Leonard Turner Has Brain Cancer. Will a New Treatment Save Him?
Leonard Turner sits in a hospital room with walls decorated in cheery shades of pink and blue, a pair of new yellow socks on his feet. But the bright colors do little to lighten his mood. Today, Leonard, 8, will undergo his third operation at Chicago's Children's Memorial Hospital to remove an intractably recurring malignant tumor on the back of his brain. He knows what to expect—and what to dread, like the insertion of the IV tube. "Do they have to stick me again?" he asks his mother. "Do they have to poke me?"
His plea is a familiar one to doctors who treat the 2,500 kids diagnosed each year with brain tumors, the leading cause of childhood deaths from cancer. Nothing is more heartbreaking than to see a child stricken with such an excruciating terminal illness. But an end to the suffering may be in sight, thanks to the Intrabeam, a pioneering device designed to deliver radiation to pediatric brain tumors more safely and effectively than with traditional methods. Although clinical trials are still in the early stages, initial results are promising. Eleven children with Leonard's type of tumor—a particularly aggressive form of brain cancer called an ependymoma—have undergone Intrabeam radiation thus far; three have experienced a recurrence, including two patients who have since died. "I think Intrabeam can be a tool in a cure," says one of Leonard's physicians, Dr. Stewart Goldman, 44, medical director of neurooncology at Children's Memorial's Brain Tumor Center.
At the moment, Intrabeam is the last best hope for patients like Leonard, whose condition has no cure. Only a third of all ependymoma patients who have a recurrence survive—and Leonard's tumor has come back twice. "I feel we are blessed," says his father, Leonard St., "that they came up with something new to try out for him."
A similar technology was first tested at Boston's Massachusetts General Hospital in the late '90s, where it was used on adults in an attempt to control metastatic cancers that had spread from other parts of the body. The device did not destroy adult malignant brain tumors, but is hoped to be more successful in children, because most pediatric brain tumors come back at the same site—and the Intrabeam delivers concentrated treatment to that site, sparing normal tissue. And so a handful of doctors—including Goldman and Leonard's surgeon, Dr. Tadanori Tomita, 57, director of the Falk Brain Tumor Center—began employing the machine in their most challenging pediatric cases.
Until then, doctors typically tackled brain tumors in kids with external beam radiation or a Gamma Knife, which zaps radiation through the brain. This approach is effective in destroying cancer cells—but also wipes out healthy brain tissue, leaving doctors to "worry about what we're doing to patients' intelligence," Gold-man says. "Will these patients be able to live on their own? What about their ability to go to school and get married?" As Dr. Mary Anne Marymont, the hospital's director of pediatric radiation, puts it, "Normal radiation is like a big linebacker. It's real strong but not too smart."
The Intrabeam, on the other hand, allows doctors to restrict radiation to the area immediately around a brain tumor (see box). What doctors don't yet know is whether the localized approach of the Intrabeam is enough to wipe out all the cancer cells in a patient's brain. One encouraging case is that of Stephanie Flood, 16, who was diagnosed with an ependymoma in the fourth grade. She underwent surgery as well as chemotherapy and radiation at Children's Memorial, only to have the tumor return four times. In January 2002 Flood became the fourth patient at Children's Memorial to undergo Intrabeam treatment for pediatric brain tumors; 18 months later her brain scans show she is cancer-free. "I was excited to pioneer the Intrabeam and see how it would go," says Flood, a high school junior who has testified before a Congressional committee on pediatric-research funding.
The Turners hope Leonard will be as lucky. The youngest of four children, he was only 13 months old when his parents noticed something wrong. "Usually babies in a walker reach for everything," Leonard Sr. says. "He wouldn't move, and he started to cry a lot." During a trip to Children's Memorial, doctors found a tumor the size of a lemon on the back of Leonard's brain.
After surgery and four months of chemotherapy, he spent five years in remission. Then in September 2001, an MRI revealed that the tumor had grown back—and was now the size of an orange. Doctors cut it out, only to have it return 16 months later. Tomita, Goldman and others felt the Intrabeam provided the best hope for treatment.
And so, on Jan. 14 the Turners once again made the 90-minute rush-hour drive from their Joliet, Ill., home to Children's Memorial. After Leonard's tumor was cut out, doctors fit the Intrabeam with a head three centimeters in diameter and spent 27 minutes zapping Leonard with 1,000 rads of radiation (the same amount typically delivered by the more conventional forms of radiation). All told, Leonard was in the operating room less than three hours.
Unfortunately, his recovery took a bit longer. Over the next months Leonard was hospitalized seven times for repeated vomiting and dehydration. Doctors installed a shunt to relieve pressure from built-up spinal fluid, and Leonard began to recover. His mother, Angela, 39, took time off from her teaching job during each hospitalization ("I would hate for Leonard to wake up and be afraid," she says), soothing her son by rubbing baby oil on his legs. Meanwhile Leonard Sr., 38, a home building inspector, did the housework with the help of sons Jesse, 17, and Brenton, 14, both students (oldest child Tessah, 22, lives in Massachusetts). "They make sure clothes are washed and the house is in order as best they can," Angela says. "That and prayers is the only way I can do this."
By May, Leonard was feeling well enough to take a Make-a-Wish Foundation-sponsored trip to Disney World. "We had a Jacuzzi in our room and two TVs!" he says. Later that month, he returned to first grade at Joliet's Dirksen Elementary School, where he wasted no time reacquainting himself with his classmates. During a relay race in gym class, "I heard him say to the boy he was racing, 'Watch out,'" says his teacher Rachel Kascher. "'I'm going to wash the floor with you.'"
Now, like any healthy boy, Leonard enjoys wrestling with his brothers, and his renewed appetite for life is matched only by his yen for hot dogs, spaghetti and other old favorites. "He eats all the time," says Angela, adding happily, "His pants are getting too short and he has gone from a size 1 to a size-2 shoe in just a month!" Leonard's inner life has grown too. "His spirit," she says, "is wonderful."
Giovanna Breu in Chicago
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