Inside the Tulane Cancer Center
Spring 2003 Newsletter
Headlines in this Issue
IMRT at Tulane Cancer Center: Offering Options No One Else Can
Komen Grant Funds New MCLNO Breast Center
Genetics and Prostate Cancer in African American Males
Support Groups Aid Rehabilitation
New Chemo Study for Patients with Locally Advanced Breast Cancer
A Message from the Director
Accolades: Faculty honors and awards
Index to all archived issues
Index to archived articles by topic
Editorial Staff & Contacts


IMRT at Tulane Cancer Center: Offering Options No One Else Can
The Tulane Cancer Center recently began treating patients with the latest innovation in Radiation-Intensity Modulated Radiation Therapy (IMRT). IMRT is a method for delivering higher, more precisely targeted doses of radiation to tumors. "We are hopeful that IMRT will cure more of our patients with fewer side effects and complications than conventional radiation therapy," said Ellen L. Zakris, M.D., Associate Professor and Chief of Radiation Oncology at the Tulane Cancer Center. IMRT offers patients several advantages. Because radiation doses to the tumor can be significantly higher with IMRT, there is a greater chance of curing some cancers. IMRT provides new opportunities for some patients with metastatic disease who were previously not candidates for radiation therapy because of the high risk of harming surrounding healthy tissues. It can also reduce dry mouth, rectal irritation and other bothersome side effects of radiation. "Tulane University Hospital & Clinic invested over $1 million in equipment upgrades and software so that the Tulane Cancer Center could offer its patients the most technically advanced radiation treatments commercially available today," said Lucien A. Nedzi, M.D., Assistant Professor of Radiation Oncology at Tulane. The result? "Tulane's IMRT program is unlike any other in the area," said Dr. Nedzi. "Our trailblazing clinical trials, our treatment planning and dose calculation software systems, and our highly qualified staff and team approach to patient care allow us to offer our patients options no one else can."

First and Only IMRT Clinical Trials
As an academic cancer center, the Tulane Cancer Center places a high level of importance on research. It is proud to be the first and only center in New Orleans with an ongoing clinical trial using IMRT. The study seeks to determine whether IMRT is an effective alternative to whole brain radiation for selected patients with brain metastases. Does IMRT improve efficacy while reducing toxicity for these patients? That's the question this trial and Tulane's team of experts hope to answer. And that's where the importance of clinical trials becomes evident. Clinical trials advance science by shedding light on the answers to such questions. Access to clinical trials has been shown to improve outcomes among cancer patients. Three additional clinical trials for IMRT are expected to open at Tulane later this year. Two of them are ongoing studies sponsored by the Radiation Therapy Oncology Group. One study seeks to determine whether IMRT reduces dry mouth for patients with oropharyngeal cancer. The other questions whether IMRT with chemotherapy reduces side effects and increases cure of nasopharyngeal cancers. A Tulane investigator-initiated trial is also planned to examine the usefulness of IMRT for patients with liver, lung, or adrenal metastases. Preliminary clinical data from the University of Rochester and Sweden have suggested that a small number of precisely directed doses of radiation can be highly effective for patients with metastatic disease in these sites. This patient population is not suitable for conventional radiation therapy because of the high potential for damaging the normal tissue surrounding the tumors. "We will try to determine whether IMRT, which allows us to deliver very high and precisely localized doses of radiation to these metastatic tumors, will provide these patients with alternatives to extensive surgical therapy," said Nedzi.

Equipment/Software Second to None
And Tulane is the only place in Louisiana doing the development work to assure accurate delivery of these IMRT doses within the liver and lung. "That's because we are the only treatment facility in Louisiana to acquire the Peregrine Monte Carlo dose calculation software," said Dr. Nedzi. "It's the most sophisticated and accurate method for the calculation of radiation doses available today. In fact, we're one of only a very few academic institutions in the country to possess it. This software gives our physicists one more way to check radiation doses, thereby increasing patient safety," said Nedzi. "Because of the complicated nature of IMRT, this is an important consideration for all patients thinking of receiving the new therapy." In addition to the cutting-edge Peregrine software, Tulane Radiation Oncology uses Corvus IMRT treatment planning software, which has been proven through nearly a decade of clinical use, as well as the Exactrac real time computerized positioning and tracking system to provide precision delivery of IMRT.

Tulane Cancer Center's Radiation Oncology team (from left):
Mandy Carter, RT(R)(T); Linda Lee Murphy, RT(R)(T); Anna Hall, RN; Deirdrea Churchman, RT(R)(T); Nicole Candiff, RN, BSN; Lucien Nedzi, MD; Bailey Pullen, PhD; Ellen Zakris, MD; Robert Sanford, PhD; Alichia White, CMD; Anthony Breyel, CMD; Raymond Wilenzick, PhD; and Scott Alleman, MS.
Expertise and a Team Approach to Delivery of Care
But that's only one factor in the equation, according to Erol Akdamar, chief operating officer for Tulane University Hospital & Clinic. "Making the commitment to upgrade equipment and purchase the most dynamic software available was the easy part," said Akdamar. "Any institution can purchase equipment. What truly sets you apart is having the expertise - the dedicated, experienced personnel - capable of maximizing the equipment's potential. And that's another area where Tulane excels." The Tulane Cancer Center's Radiation Oncology team boasts two full-time physicists - Robert Sanford, Ph.D., and Scott Alleman, M.S. Dr. Sanford has done extensive research in quality assurance and positioning accuracy for IMRT and has presented his work at a number of national medical physics meetings. Alleman is board-certified and the latest addition to the team. The team also enjoys the part-time participation of two additional highly experienced, board-certified physicists -- Ray Wilenzick, Ph.D., and Bailey Pullen, Ph.D. -- as well as two Harvard-trained radiation oncologists -- Drs. Nedzi and Zakris. While most cancer centers have only one physicist on staff, Tulane Cancer Center has four. In addition to calibration and quality assurance testing of all radiation therapy equipment, the staff physicists closely oversee IMRT's precision dosing. Both Sanford and Alleman have several years of extensive clinical experience with IMRT, which translates into improved safety and efficacy, as well as new frontiers in treatment for our patients. In addition, Dr. Nedzi holds a master's degree in applied physics and has done extensive research on IMRT's potential in stereotactic radiosurgery. In fact, he was selected by his peers to present his IMRT research at an international stereotactic conference. Dr. Nedzi is also widely published in such medical journals as the International Journal of Radiation Oncology, Biology & Physics; Neurosurgery; and Medical Physics.

As part of Tulane Cancer Center's multidisciplinary approach to patient care, our Radiation Oncology team also draws input and advice from physicians and researchers of all specialties. At weekly conferences, each patient's case is discussed by a roomful of experts - oncologists, pathologists, surgeons, radiologists, and several others - so that the most beneficial course of treatment can be mapped and patient progress followed. This means quality care with convenience for our patients, who get the benefit of input and advice from several specialists without having to visit each individually. "Our IMRT team is very special," said Roy S. Weiner, M.D., Director of the Tulane Cancer Center. "Our physicians and physicists are committed to improving current techniques and expanding the use of IMRT to more tumors and more tumor sites. As an academic cancer center, we are privileged to offer our radiation patients the best of today and the best of tomorrow."

Transverse view of the seven-field IMRT prostate isodose plan.

Program to Expand in 2003
Eight of the first 16 patients treated with IMRT at Tulane have prostate cancer, and so far the new modality shows extreme promise. "Side effects to the bladder and rectum are lower than with conventional radiation treatments, and studies have shown that control of the cancer is better compared with lower doses delivered through conventional techniques," said Nedzi. Of the remaining eight patients, four were treated for brain tumors (one on Tulane's clinical trial LN01.1), two for abdominal tumors, and two for head/neck tumors. "In the near future, we will also be offering IMRT to patients with breast cancer in hopes of reducing the skin toxicity of radiation therapy," said Dr. Zakris. In fact, the volume of patients treated with IMRT at Tulane is expected to steadily increase throughout 2003. "Eventually, we hope to offer IMRT to one-third of our radiation therapy patients," said Dr. Nedzi.
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Komen Grant Funds New MCLNO Breast Center
"Data from 1992 - 2000 reveals that 29% of all breast cancers diagnosed at the Medical Center of Louisiana at New Orleans (MCLNO) were late-stage cancers," said Melissa Brammer, M.D., Assistant Professor of Medicine at Tulane University Health Sciences Center. "And 32% of African-American women had late-stage diagnosis." Comparative national figures show late-stage diagnosis in less than 10% of all women and in 15% of African-American women. "In 2000, only 21% of eligible women aged 40 or older in Louisiana received mammograms compared to a national average of 66%," said Dr. Brammer. "Clearly, the problem in Louisiana and especially at MCLNO is inadequate screening rates and late-stage diagnosis." But Dr. Brammer and a multidisciplinary team of Tulane, LSU, and MCLNO physicians, nurses, and staff have recently come together to change this, and they're gaining momentum.

Left to right at the check presentation:
Komen Board members Martin Miller III, Kristi Post, Pat Denechaud, and Marbury Little; Roy S. Weiner, M.D.; Melissa Brammer, M.D.; Dwayne Thomas, M.D.; Oliver Sartor, M.D., Director, LSU Stanley S. Scott Cancer Center; Mary Abell, M.D.; and Donna Williams.

At a recent check presentation ceremony, representatives of the Susan G. Komen Foundation New Orleans Affiliate presented a $150,000 check to Dwayne Thomas, M.D., chief executive officer of MCLNO, to support the team's new Breast Cancer Education and Resource Center. Located on the 10th floor of MCLNO, the new Center provides a walk-in or referral screening, diagnosis and treatment program for patients with breast abnormalities. "Our overall goal is to provide a one-stop resource for patients who come to us for care," said Dr. Brammer. "We want to improve the process by which patients are seen, diagnosed and treated at MCLNO in the hopes of improving outcomes and quality of life." "In addition to screening, diagnosis and treatment, the Breast Center serves as an oasis of support, a place where patients can come not just for information, but to relax and speak with our professionals or with others who have been recently diagnosed with the disease," said Dr. Thomas.

Co-medical directors of the new Breast Center are Dr. Brammer and Mary Abell, M.D., Assistant Professor of Medicine at Louisiana State University Health Sciences Center. The Center will be directed by Cancer Nurse Specialist Tyler Bartley, RN, MSN, CNS, and she will be assisted by Jill Hutchinson, diagnostic cancer care coordinator. Other collaborators include: Donna Williams, Department of Public Health and Preventive Medicine; William McKinnon, M.D., Tulane Surgical Oncology; Michael Boyle, M.D., LSU Surgical Oncology; Dr. Jane Clayton, MCLNO Radiology; and Dr. Myra Kleinpeter, Director of Ambulatory Care at MCLNO. According to Dr. Brammer, dedicated space on the first floor of University Hospital will soon house a multidisciplinary diagnosis and treatment center. "The success of this program will do much to improve medical care and breast cancer screening for an historically underserved segment of our population," said Dr. Brammer.
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Prostate Cancer and African-American Males:
Is There a Genetic Explanation for Increased Incidence/Mortality?
Prostate cancer is the second leading cause of cancer-related deaths in American males. African-American males, however, tend to get prostate cancer at earlier ages, in larger numbers, and die from it more rapidly than Caucasian men of similar education and socio-economic background. Asim Abdel-Mageed, D.V.M., Ph.D., Assistant Professor of Urology and Adjunct Assistant Professor of Pharmacology at Tulane, wants to find out why. He thinks the answer can be found by studying genes. "Although considerable progress has been made in prostate cancer research, there are still more questions than answers," said Dr. Abdel-Mageed. "The disease remains elusive, and there is a clear disparity in the reported incidence of clinical prostate cancer between different ethnic groups. I believe genetic alterations can account for these differences." Using state-of-the-art technology, such as laser capture microdissection and microarray analysis, Dr. Mageed's laboratory performs highly detailed examination of prostate cancer specimens from patients of matching age and tumor stage but differing racial backgrounds. He's hoping to identify novel genetic factors for the disease. "This approach should allow us to identify those genes contributing to the development of prostate cancer among ethnic groups," said Dr. Abdel-Mageed. Dr. Abdel-Mageed believes this research will not only strengthen our basic understanding of the link between prostate cancer and various racial groups, but it will also provide a new frontier for the establishment of more effective therapeutic and preventive strategies for the disease.

Dr. Abdel-Mageed performs laboratory tests in order to find a genetic explanation for differences in prostate cancer incidence among ethnic groups.

Dr. Abdel-Mageed holds a degree in veterinary medicine from the University of Khartoum, Sudan, and Masters and Ph.D. degrees in molecular physiology/toxicology from Kansas State University, 1993. He completed his postdoctoral training in cancer pharmacology at Tulane University Health Sciences Center. In 1997, he joined the Department of Urology at Tulane as an Assistant Professor and Director of the Molecular Oncology Laboratories. Dr. Abdel-Mageed's research is supported by a grant of nearly $1 million from the American Cancer Society.
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The Support Group Dynamic
Studies have shown that support groups can assist cancer patients and their families in reducing the anxiety associated with a cancer diagnosis. "Patients who go to support groups report more satisfaction with their lives, their social relationships, and their spirituality," said Timothy Pearman, Ph.D., Clinical Assistant Professor of Psychiatry & Neurology and Director of the Patricia Trost Friedler Cancer Counseling Center. According to Dr. Pearman, focus on the human side of cancer began with the hospice movement in England in the 1970s. This was the first time emphasis was placed on the patient's perspective as he or she went through cancer diagnosis and treatment. As survival statistics started to improve by the late 70s, larger numbers of patients were able to tell others about the anxiety surrounding their experiences. Support groups began as a means of assisting patients in dealing with their anxiety. In the late 1980s, Stanford psychiatrist David Spiegel and colleagues published a study which showed a survival benefit of 18 months in women with metastatic breast cancer who had participated in a support group, compared to those who didn't. "This groundbreaking research sparked a larger interest in the possible benefits of psychological treatment as an adjunctive cancer therapy," said Dr. Pearman. Although Spiegel's study has been replicated several times with no one able to find as strong an impact from support groups, what is clear from the literature, according to Dr. Pearman, is that support groups routinely improve quality of life in a cancer population.

More recent research is focusing on the types of support groups which are most effective (i.e., educational, supportive, combination, telephone groups, etc.), and which patients (i.e., diagnosis, age, sex, stage of cancer, etc.) benefit most from which types of groups. In the meantime, Dr. Pearman feels it's important that those patients who have not yet experienced the support group dynamic know that it could be very beneficial. "Going to these groups reduces the stress of cancer treatment," said Dr. Pearman. "I would encourage all of my patients to give it a try."

The Tulane Cancer Center hosts a variety of support groups, all free and open to persons diagnosed with cancer, their loved ones and caregivers, regardless of where the patient receives his or her primary medical treatment. Support group meetings are generally held in room PS-13 of the Tulane Cancer Center Comprehensive Clinic, 150 S. Liberty St. In addition to patient-oriented support groups, Tulane also offers support group therapy to interested personnel:
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Office of Clinical Research
"GET" Study Examines Pre-Surgical Chemotherapy for Breast Cancer
Patients with locally advanced breast cancer may be eligible to participate in a clinical study which seeks to determine whether a new combination of three chemotherapeutic agents -- Gemcitabine, Epirubicin, and Taxol(R) (GET) -- are effective in shrinking tumors prior to surgery. "Each of these agents has been used individually to treat breast cancer," said Melissa Brammer, M.D., Assistant Professor of Medicine and one of the investigators enrolling patients in this study at Tulane Cancer Center. "This trial seeks to determine whether the novel combination of the three can be more effective." In other clinical studies of neo-adjuvant therapies, or chemotherapy prior to surgery, some patients responded very well. "Some had non-detectable tumors at surgery," said Dr. Brammer. "This study seeks to determine on a molecular level why some tumors respond better to systemic chemotherapy and to determine if this response can be predicted prior to treatment." Therefore, patients enrolling in the study will agree to provide biopsy specimens of their tumors by core or incisional biopsy prior to beginning the chemo treatments. A similar gene analysis will be made of tumorous tissue removed during surgery, and the two samples will then be compared. Shrinking the tumor prior to surgery also provides better opportunity for breast conservation, a choice patients with locally advanced disease haven't historically had. "If the patient responds well and the tumor shrinks, we may be able to provide that alternative," said Dr. Brammer.

Patients who enroll in the study will receive four to six 21-day cycles of pre-surgical GET chemotherapy, depending upon response. Participants must have a histologically confirmed diagnosis of invasive breast cancer without evidence of metastasis and measurable tumors which can be monitored for change by physical exam, mammography, sonogram, CT scan, MRI, and X-ray. Participants must also have normal kidney, cardiac, and hematologic function. Patients who have an active infection, are pregnant, have cancer in both breasts, have received prior therapy for breast cancer, or have active cardiac disease cannot participate in this trial.

Detailed information on the "GET" study at http://www.canceriscurable.com/protocols/get.html
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A Message from the Director
Roy S. Weiner, M.D.
Director of the Tulane Cancer Center
Progress on all fronts. I am pleased to report that the Tulane Cancer Center has made significant progress in each of our missions.

In the clinic, we have inaugurated this region's most advanced radiation therapy program, pushing the frontiers of Intensity Modulated Radiation Therapy (IMRT). IMRT is based on sophisticated physics and high-tech delivery equipment which permits the radiation oncologist to deliver higher, more effective doses to the tumor while protecting the surrounding normal tissue from injury. Drs. Ellen Zakris and Lucien Nedzi are expert physicians in the application of IMRT and will be adapting the technique to treat brain, head and neck, prostate, liver, lung, and breast cancers. The new uses of IMRT depend on the expertise of our team of physicists. Robert Sanford, Ph.D., and Scott Alleman, M.S., bring to Tulane the experience and expertise in radiation physics that permit us to "push the envelope" of better care. Congratulations to our Radiation Oncology team, and thanks to Mr. Jim Montgomery, Tulane University Hospital and Clinic's CEO, for his support of IMRT at the Tulane Cancer Center Comprehensive Clinic. Our clinical activity encompasses the Medical Center of Louisiana in New Orleans (Charity Hospital), where Melissa Brammer, M.D., in partnership with LSU's Mary Abell, M.D., has inaugurated a new comprehensive breast care center. Tulane's multidisciplinary model of breast cancer care has been adopted by Charity Hospital. Charity has also taken breast cancer diagnosis to the next level by inaugurating digital mammography, with its greater sensitivity and increased capacity to screen more women. The Komen Foundation has demonstrated its confidence in Drs. Brammer and Abell by awarding an initial grant of $150,000 to fund case managers and just recently awarded a second grant of $88,000 to expand the program to include psychosocial counseling, physical therapy, and new ultrasound equipment to facilitate minimally invasive biopsies. Congratulations to Melissa and Mary and congratulations to Dr. Dwayne Thomas, Charity's CEO, for his vision and his support.

Dr. Tim Pearman of Tulane's Friedler Cancer Counseling Center has done a magnificent job in expanding our psychosocial support services. You will read in this issue how support groups help patients live life to the fullest after diagnosis of and treatment for cancer. Psychosocial rehabilitation is as important as physical rehabilitation. All support services, including individual, couple, and family therapy, are free, and open to persons diagnosed with cancer, their loved ones and friends, regardless of where the patient receives his or her primary medical treatment.

Our clinical research mission is enhanced by new clinical studies initiated by our faculty. In addition to the innovative studies in stem cell transplantation, we have opened recently a study [BA-002] for advanced gastrointestinal cancers and genitourinary cancers. We are pleased as well to participate in a landmark study [NSABP#FG-GE-001 ("GET")] sponsored by the National Cancer Institute through the National Surgical Adjuvant Breast Program for locally advanced breast cancers. This study uses the latest technology in gene array to characterize the mechanisms by which some breast cancers may be resistant to chemotherapy. The technology is exciting and the information it will provide may well revolutionize how we select treatment for individual patients.

Our basic research programs are gaining more national prominence and are expanding in a very competitive environment. Drs. Erik Flemington, Frank Jones, Matt Burow, and Weiping Zou all were notified recently that they won new federal grant support for their cancer research. Dr. Abdel-Mageed's research in prostate cancer is highlighted in this issue. He is probing the molecular basis of the more aggressive biology of prostate cancer in African-American men. In a future issue, we will feature the many areas in which the faculty of Tulane Cancer Center enrich the educational environment for medical students, graduate students, and post-doctoral fellows.

I hope you find this issue of Inside Tulane Cancer Center interesting and informative. Melanie Cross has done a great job. As always, we welcome your feedback and especially your interest in specific items for future issues.
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Inside the Tulane Cancer Center is a quarterly publication of the Tulane Cancer Center, Tulane University Health Sciences Center, New Orleans.
Executive Editor: Roy S. Weiner, M.D., Editor: Melanie N. Cross, Art Director: Kathy O. Barbazon

Address inquiries regarding this newsletter to: Melanie N. Cross
(504) 988-6592, fax (504) 988-6077, mcross@tulane.edu

To inquire about cancer research and treatment programs at Tulane
please call one of these toll-free numbers:
(800) 588-5300 (Physicians) 24 hours a day
(800) 588-5800 (Patients and others) 8:00 am to 8:00 pm US Central Time
Tulane University Hospital & Clinic (http://www.tulanehospital.com)

Tulane Cancer Center
http://www.som.tulane.edu/cancer or http://www.canceriscurable.com
Box SL-68, 1430 Tulane Ave., New Orleans, Louisiana 70122-2699
(504) 988-6060, fax (504) 988-6077
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