Treating childhood cancer: 60 years of progress

by Tripp Underwood on September 29, 2011

Jean in 1968

When Jean Shaw first came to Children’s Hospital Boston in 1951, the world was a rapidly changing place. The Korean War was escalating new tensions between America and the Soviet Union, a reactor in Idaho became the world’s first electricity-generating nuclear power source and teenagers everywhere were discovering a new type of music called rock n’ roll.

Fortunately for Jean, the world of medicine was changing as well.

When she arrived in Boston to seek a cure for osteosarcoma, a type of bone cancer that occurs most often in teenagers, the standard treatment was amputation. It was a successful method in the short-term, but over time the cancer came back, often in a more lethal form like lung cancer. Given the severity of the diagnosis, Jean’s mother was frightened. It was a great relief when their doctor, Sydney Farber, MD, said he saw a different treatment option for the young girl.

Sydney Farber, MD

“When the doctor in our home town told my mama I had bone cancer she was terrified, because the doctor said he hadn’t known of any child who survived the disease, even after they had their limb removed,” Jean remembers. “Still, he suggested we go to Children’s Hospital Boston to see if they could help. When we got there Dr. Farber took a look at me and said there may be a different way to treat me.”

She didn’t know it at the time, but Jean was about to become one of the earlier patients to receive a new form of cancer treatment pioneered by Dr. Farber. By incorporating chemotherapy or radiology into treatment— instead of relying solely on surgery— Dr. Farber and his colleagues were able to better treat patients like Jean, both in the short and long-term.

“In the 1940s, when doctors were mainly relying on surgery to remove osteosarcoma, 80 percent of the patients experienced recurrence, and survival rates were low,” says Katherine Janeway, MD, a pediatric oncologist at Dana-Farber/Children’s Hospital Cancer Center. “But when doctors like Sydney Farber started using Methotrexate and other chemotherapy drugs in addition to surgery, they saw cure rates jump to 40 to 50 percent.”

Not content to rest on improved statistics, researchers soon began looking for ways to refine the work of Farber and his peers.

In their search it was discovered that some osteosarcoma cancer cells were developing a resistance to chemotherapy, especially after repeated exposure to the same drug. To counter this defense, researchers developed new treatments that included multiple chemotherapy agents that would strengthen the effectiveness of the therapy and weaken the cancer’s resistance to a single drug; by the early 1980s it had become the gold standard for the medicinal portion of osteosarcoma treatment.

Katherine Janeway, MD

On the surgical side, things were advancing as well. For almost 30 years amputation was the most effective way to remove cancer cells from infected bones or limb tissue, but the process resulted in loss of mobility for some patients and the surgeries were disfiguring.  To avoid this problem, doctors began perfecting a surgical technique known as limb-salvage surgery, where the tumor and some surrounding tissue is removed, but the limb itself is left intact.

“Before the 1980s you still saw a lot of amputations in osteosarcoma survivors, but since then the vast majority of patients are having limb salvaging surgeries,” Janeway says. “It’s been a dramatic shift and has really improved patients’ lives as a result.”

Today, as a result of all these advancements, pediatric osteosarcoma now has a 65 percent cure rate in the United States and survivors are left with fewer negative effects of treatment than in the past. It’s comforting news, but Janeway says there is still work to be done.

“You saw this graded improvement in treatment from the 1950s through the 1980s, but we haven’t seen many advancements since then,” she says. “We’re motivated by that and want to continue to improve on the work that has gotten us this far.”

To do so, Janeway and her colleagues are researching medications designed to compliment chemotherapy treatment, with the hopes of increasing its effectiveness and possibly even reduce the amount of chemotherapy needed in future treatment.

“We’re looking at new approaches to treatment, because increasing the amount of chemotherapy used isn’t a real option,” she says. “By researching new medicines and alternate ways to target and attack osteosarcoma, we’re becoming more specific in our methods.”

Jean today- 60 years after being treated by Dr. Farber

And while osteosarcoma treatment may have come a long way since Jean was a patient, the 75- year-old great-grandmother of three says the fundamentals of recovery haven’t changed much in the six decades since she was a patient at Children’s Hospital Boston.

“In life you only get one chance, so even when things get tough you need to face them head on and do the best with what comes your way,” she says. “We can’t live to fear the unknown, but live to enjoy the moment. At the end of the day that’s all we have. Sick or not, you’ve got to try and focus on what makes you happy.”

 

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