and malignant, is a complex endeavor: The brain is surgically less accessible than many other parts of the body, and unintended collateral damage to healthy brain tissue can have serious consequences for the patient. At the same time, the blood-brain barrier presents a significant challenge for the delivery of chemotherapy. But three powerful new technologies at Roswell Park Cancer Institute are increasing both patient safety and the likelihood of a positive outcome. RPCI s Neuro-Oncology Center is the first in Western New York and one of very few in North America equipped with the PoleStar N20 imri Navigation Suite; the Trilogy image-guided radiation therapy (IGRT) system for the delivery of stereotactic body radiation therapy (SBRT); and the Model 4C Gamma Knife for stereotactic radiosurgery. PoleStar, an intraoperative imaging system in the operating room, can produce real-time images of the brain while surgery is underway. In the past, neurosurgeons had to rely on images captured immediately before surgery to locate the tumor and to distinguish between the tumor and healthy tissue, which often look alike. But those images become obsolete soon after surgery begins, because the brain shifts as soon as the skull is opened. The constantly updated images provided by PoleStar correct for that fact. PoleStar makes it possible to remove the tumor with greater accuracy; to pinpoint the tumor margins to prevent injury to healthy brain tissue; and to recognize any problems before the skull is closed, thereby reducing the need for re-operation. Three powerful tools boost RPCI s brain power A2

3 For Physician Referrals: ROSWELL Gamma Knife stereotactic radiosurgery is a noninvasive approach to treating many otherwise inoperable brain tumors and brain disorders centered in inaccessible areas of the brain. The Gamma Knife targets tumors and arteriovenous malformations (AVMs) with 201 intersecting gamma ray beams, delivered simultaneously. The outpatient procedure requires no anesthesia, virtually eliminates the risk of infection and bleeding associated with conventional surgery, and helps protect normal tissue adjacent to the tumor site. RPCI has treated more than 1,500 patients with Gamma Knife technology since RPCI is the first treatment center in the region to offer SBRT, which delivers very high doses of radiation with such precision that it avoids damaging healthy tissue near the tumor site and makes it possible to knock out tumors that were previously resistant to radiation. It can be useful for treating spinal tumors in addition to, or instead of, surgery. SBRT is delivered over a shorter treatment period than conventional radiation therapy. RPCI researchers are at the forefront in investigating the effectiveness of SBRT for treating skull base tumors, which are difficult to reach by conventional surgery and inaccessible to Gamma Knife radiosurgery. These tools further enhance the capabilities of RPCI s Neuro-Oncology team, which annually performs more than 350 Gamma Knife procedures and about 170 neurosurgical operations for brain, pituitary and spinal problems. The Neuro-Oncology team also routinely employs the following tools and methods to enhance treatment: Cortical mapping during awake brain tumor surgery, to help preserve the function of specific regions of the brain located close to the tumor. Stereotactic image-guided craniotomy, which guides the neurosurgeon along the most direct route to the tumor and improves the thoroughness of tumor removal. Endoscopic neurosurgery, a less-invasive method for removal of specific types of skull base tumors. The opportunity to enroll in clinical research studies aimed at identifying more effective treatments for brain tumors. To search currently accruing trials, visit RPCI s Neuro-Oncology team draws on the expertise of specialists in several disciplines to provide a full complement of services before, during and after treatment. These include neurosurgeons; radiation oncologists; medical neuro-oncologists; neuroradiologists; neuropathologists; radiation physicists; neuropsychologists; physical, occupational and speech therapists; nurse practitioners; nurse case managers; and social workers. Referring physicians who would like further information about treatments offered at RPCI for benign or malignant brain tumors, pituitary tumors, spinal tumors, and such conditions as arteriovenous malformations (AVMs) and trigeminal neuralgia (TN) should contact Robert Fenstermaker, MD, FACS, Chair of the Department of Neurosurgery and Director of the Neuro-Oncology Program, at Robert.Fenstermaker@roswellpark.org or A3

4 SIX MONTHS IN AND LOOKING FORWARD RPCI s New President & CEO Shares His Vision and Goals Donald Skip Trump, MD, FACP, says serendipity played a large part in setting him on his four-decade career in cancer research. One might argue that his choice had less to do with fate than with his keen vision and instinct, which continue to lead him to unexplored territories in search of hidden riches. As a medical student at Johns Hopkins University, Trump was set on becoming a cardiologist. But after earning his medical degree, a clinical rotation in the Johns Hopkins cancer unit intervened. In those days, he says, that was the place where you went to learn how to take care of sick patients. He became intrigued by the new challenges and interesting scientific problems that cancer posed. But I was also struck by the commitment and energy of the people doing the work, he says, from the scientists studying in the lab to the A4 clinicians, to the nurses and the other support staff. The experience changed my life. I decided I wanted to learn more about cancer. Having taken the reins last April as Roswell Park Cancer Institute s President and CEO, Trump is more immersed than ever in the science and medicine of cancer, and still expresses awe toward the legions of researchers, caregivers and others who are doing the work. And he is still seeking those hidden riches. My goal is that we should be one of the top ten cancer centers in the country, he has declared. Six months into the job, he is marching toward that goal by expanding RPCI s efforts in several research and clinical technologies, and by refining the very culture of the Institute.

5 TAKING A CLOSER LOOK One area of focus that straddles both research and clinical care is medical imaging the ability to noninvasively peer into the living body of a patient or research animal to monitor cancerous cells and tissues. While tumor imaging technologies have been around for decades, RPCI researchers are now developing new ways to image individual cell types, and can even trace the very molecules associated with tumors. These biomarkers are invaluable for following the spread of cancer or for assessing the effectiveness of a patient s treatment regimen. The new imaging tests can do wonders for today s cancer patients, but Trump thinks the technology will have even greater impact on developing tomorrow s cancer therapies. Traditionally, screening cancer drug candidates has involved months-long experiments with large groups of animals to measure tumor shrinkage, or animal survival at the end of the test. Molecular imaging may speed the evaluation of new drugs by giving researchers the power to quickly and continuously monitor the earliest molecular signs of anticancer drug action, Trump explains. RPCI researchers are creating light-sensitive compounds that can pull double duty as cancer trackers and killers. First, the chemicals, developed by Ravi Pandey, PhD, Distinguished Member in Cell Stress Biology, seek out and mark cancer cells. Then, after being exposed to light, the compounds destroy them. Mohamed K. Khan, MD, PhD, Director of Basic and Translational Radiation Research, and Lajos P. Balogh, PhD, Director of Nanotechnology Research, have taken the technology a step farther, devising ways to insert these magic bullet compounds into nanoparticles, tailor-made to target any chosen cell type or cancer molecule. DATA OVERLOAD One of the challenges for scientists and clinicians is dealing with an overload of information, Trump says. In the genomics age, measurements from thousands of different genes and proteins can be collected from a single tumor. How can scientists and physicians sort through all that information to come up with the best treatment? The solution, he says, is an important new computer system being developed at RPCI called the Laboratory Information Management system, which will track and link all of the laboratory and clinical information from an individual patient. That will be an incredibly powerful database as it develops. For Physician Referrals: ROSWELL My goal is that we should be one of the top ten cancer centers in the country. TAKING STOCK Apart from the technological improvements and the wave of recruiting to achieve them, Trump says he is most proud of his efforts to enhance the work culture of the Institute. Our 3,000 employees are vitally important for our patient care programs and cancer research programs, Trump says, and we need to make sure that this is the best possible place for them to do their work, so that we can do the important work of the Institute. You may contact Dr. Trump via at Donald.Trump@roswellpark.org. A5

6 RPCI Headliners CHU HAILED FOR PSA DISCOVERY Honoring an eminent scientist for a landmark discovery, The Prostate Net presented its 2006 In the Know Award for Clinical Research Excellence to T. Ming Chu, PhD, DSc, Chair Emeritus of Diagnostic Immunology Research at Roswell Park Cancer Institute. Chu s discovery of the prostate-specific antigen (PSA) in the late 1970s led to the development of the PSA test for early detection of prostate cancer. The test has been cited as one of the most significant cancer-related developments of the 20th century. TRUMP ELECTED TO AACI BOARD RPCI President and CEO Donald Trump, MD, FACP, has been elected to a two-year term on the eightmember Board of Directors of the Association of American Cancer Institutes (AACI). The AACI promotes the common interests and efforts of the nation s leading academic cancer centers that work to eradicate cancer through a comprehensive, multidisciplinary program of research, treatment, patient care, prevention, education and community outreach. Trump s term began in October Ernesto Sebrie, PhD, (center) of RPCI s Division of Health Behavior, accepts the 2007 GSP Award for Research on behalf of RPCI. OUT FRONT FOR A SMOKE-FREE FUTURE RPCI s leadership in promoting a smoke-free world was recognized recently with the 2007 Global Smokefree Partnership (GSP) Award for Research. The award was presented by the GSP at a meeting of the Society for Research on Nicotine and Tobacco in Rio de Janeiro, Brazil, for RPCI s outstanding and sustained contributions to advancing smoke-free policies in the U.S. and around the world. AMBROSONE NAMED TO NCI LEADERSHIP Christine Ambrosone, PhD, Chair of Cancer Prevention and Control at RPCI, has been appointed to the Board of Scientific Advisors of the National Cancer Institute, for a five-year term ending June 30, Among other responsibilities, the board assists and advises the NCI Director; oversees the Institute s extramural programs; and advises Extramural Division Directors on current and future scientific policies. INTERNATIONAL AWARD BEARS DOUGHERTY S NAME The Society of Porphyrins and Phthalocyanines, based in France, has established the Dougherty Award for Excellence in Photodynamic Therapy (PDT), sponsored by RPCI in honor of Thomas Dougherty, PhD, Chief Emeritus of the Institute s PDT Center. Dougherty pioneered the development of PDT, which uses lasers to activate light-sensitive, cancer-killing drugs called photosensitizers. Today the treatment is FDA-approved and used worldwide to treat certain types of cancer and other conditions. The award will be presented for the first time at the Fifth International Conference of Porphyrins and Phthalocyanines in Moscow in July 2008, and every two years thereafter. GOVERNOR TAPS HOHN FOR STEM CELL BOARD New York State Governor Eliot Spitzer has appointed David C. Hohn, MD, Executive Director of Health Care Policy and Past President of Roswell Park Cancer Institute, to serve on the newly formed Empire State Stem Cell Board. The board will oversee and administer $600 million in funding for the Empire State Stem Cell Trust Fund to promote stem cell research and development. A6

7 Roswell Park Cancer Institute Case Study For Physician Referrals: ROSWELL Brain Mass The Patient: 46-year-old woman Presented with new-onset seizures and memory problems The Work-up: MRI shows a 5 cm frontal lobe brain mass Positron Emission Tomography (PET) defines a hypermetabolic mass in patient s left frontal lobe Stereotactic needle biopsy of mass identifies an anaplastic oligodendroglioma Tumor positive for loss of markers on chromosomes 1 and 19 The Team: Patient seen by neurosurgeon, neuro-radiation oncologist and medical neuro-oncologist. Case discussed at neuro-oncology multidisciplinary conference with appropriate medical and surgical disciplines, plus education and support professionals. Robert Fenstermaker, MD Clinical Chair, Neurosurgery The Treatment: Initial surgical resection with intraoperative MRI. Post-operative treatment with IMRT (Intensity-Modulated Radiation Therapy) Post-radiation chemotherapy with combination of oral and intravenous chemotherapy Robert Fenstermaker, MD Result: Patient back to work, alive and well, five years after treatment, with no evidence of disease. For more information about the diagnosis and treatment of brain tumors at Roswell Park Cancer Institute, contact Robert Fenstermaker, MD, at , or via at Robert.Fenstermaker@roswellpark.org. A7