Chapter 06 : Early Research that Leveraged the MD Anderson Team Approach
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Description
In this chapter, Dr. Leeds begins to trace the history of the research he conducted at MD Anderson. He begins by talking about his work (1998-2000) on imaging techniques to differentiate brain tumors from trauma and other causes. He discusses three-dimensional imaging and functional imaging and their roles in this process.
Next he talks about a landmark investigation of the use of dynamic contrast enhancement to identify malignant brain tumors. He notes that this technique became a significant factor in brain surgery.
Dr. Leeds next praises the team, multidisciplinary approach that was important to his research advances and which he says makes MD Anderson unique. He talks about the breadth of experience that MD Anderson faculty bring to research teams, the number of cases they have access to.
He briefly speaks about losing his wife to ovarian cancer.
Identifier
LeedsNE_02_20170620_C06
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; Discovery and Success; Understanding Cancer, the History of Science, Cancer Research; Critical Perspectives on MD Anderson; Personal Background; Multi-disciplinary Approaches; Leadership; On Leadership; Overview; Definitions, Explanations, Translations; Technology and R&D
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.:
OK, we are recording, and the day—date is June 20th, 2017, and I’m in the Reading Room of the Historical Resources Center at MD Anderson Cancer Center in Houston, Texas for my second session with Dr. Norman Leeds. So thank you very much for joining me this morning.
Norman Leeds, MD:
Thank you. T.A. Rosolowski, Ph.D. And just for the record, my name is Tacey Ann Rosolowski. So... Oh, and the time is 25 minutes of 10:00. T.A. Rosolowski, Ph.D. So we wanted to start with your research, the arc of your research since you came to MD Anderson. Please tell me about that.
Norman Leeds, MD:
Well, we worked particularly on several things, some of which I supported with my chair funds, a physicist. We worked on looking at diffusion of the spine with MR to evaluate and separate tumors from trauma and other causes, and actually resulted in two papers on the use of MR diffusion of the spine. In addition, we worked on tractography. T.A. Rosolowski, Ph.D. Can I interrupt you just one sec? When did you start doing that work with the MR diffusion in the spine?
Norman Leeds, MD:
Let me think... Probably in—around 1998 to 2000, and then... Then we started to do tractography, which is to define the tracts in the brain with the Physics Department, and— T.A. Rosolowski, Ph.D. What does that mean, “tracts in the brain”?
Norman Leeds, MD:
(laughs) The brain communicates with everything, so therefore there are tracts in the brain— T.A. Rosolowski, Ph.D. Oh, I see. So these are neural tracts.
Norman Leeds, MD:
Neural tracts in the brain, and we identified them, and looked at them, and an excellent paper came out on 3D imaging, which we were able to also perform here with the aid of an excellent researcher to get 3D maps of the tracts of the brain. And this also was presented at national meetings. T.A. Rosolowski, Ph.D. Now, what is the significance of that for neurooncology?
Norman Leeds, MD:
Oh, very significant, because it determines where you can operate, where you can’t operate, where function is. We’re looking about, defining—we do functional imaging, which is where the various centers are: speech, motor, vision, etc. And to identify speech and motor is critical to determine the approach to use for surgery, and areas you probably should avoid, or prepare the neurosurgeon to do an awake craniotomy because of the proximity of the tumor to these important tracts that you don’t want to damage. So we did that. And then, in 1998, one of the significant things we developed, which led to a lot of others following our footsteps, was called—let’s see, what title did I give it? It’s... It is looking at the contrast... DCE, it’s called, dynamic contrast enhancement. And the way it occurred to identify the more malignant tumors within the brain, if you can’t reach the tumor, or take it out, and you want to know its activity, it’s at least the site for the—best site to do a stereoscopic biopsy to find out what you’re dealing with. And dynamic contrast enhancement has become a significant factor in advanced brain tumor imaging, which I’m still doing at MD Anderson. And this we started in 1998, and it is getting better and better, and also has been published. T.A. Rosolowski, Ph.D. So I’m assuming that this is all very reliant on evolving technology.
Norman Leeds, MD:
Yes. T.A. Rosolowski, Ph.D. So can you sketch a little bit about what those advances are that enabled this kind of imaging?
Norman Leeds, MD:
Well, it’s—what it was is we were able to take multiple images in a shorter series of time. In fact, the physicist who worked with me on the project came to us from General Electric, where he had worked on their advanced imaging techniques, so he was really able to optimize these, and he also was able to help and design the diffusion imaging. In addition, to help one of our neurosurgeon researchers, who is now the Head of Research at the Fred Hutchinson Cancer Center, Eric Holland, [MD], who left MD Anderson to go to Memorial, and then to the Hutchinson Cancer Center, he developed—we developed a small [bore magnet with GE], a means to image the mouse. He had developed a mouse tumor [after] he injected a virus [into the brain], and then got, first mouse tumor. We designed a—with General Electric—a small tube, which I demonstrated first with plastic that the mouse would fit in. And so it was made to put the mouse in closer proximity to the MR. And we used that, and that, too, was later published. We also demonstrated that these tumors, for the first time, showed what the human tumor does. It was infiltrating. So we demonstrated this with Eric, and this, too, was published. T.A. Rosolowski, Ph.D. Now, just to make sure I’m clear, is Eric Holland the person from General Electric, or is...?
Norman Leeds, MD:
No, Eric Holland is the neurosurgeon who was at the Fred Hutchinson Cancer Institute. I think he’s the head of the Fred Hutchinson, but he was here. He came here, and he and I worked together, and he was really a PhD neurosurgeon, an excellent neurosurgeon, as well as being a top researcher. And he wrote an excellent paper in which he published that whatever you see in the mouse, you know, and think you’ve got is really not the human. And it’s important to know [this]. But this was the first time, I believe, that we’re able to show not a localized tumor as it metastasized, but an actual infiltrating neoplasm. T.A. Rosolowski, Ph.D. Wow. Do you recall the name of the man from General Electric who helped design this?
Norman Leeds, MD:
Oh, the... No, the... Yes, the one who worked here, that worked with me on several of—on all—almost all these projects, he and I, and I supported his graduate student with my research funds from the Kennedy Chair was Joseph Zhou, Z-H-O-U, PhD, who moved from here to Illinois, University of Illinois. I tried to recruit him at Mount Sinai but wasn’t able to [come]. T.A. Rosolowski, Ph.D. OK. I mean, it sounds like you had a really, you know, tremendous group of people to work with. You were underscoring that last time, too.
Norman Leeds, MD:
Well, I think the important thing—and I think what makes us unique—is the team. I mean, I think we approach brain tumors with a team. It—you know, you need excellent people, but if you don’t have the group doing their function jointly, or responsibly, together, you don’t accomplish. And I think that was one of the reasons we grew. Dr. Sawaya [oral history interview], who is—was and is still—the Chair of Neurosurgery and I worked very closely together. We are very good friends now, as a consequence, and we came together. We both were within two weeks. I came two weeks later than he did. T.A. Rosolowski, Ph.D. You know, I was going to ask you about that, because I happened to be reviewing his transcript just yesterday, and I noticed the date when he came to the institution. And I thought, oh, yeah, that’s really around the same time.
Norman Leeds, MD:
We came together, yes. And we worked [together]. And we still do. We still work together. So we built that relationship, and it became a friendship. T.A. Rosolowski, Ph.D. And he had a very clear vision, because when I was interviewing he said—he pointed behind him to that picture of the tree in his office that showed all of the elements of treatment of brain tumors that went beyond neurosurgery itself to all the other specialties.
Norman Leeds, MD:
Well, you need... Well, that’s—what we’re saying is the—to improve the care—and I think... This is the particular advantage of MD Anderson: everything is centered on cancer. So we have experts in neuropathology, like Dr. Fuller, who’s another friend of mine, and I helped bring Dr. Fuller here. Because I was recruiting someone from Duke, and he said to me they have an excellent fellow in neuropathology, in brain tumors, who’s from Texas and really wanted to go back. So we got Dr. Fuller here, and [he’s great]. T.A. Rosolowski, Ph.D. His first name?
Norman Leeds, MD:
Gregory Fuller [MD]. I think—he said to me he recommended that you interview me early, but he said it must—it took them a while more. But it’s—the team is only as good as the whole. It’s the gestalt: you need all the parts. And we were very fortunate. I think Greg was the last piece to fill the hole. I mean, there were good neuropathologists, but there is no one quite like Greg Fuller. T.A. Rosolowski, Ph.D. What makes him so good?
Norman Leeds, MD:
Well, he’s interested in the whole area. He’s got interested in neuroradiology, and he will, you know, say that you need both to accomplish things, so... T.A. Rosolowski, Ph.D. So I’m kind of getting the impression as you’re talking—and you use the word “unique” and “advantage”—that this team approach you don’t find so strongly expressed at other institutions.
Norman Leeds, MD:
Not at every institution. No, we were very lucky. We all came together. But that’s the advantage of the institution: the neuropathologists... Really, it’s the material. I’ve come to the conclusion that this place is unique because it has a breadth of experience, not just in brain tumors, which—but in other tumors. I mean, I’ve helped two people, including a family member, with breast cancer, which was seen at other—which, unnamed—leading institutions, some of which were misdiagnosed, or not understood. And the interpretations of these clinicians, including breast cancer, were far superior to... Very good. And so we’re not talking about Podunk. We’re talking about elegant institutions. So I think that showed, to me, the advantage of seeing so much. I mean, we have really such a good team, and such a volume of material, that you learn. You learn from your errors. They are not truly errors, but, you know, it’s lack of knowledge. And we’ve built our knowledge base on many, many, many cases. I don’t think there’s another institution that has the number of cases, the number of neurosurgeons, just devoted to brain and spine tumors. So that our group is very experienced, but not just—I mean, when I say this—I just wanted to bring this up—it’s not just that we are leaders in brain tumor, but in all other things, as well. I mean, I was very impressed with the breast [oncologists]. I had nothing to do, I just called on the right clinical people here. And again, like in the neuro field, they are—and we’re talking about outstanding institutions—making significantly different diagnoses, and leading to... Now, are results always good? No. Cancer is a bad thing, and I experienced it. I lost my wife from ovarian cancer. So I am... And this is despite all we know, and she got the best of care here and at Memorial Sloan Kettering. It didn’t help. But I think there are things we can accomplish, and that is because of the team effort.
Recommended Citation
Leeds, Norman MD and Rosolowski, Tacey A. PhD, "Chapter 06 : Early Research that Leveraged the MD Anderson Team Approach" (2017). Interview Chapters. 1306.
https://openworks.mdanderson.org/mchv_interviewchapters/1306
Conditions Governing Access
Open
