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The spark of a cancer revolution

How do you figure out how to battle cancer? Sometimes a single, tiny patient sparks a revolution. That's what happened at Stanford in the early 1970s, when the recipe for a breakthrough was one very sick toddler, two worried doctors and a new idea that paid off big.

For kids with cancer, "our goal today is to cure without late effects," says Sarah Donaldson, MD, a physician at Lucile Packard Children's Hospital and professor of Radiation Oncology. That means achieving cures without strings attached - cures without long-term health problems caused by the treatment itself.

When Donaldson was training as a radiation oncologist four decades ago, the idea of a no-strings cure for pediatric cancer was a distant dream. Physicians had barely begun to figure out how to pull pediatric cancer patients back from the brink of death.

Working with Stanford cancer pioneer Henry Kaplan, MD, Donaldson observed the price of cure in the first teenage and young adult survivors of Hodgkin's lymphoma. The large doses of radiation that had cured these patients also impaired their endocrine function, linear growth and development.

Then, an unusual new case gave Kaplan and Donaldson more to worry about. An 18-month-old - far younger than most Hodgkin's patients and therefore more vulnerable to radiation's aftereffects - came from Brazil to be treated by the Stanford team.

"I looked at this baby from Brazil and said, 'Dr. Kaplan, how are we going to treat him?'" Donaldson recalls. She couldn't imagine using the high-dose, extended-field radiation therapy that was then standard on the youngster. "He said, 'Well, Sarah, maybe we can think of something novel.'"

The approach they tried - a much-lowered radiation dose combined with experimental chemotherapy - was so successful that they soon carried out a clinical trial for it. Their attempt to protect patients' growth and development worked even better than they hoped: It also increased cure rates.

The drive for cures continued after Packard Children's opened in 1991, with Donaldson and her colleagues making many more contributions to the long-term well-being of young cancer patients. A 1997 multi-center trial showed that standard chemotherapy for most children with early-stage non-Hodgkin's lymphoma could safely be reduced, for instance.

Today, the Packard Children's pediatric oncology team cares for kids at the hospital's state-of-the-art Bass Center for Childhood Cancer and Blood Diseases, providing treatment that is a far cry from the guesswork of the early days.

But, for Donaldson, one thing has stayed the same: The thrill of getting it right for her patients hasn't lessened a bit.

Remembering that first success inspired by the baby from Brazil, she said: "It lit up the whole world."

This month marks the 20th anniversary of Lucile Packard Children's Hospital, which opened its doors on June 10, 1991. Each Friday in June, we'll take a look at the hospital's first two decades.

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