Cancer: Turning off the tap
PET therapy
The kindest cut

Clinical update

Cancer: Turning off the tap
In February, the Food and Drug Administration approved the use of Avastin, the first cancer drug that works by blocking the growth of new blood vessels that feed tumors. Children's Hospital Boston cancer researcher Judah Folkman, MD, first proposed the theory behind the drug in 1970. Avastin, along with several other new treatments, significantly improves doctors' ability to treat colon cancer, which afflicts about 150,000 Americans a year. It was approved for use in conjunction with standard chemotherapy for patients with colon cancer that has spread to other parts of the body. In tests that led to its approval, Avastin extended the lives of patients with the deadly cancer by about five months on average. Late-stage clinical tests for the use of Avastin against cancer of the lung, kidney and breast are already underway.

PET therapy

With the addition of a Positron Emission Tomography (PET) scanner, Children's Hospital Boston now has a valuable new weapon in the fight against disease. PET scans show the chemical and physiological changes of disease that often take place before the physical changes, making PET a key tool for early diagnosis and treatment, especially in pinpointing the activity, location and size of cancerous tumors and any distant metastases. It also aids in the diagnosis of epilepsy and cerebrovascular disorders, can monitor therapy efficacy and perform high-resolution skeletal imaging.
"This system will help us determine the most effective and least invasive way to treat our patients," says S. Ted Treves, MD, chief of Children's Division of Nuclear Medicine. "It's going to decrease the time between the identification and treatment of a disease."
Children's is the first hospital in the country to have a PET scanner solely dedicated to pediatric patients and run by a specially trained staff of pediatric physicians, nuclear medicine technologists and nurses.

The kindest cut

Children's Hospital Boston is leading a clinical trial of the "Cutting Balloon" to treat branch pulmonary artery stenosis in children. Some children have dozens of blockages called stenoses—sometimes deep inside their lungs—that obstruct the amount of oxygen flowing to the blood and place high pressures on the heart's right ventricle, potentially leading to heart failure and death. Blockages in the major pulmonary arteries can be fixed surgically, but surgery cannot repair the smaller arteries that branch off inside the lungs without causing extensive lung damage. Balloon angioplasty is the current standard of care, but blockages persist 40 to 60 percent of the time, and the child's only option is a lung or heart-lung transplant.

Donated to Children's by Boston Scientific, Inc., the Cutting Balloon—which is primarily used in adult coronary arteries—has three to four tiny knife blades that create small cuts, spaced evenly around the inside of the vessel wall. These cuts then become controlled tears that allow a second, low pressure balloon to stretch and dilate the vessel.

In the clinical trial, Children's cardiologist Lisa Bergersen, MD, and her colleagues will enroll 50 children who have persistent vessel obstructions after conventional angioplasty to see if the Cutting Balloon provides a better long-term solution.