Barnes-Jewish Hospital | Washington University Physicians
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SITEMAN CANCER CENTER AT 20: A RETROSPECTIVE

BY PAM MCGRATH
IMAGES COURTESY OF WASHINGTON UNIVERSITY SCHOOL OF MEDICINE AND SITEMAN CANCER CENTER

When Barnes-Jewish Hospital and Washington University School of Medicine established the Alvin J. Siteman Cancer Center in 1999, the partnering institutions already shared a decades-long history of advancing cancer research and treatment. In 1984, the hospital and medical school had established an affiliation agreement that led to the following oncology milestones:

  • A research study that was the first to link smoking to lung cancer (1950) and one that established prostate-specific antigen (PSA) as a viable screening test for prostate cancer (1991)
  • The invention of positron emission tomography (PET) imaging technology (1972) and contributions to the development of the first computerized tomography (CT) scanner prototype (1974)
  • Development of a genetic screening test that detects a rare form of thyroid cancer in its preclinical state in children predisposed to the disease, thus allowing these young patients the chance to undergo surgery to prevent cancer (1994)

Covid Response
IN 1950, ADELE CRONINGER, ERNEST WYNDER, MD, AND SURGERY CHAIRMAN EVARTS GRAHAM, MD, PARTICIPATED IN A STUDY THAT LINKED SMOKING TO LUNG CANCER.

By the 1990s, both institutions were ready to expand their capacity to treat people with cancer and advance the university’s cancer-research programs. A $35 million gift from St. Louisans Alvin J. and Ruth Siteman provided the initial funding for what was envisioned as a world-class cancer center.

By 2001, Siteman had met the rigorous, peer-reviewed research standards required to be named a National Cancer Institute (NCI)-designated cancer center. In 2004, Siteman achieved NCI Comprehensive Cancer Center status, a recognition of the center’s leadership, resources and expertise in researching better ways to prevent, diagnose and treat cancer.

These NCI designations soon aided researchers in their quests to secure funding for potentially lifesaving studies and clinical trials, and the research program at Siteman became even more robust. Reaching this milestone meant the center was able to honor its mission to prevent cancer in the community and transform patient care through scientific discovery.

A commitment to all

While some cancer centers specialize in treating specific types of cancer, Siteman’s goal from the outset was to treat all forms of cancer. Toward that end, it developed multidisciplinary programs for all of the major diseases, each staffed with oncologists, nurses and other caregivers who specialize in specific cancers. Each center was designed to provide medical therapy, radiation therapy and surgery, all aimed at meeting the specific needs of individuals. And in a time of rapidly advancing cancer treatment, each center was committed to offering the most current and effective care possible.

Parkview Tower
IN 2018, SITEMAN BEGAN CARING FOR PATIENTS IN ITS NEW PARKVIEW TOWER.

Advances in medical therapy

Chemotherapy, often only associated with intravenous or systemic cancer treatment, actually includes all drugs a person takes to fight cancer. In addition to medications taken orally, applied topically or delivered systemically, today’s chemotherapy options include:

  • Immunotherapy (or biologics): boosting the body’s natural defenses to fight cancer
  • Targeted therapy: using drugs to target a cancer’s specific genes, proteins or tissues

Since its inception, Siteman or one of its parent institutions has participated in, and led, many of the advances that have occurred in medical therapy for cancer. From 1982 to today, Siteman has been home to a program for bone marrow and stem cell transplant that performs 400 such transplants a year, for a total of more than 7,500 to date. Washington University oncology researchers at Siteman are using today’s new understanding of DNA to create personalized cancer vaccines that can boost a person’s immunity to cancer cells. And people receiving treatment at the center have access to a variety of clinical trials, including one that currently is looking at a vaccine to slow the progress of metastatic breast cancer.

Advances in radiation therapy

Since Siteman was founded, the field of radiation oncology has seen significant advances in technology and in its ability to support other treatments in addition to serving as a primary treatment option. The team of oncology specialists at Siteman has been instrumental in moving this field forward.

immunotherapy
RESEARCH AT SITEMAN INCLUDES A STUDY OF A MELANOMA VACCINE.

In 1998, Washington University School of Medicine oncologists and neurosurgeons were the first in Missouri to use Gamma Knife radiosurgery to treat cancer. Not really a knife at all but a form of treatment that delivers about 200 tiny beams of radiation to a tumor, this procedure damages cancer cells with minimal harm to nearby cells. And Siteman radiation oncologists were instrumental in developing the first big bore CT scanner, which uses immobilization devices to ensure the patient is as still as possible during the procedure, thus delivering even more precise treatment. Today, this device is the de facto standard for specific kinds of imaging and treatment delivery.

In 2013, Siteman specialists treated the first patient with the world’s first compact proton therapy system — compact because what had once been an expansive and expensive system requiring significant square footage was reduced to fit into a single room. Proton therapy uses high-energybeams to treat cancer and is especially effective for childrenand for people with tumors in sensitive areas such as the eyes, brain and spinal cord. In early 2020, Siteman will have in place a second proton system that uses pencil-beamscanning to deliver a beam that is just millimeters wide, the most precise currently available.

In 2014, a patient at Siteman received the world’s first MRI-guided radiation therapy for cancer. MRI technology, or magnetic resonance imaging, allows a practitioner to visualize the tumor and precisely guide the radiation beam, thus protecting nearby healthy tissue.

Advances in cancer surgery

In 1998, a Washington University neurosurgeon was the first in the world to use magnetic fields to precisely maneuver the surgical tools used during brain surgery, a technology called magnetic stereotaxis. Since then, the center has used this and other advances to go beyond standard open surgery. (Open surgery allows the surgeon to see the tumor and surrounding tissue; the size of incision, however, can lengthen recovery time and incur other risks.) Today, many people with cancer are treated with laparoscopic surgeries: small incisions through which a surgeon can insert a camera and instruments that are manipulated using robotics. The result is a procedure that benefits the patient while offering the surgeon precision, flexibility and control.

In 2014, a Washington University surgeon at Siteman was the first to use high-tech investigational glasses developed at the university to help visualize cancer cells, which glow blue when viewed through the eyewear. The goggle system was designed to help ensure no stray tumor cells are left behind during surgery.

Discovering the future of cancer care

In 2008, a team of scientists at what is now The Elizabeth H. and James S. McDonnell III Genome Institute at Washington University was the first to decode a cancer patient’s genes, finding a suite of mutations that might have caused the disease or aided its progression. The team believes that the project can lead to new therapies and that doctors, when armed with a genetic picture of a person’s cancer, can make more informed choices among existing treatments.

Proton Therapy Center
A PATIENT RECEIVES PROTON THERAPY TREATMENT AT SITEMAN’S S. LEE KLING PROTON THERAPY CENTER.

In a 2017 clinical trial at Siteman, Washington University researchers found that 80% of people with an aggressive form of lymphoma, who had not responded to standard therapies, went into remission after receiving CAR-T cell immunotherapy. Now approved by the Food and Drug Administration to treat certain types of advanced non-Hodgkin lymphoma, CAR-T therapy initially was available at just a few centers in the U.S., including Siteman.

Another study, in 2018, tested the effectiveness of a vaccine to treat glioblastomas and found that it allowed some patients to “live significantly longer”— up to seven years longer — than others diagnosed with this type of brain cancer. In the study, researchers developed a personalized vaccine for each participant by combining pieces of tumor with cells from the patient’s immune system. This process “trains” the immune cells to identify and attack cancer when they are reintroduced to the patient’s body in the form of a vaccine.

Expanding the reach

In 2019, Siteman Cancer Center is one of the five largest centers in the U.S., treating more than 50,000 people each year, including 12,000 newly diagnosed patients, at six locations in the St. Louis area. In addition, Siteman is a partner with St. Louis Children’s Hospital, treating young patients through a program called Siteman Kids at St. Louis Children’s Hospital. And this year, Siteman and Washington University School of Medicine announced their collaboration with a China-based organization to help train physicians and design a new medical center in Suzhou, China.

A commitment to prevention

In addition to treating cancer, Siteman remains focused on cancer prevention. People visiting the center’s website, siteman.wustl.edu, can assess their risk for cancer and learn about ways to diminish that risk. Graham Colditz, MD, DrPH, director of the Division of Public Health Sciences at Washington University School of Medicine, published a paper in 2012 arguing that half of all cancer cases can be prevented. Today, Colditz, who also is associate director of prevention and control at Siteman, continues to study the links between cancer and alcohol use, diet, exercise and other factors.

Learn more about cancer care and prevention: siteman.wustl.edu

Learn more about immunotherapy: outlook.wustl.edu/the-warrior-within


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