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scans. Lauren says she feels lucky. “I’ve been given a second chance,” she says. A longer version of this story originally appeared on MD Anderson’s Cancerwise blog. 44 MD Anderson Cancer Center patients and survivors with various forms of vascular disease. Thoracic surgeons are also part of MD Anderson’s Lung Cancer Moon Shot, a comprehensive program that aims to dramatically reduce lung cancer deaths. Making inoperable surgeries possible Often the recoveries outlined for patients dealing with thoracic cancers can be high-risk and come with long recoveries or uncomfortable side effects. At MD Anderson, we focus on minimizing those and getting our patients back to their everyday lives as quickly as possible. In some cases, our thoracic surgeons even have the expertise necessary to perform surgery on cancers that elsewhere have been deemed inoperable. Take our treatment for early-stage esophageal cancer patients. Until recently, patients with esophageal cancer were treated with esophagectomy, removal of the affected part of the esophagus and surrounding lymph nodes, followed by reconstruction. Barrett’s esophagus with high-grade dysplasia, which carries a substantial risk of progressing to cancer, was treated the same way. However, esophagectomies lead to significant lifestyle changes, including diet limitations and an inability to sleep horizontally. The operation itself can be dangerous for some older patients. At MD Anderson, we’ve incorporated new modalities in the diagnosis, treatment, and prevention of esophageal cancer. Among the new treatments is the use of local therapy administered endoscopically to remove early-stage tumors or dysplastic cells while preserving the esophagus. “Around 2007, we began a program here at MD Anderson of performing local therapy for early esophageal disease,” said Wayne Hofstetter, M.D., a professor and the director of the esophageal surgery program in Thoracic and Cardiovascular Surgery. “We perform ablation for precancerous conditions and endoscopic mucosal resection followed by ablation for early-stage cancers.” Esophageal cancer is known for advancing quickly and silently. Research suggests that this may be because some cases of esophageal cancer that appear to be early stage are actually late stage and advancing through the blood stream. Now Hoftsetter and others are studying early-stage esophageal cancer, in search of genetic mutations that serve as biomarkers of advance disease, as well as looking at how immunotherapy and surgery can be used together to lead to longer survival. The esophageal surgery program has brought focus to first-line strategies in managing esophageal cancer and continues to seek better up-front choices for patients with early disease. “Our first shot at cancer is our best shot,” Hofstetter says. Looking for lung cancer’s Achilles’ heel Thoracic and Cardiovascular Surgery has a robust research program to explore the cellular and molecular mechanisms of thoracic cancers. The translational research done here helps us treat thoracic cancers with a deeper understanding and enables us to bring our patients the latest in treatment. One of its lead scientists and a pioneer in gene therapy is Jack A. Roth, M.D., professor and director of the W.M. Keck Center for Innovative Cancer Therapies at MD Anderson. He was among the first to identify and characterize a number of tumor suppressor genes for lung cancer and discover a way to deliver them to cancer cells using nanoparticles. “I’m constantly looking for the Achilles’ heel of lung cancer,” Roth says. His research focuses on identifying vulnerabilities within lung cancer. Thanks to the MD Anderson Lung Cancer Moon Shot and Lung Cancer SPORE Program, MD Anderson is home to one of six patient-derived xenograft centers. In addition to conducting translation research, our lung cancer surgeons are studying the latest in lung cancer treatment to bring our patients the greatest outcomes. In a randomized clinical trial referred to as Neostar, Boris Sepsis, M.D., is evaluating immune checkpoint inhibitors in patients with operable early-stage non-small cell lung cancer. In this trial, patients receive one or two checkpoint inhibitors before resection. “We believe that checkpoint inhibitors given during the six-week period before tumor resection can induce a major pathological response in a substantial proportion of patients,” Sepsis says. “Moreover, our hope is that this treatment paradigm can train the patient’s immune system to recognize the tumor antigens while the tumor is still present and potentially induce a durable response.” In a similar study refered to as Lonestar, we’re hoping to learn if local consolidation treatments including surgery and/or radiation plus ipilimumab and nivolumab (two types of immunotherapy) is more effective than ipilimumab and nivolumab alone in treating patients with metastatic nonsmall cell lung cancer who have not previously received immunotherapy. Division of Surgery | Surgical Outcomes FY18 45 Volumes Esophageal procedures volume Fiscal Years 2016-2018 189 Open 129 Endoscopic mucosal resection 52 Minimally invasive surgery (MIS) 0 10 20 30 40 50 60 Chest wall resection volumes Fiscal Years 2016-2018 2016 2017 2018 42 53 44 0 50 100 150 200 250 300 2016 102 2017 99 2018 103 Primary lung resection volumes Fiscal Years 2016-
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