Chapter 07: Research on Brain Necrosis and Work in Neuro-Pediatrics
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Description
Dr. Leeds begins this chapter with the statement that his “real contribution” was in studying the impact of cancer therapy on brain necrosis and its effects on brain tissue. He gives the example of a twenty-two year old patient who died from treatment induced brain necrosis.
Dr. Leeds then comments on how work of this kind demonstrates the value of specialty hospitals that bring together people, teams, and materials. He then talks about the impact of Dr. Raymond Sawaya, chair of Neuro-Surgery.
Dr. Leeds then talks briefly about the difficulty of treating brain cancers, particularly glioblastoma, the successes that have been achieved.
Next, Dr. Leeds turns to his work in neuro-pediatrics. He summarizes his professional path to neuroradiology then explains that he met Dr. Kenneth Schulman who asked him to come to University of Pennsylvania Children’s Hospital [CHOP]. Dr. Leeds explains how children’s cancers differ from those seen in adults, a subject he has investigated. He notes that he helped create a strong pediatric neurology program at CHOP, one that eventually became a leading program in the nation. He notes that MD Anderson’s pediatric neuro-oncology program became stronger over time.
Identifier
LeedsNE_02_20170620_C07
Publication Date
6-20-2017
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - The Researcher; The Researcher; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Discovery and Success; Patients; Patients, Treatment, Survivors; Cancer and Disease; Multi-disciplinary Approaches; Overview; Definitions, Explanations, Translations; Education; On Education; Research
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
T.A. Rosolowski, Ph.D.:
Well, let me ask you. I mean, we—I’d like to talk more about the evolution of that team in the department, but I don’t want to derail you from talking about your research. Which would you like to continue with right now?
Norman Leeds, MD:
Well, I’ve literally... (laughs) The only thing we’ve done is, you know, we’ve also written, and one of the things that we’ve really contributed is on necrosis of the brain from treatment, whether it’s chemotherapy or radiation. And I think we have probably one of the best articles, by the number of citations, on that subject. So that I accomplished because I was here, and we had all that material, and we utilized it. T.A. Rosolowski, Ph.D. So this was something—were you using samples from the tumor bank, and—or...?
Norman Leeds, MD:
No, no, from our—you know, from the clinical experience. We had, you know—we had an excellent neurooncology team, and in the radiation, and working together with Victor Levin [MD] and the radiotherapist, Moshe Maor [MD], we were able to better evaluate the treatment effects on tumor. T.A. Rosolowski, Ph.D. So this—so the necrosis was something that had been observed for quite a while, or you had observed it?
Norman Leeds, MD:
Quite a while. But no one realized that necrosis kills. T.A. Rosolowski, Ph.D. Oh. Oh, you mean it has an effect on surrounding tissue.
Norman Leeds, MD:
Yes, it has a... Well, it destroys the brain. And we actually had an autopsy on one of our tumor cases, a 22-year-old, and there was—his brain was damaged diffusely, and there was no, N-O, no tumor at autopsy. It was all treatment effect. So we pointed out tumors kill, which everyone knows, but that sometimes treatment is an offender. So I think—I would say, you know, I didn’t—that was probably one of the significant things, because we have the [material]. Again, that didn’t come because we’re smart, but because we had the volume of material, and putting everything together, and having that team. And I underlined that. I think that’s what reinforces the value of places like MD Anderson, specialty hospitals, which are devoted, in which the pathologists are devoted to cancer, and have seen all variants. And that’s what I think, and why I believe our breast cancer did those great results on patients from elsewhere, that had been at outstanding places that were unable to act as well... So we have the advantage of not only the people but the team and the material. I think you—you know, no matter how good you are, it’s the material. And Dr. Sawaya is obviously one of the neurooncological [neurosurgeons]—and developed—helped develop with us—you know, neurooncological neurosurgery is now a big fellowship here. I mean, it used to be where the neurosurgeons would allow the juniors to do the brain tumors, because they were going to die anyway. Well, you know, if you can’t do anything, it’s a way to train people, but now we can do something. I mean, the quality of life is improving. The—I mean, yeah, glioblastoma is still the smartest brain tumor, and probably the smartest tumor. It understands the treatments, and avoids them. And— T.A. Rosolowski, Ph.D. So how—what does that mean? You know, tell me, how does it avoid them?
Norman Leeds, MD:
I don’t know how it—but it develops defenses against [therapies]. That’s why they have checkpoint inhibitors, and other activities to try to change this with the new immune therapies. But so far we have not—I must tell you, I think we’ve improved the length of life. They used to live six months to a year. Now, patients live two to three years. But we used to have a tumor conference, which we shared with UCSF, which the patients came back—it was just for the patients to understand brain tumors and therapy. And one patient asked, “Why don’t we live longer than three years?” Well, three years is a long time in glioblastoma, because I remember when I was a resident at the neurological institute, which was one of the best places in the world at that time, you know, it was six months to a year, a year and a half. Now it’s up to three to four years in cases, because of improved neurosurgery, improved chemotherapy, and improved radiation, the combinations have... But still, that’s why they now have a Moon Shot Program on glioblastoma, because over the years the length of survival has not really, looking at the curves, the Kaplan-Meier survival curves have not significantly changed. They are living longer, but it’s not... So that’s why it was put forth was to see if we could improve the results. Yeah, things—I mean, if you look to what it was when I got here, survival has increased, I mean, because of all the efforts, but it still, when it comes to glioblastoma, is dismal. T.A. Rosolowski, Ph.D. What was the time period in which you were doing the work on the necrosis?
Norman Leeds, MD:
That we... I think I started that in... Let’s see, I got here in ’91. We published the paper in 2000. I think by 1994, 1995 we started to really work on this, and accumulate the cases, and evaluate the findings. And with the help of Dr. Fuller, the neurooncologist, we were able to do the—put the materials together. T.A. Rosolowski, Ph.D. Now, I wanted to ask you: last time we spoke you mentioned that you were the first pediatric neuroradiologist.
Norman Leeds, MD:
Well, yeah. T.A. Rosolowski, Ph.D. Tell me about that. (laughter)
Norman Leeds, MD:
Well, that was easy, because I trained at the Neurological Institute, and I was actually the first NIH fellow in neuroradiology, which started under Dr. Juan Taveras, who was my—the head of neuroradiology at Columbia Presbyterian. And we had an outstanding pediatric neurology program at the Neurological Institute. And I left Columbia and took my first position as the Head of Neuroradiology at the University of Southern California, and I was at the Los Angeles County General Hospital, which was a major teaching hospital for that hospital, and was an outstanding place. The only problem was it was too nice. People used to escape. You know, there was sunshine and the sea. And so I moved east, because it wasn’t as academic as, I guess, I was at that time. And I went to the Graduate Hospital of the University of Pennsylvania, which wasn’t as busy but was right next door to the Children’s Hospital of Philadelphia. So I always had an interest in pediatrics because of my experience at the Pediatric Hospital connected to Columbia, and my colleague, Dr. Kenneth Shulman, who I had been a co-resident with, who in—he was in neurosurgery; I was in neuroradiology—came to Philadelphia, and he asked me if I would come to Children’s to help with the neuroradiology. Up until that time, I don’t believe there were any neuroradiologists in pediatrics. Yes, we did it at Columbia, but we—you know. And so I learned a great deal, because we had a very large neurosurgical program, and it was outstanding, so I was lucky. And— T.A. Rosolowski, Ph.D. Let me ask you—I mean, this is obviously a very naïve question, but why were children of such a special interest? What are the particular challenges that they present? How is it different?
Norman Leeds, MD:
It’s... (laughs) That’s easy: because, one, you know, one doesn’t like to see children suffer. Children’s tumors are definitely different than adult. They are very different. And in evaluating a patient, the age is critical. And some pediatric tumors—and we’ve written on this—disappear. If you... I mean, you just take a piece out, and even if you leave it sometimes they go away. They just, you know... Children, you know, no one wants to see suffer. So pediatrics is very interesting. And, again, I was helped, because not only did I have Ken Shulman [MD], but we got one of the outstanding pediatric neuropathologists, who is still alive in Philadelphia, named Lucy Rorke [MD; Lucy B. Rorke-Adams], and she’s still at the Children’s Hospital— T.A. Rosolowski, Ph.D. I’m sorry, her last name?
Norman Leeds, MD:
Rorke, R-O-A-R-K [sic], I believe. Lucy Rorke. She’s one of the outstanding pediatric neuropathologists. So I was lucky. We had Ken Shulman. We had Lucy Rorke. And we actually had good pediatric neurology at the Children’s Hospital. So I had a wonderful five years there, and helped build the program, and start, and today it’s one of the leading centers, and I’m very proud of being at CHOP [ ]. Children’s Hospital of Philadelphia is one of the [best]. And I see all the wonderful things they’re still doing that are just tremendous. It was always... I had the privilege of working there, and consider myself lucky. You know, it’s good to be at the beginning, when there are [many] opportunities, and I guess I seized that one at Children’s, and really learned pediatric neuroradiology. T.A. Rosolowski, Ph.D. And obviously, you know, brought that knowledge to MD Anderson. What was the situation with pediatric neuroradiology when you came here?
Norman Leeds, MD:
I don’t know. It was OK. But I guess we improved on it, and worked on it. And I—we got good pediatric neurosurgery going, and it’s a love of mine, because it was—I was there at the beginning of it. Well, most of it. So I was, you know, fortunate to have gone into the specialty before it was a specialty. It was while I was a fellow that the Society was formed, the American Society of Neuroradiology. And having been there at the beginning, and worked with Dr. Taveras, I was fortunate enough to be selected as one of the founding members of the Society, and am now getting to the end, and I’m the last working, living neuroradiologist and [founding member]. But it’s interesting: I told you I had two others who shared an office at the Neurological Institute. They were my teachers, Norman Chase [MD], who later became the Chair of Radiology at NYU, and Gordon Potts [MD], who came over from New Zealand. I told him his English was quite [good]—and he laughed. He said, “No, they think I’m a foreigner. I’m from New Zealand.” And he came from Queens Square to the Neuro Institute. So he was one of my teachers. And he and Norman Chase and I shared an office at the Neuro Institute, and we were all founding members. And Gordon Potts is still alive, but he’s retired. And Norman Chase is still alive, but he’s retired. So I’m the only one [working. The others have died.] T.A. Rosolowski, Ph.D. Late-working member.
Norman Leeds, MD:
—working. And I’m getting close. (laughter)
Recommended Citation
Leeds, Norman MD and Rosolowski, Tacey A. PhD, "Chapter 07: Research on Brain Necrosis and Work in Neuro-Pediatrics" (2017). Interview Chapters. 1307.
https://openworks.mdanderson.org/mchv_interviewchapters/1307
Conditions Governing Access
Open
