Building Hope: Taking Cancer Care to the Next Level

Baylor Charles A. Sammons Cancer Center at Dallas2008 Annual ReportContentsLetter from the Director .............................................. 1Leadership Changes.................................................. 2The New Cancer Center Unveiled ...................................... 3Profile: Donna BowersBuilding Hope Through Specialized Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Blood and Marrow Transplant Unit UpdateBreast Cancer UpdateBuilding Hope One Patient at a Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Patient Navigation ProgramVirginia R. Cvekto Patient Education CenterPromoting Prevention and Cancer ScreeningsKitchens Lectureship: Music and the MindProfile: Andrew JankeBuilding Hope Through Quality Improvement Efforts. . . . . . . . . . . . . . . . . . . . . 16Commission on Cancer AccreditationCancer Registry UpdateSummary of 2007 Cancer Registry DataPCE: 10-Year Experience with Prostate Brachytherapyat Baylor Sammons Cancer CenterBuilding Hope Through Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Personalized MedicineTherapeutic Cancer VaccinesEarly Detection for Lung CancerAquatic Exercise for Breast Cancer PatientsEarly Detection of Ovarian CancerSite Tumor Conference Case Reports2008 PublicationsBuilding Hope Through Philanthropy .................................. 30$5 Million Gift for Blood Cancer Research2008 Celebrating WomenGift for Imaging Center TechnologyEveryMan Event for Prostate CancerTelephone Directory................................................ 32Location Maps .........................................Inside back coverOn the cover: Rendering of the new 450,000-square-foot outpatient cancer center.Above: Rendering of the Healing Garden atthe new cancer center.Cancer research studies on the campus of Baylor University Medical Center atDallas are conducted through Baylor Research Institute, Mary Crowley MedicalResearch Center, Texas Oncology, and US Oncology. Each reviews, approves,and conducts clinical trials independently. Their clinical trials are listed together,in this publication, for the convenience of patients and physicians.Physicians are members of the medical staff at one of Baylor Health CareSystem’s subsidiary, community, or affiliated medical centers and are neitheremployees nor agents of those medical centers, Baylor University MedicalCenter, or Baylor Health Care System. Copyright © 2009, Baylor Health CareSystem. All rights reserved. DH-BH1000-02/09

Letter from the DirectorThe year 2008 was a turning point for Baylor Sammons Cancer Center. After 3 years of strategic planning, the new cancer centerproject was approved by the Baylor board of trustees. The three-phase, 5-year project will include a new 450,000-square-footoutpatient cancer center, conversion of the Collins building into a dedicated cancer hospital, and renovation of the Sammonsbuilding. All of us are excited about this major expansion of oncology at Baylor Dallas! The project was formally announced inSeptember at a ceremony featuring Governor Rick Perry and Mayor Tom Leppert. In November, we were pleased to welcomeAlan M. Miller, MD, PhD, as the new director of the Sammons Cancer Center and chief of oncology. Dr. Miller was selected forthese positions on the recommendation of a search committee headed by Dr. Pick Scruggs. Dr. Miller is an expert on blood andstem cell regulation. He was the founding director of the bone marrow transplant program at Tulane. He also served as associatesenior vice president for health sciences at Tulane and headed a Louisiana Board of Regents–funded clinical and translationalresearch, education, and commercialization program. The announcement of the new cancer center project and arrival of Dr.Miller ushered in a new era in oncology at Baylor University Medical Center and Baylor Health Care System.Dr. Scruggs announced his retirement in November and will be sorely missed. In addition to directing radiation oncology atBaylor, Pick served as chair of the Cancer Center Medical Committee for 18 years. Fortunately, the medical committee chair hasbeen assumed by Dr. John Preskitt, our longstanding division director of surgical oncology and immediate past president of theBaylor Dallas medical staff.Excellence in patient care, research, and education continues to be our goal. Advances in molecular biology, genetics, and immunologyhave identified new pathways that make targeted therapy to the cancer cell increasingly effective. Oncology has emergedas one of the most exciting fields in medicine, in large part because progress in the basic sciences is being rapidly translated to thebedside and clinic. The result will be improved outcomes for patients. We will bring these new advances to our patients as swiftlyand safely as possible.This is my final director’s letter. It has been a privilege to serve in this position for the past 32 years, and I thank my physiciancolleagues and Baylor staff for their support and encouragement.Sincerely yours,Marvin J. Stone, MD, MACPBuilding Hope: Taking Cancer Care to the Next Level 1

Leadership ChangesAlan M. Miller, MD, PhDAlan M. Miller, MD, PhD, becamedirector of the Baylor Charles A.Sammons Cancer Center and chiefof oncology for Baylor Health CareSystem in November 2008. Beforecoming to Baylor he served as associatesenior vice president for health sciencesat Tulane University Health SciencesCenter and in 2007 as interim seniorvice president for health sciences atTulane University. He is a practicingmedical oncologist and previously servedas director of the bone marrow transplantprogram and vice president and associatedean for clinical affairs at Tulane.Dr. Miller received his PhD in physiologyfrom the Roswell Park Division ofthe State University of New York atBuffalo and his MD from the Universityof Miami. He did his residency in internalmedicine and fellowship in medicaloncology at the University of Florida. Dr.Miller’s research and clinical activity havefocused on blood and stem cell regulation.He has published numerous articlesin peer-reviewed journals on this subject.While at Tulane, Dr. Miller served asprincipal investigator of a LouisianaBoard of Regents–funded clinical andtranslational research, education, andcommercialization program. For 10years he led the National Institutesof Health–funded Tulane SouthwestOncology Group efforts. Dr. Miller hasstrong interests in health care policy andserves on the Association of AmericanMedical Colleges Healthcare AdvisoryPanel and was formerly vice chairman ofthe Louisiana Health Care Commission.“It is an exciting time to be joiningBaylor Sammons Cancer Center,” Dr.Miller stated. “The next few years willsee a tremendous growth in the center’sprograms and facilities. We have atremendous opportunity to build on thefoundation established by Dr. MarvinStone and the leaders of the cancer centerto grow our reputation as a regionaland national destination cancer centerthrough patient care, education, andresearch.”Dr. Alan M. MillerJohn T. Preskitt, MD,FACPJohn T. Preskitt, MD, FACP,was named chair of the SammonsCancer Center MedicalCommittee in September 2008.Dr. Preskitt replaces Robert“Pick” Scruggs, MD, whoretired after serving as chairsince 1990. Dr. Scruggs was a leader at BaylorUniversity Medical Center at Dallas for morethan 30 years, serving as medical director ofradiation oncology and assistant chief of theDepartment of Oncology since 1995, presidentof the medical staff in 2001, and chairman ofthe medical board of Baylor Dallas in 2002.Dr. John T. PreskittDr. Preskitt joined the Baylor Dallas medicalstaff in 1981 after completing his internshipand residency at Baylor Dallas and a surgicaloncology fellowship at M. D. Anderson. He isactive in the teaching of surgical residents andhas served as medical director of surgical oncologyof the Department of Oncology, presidentof the medical staff in 2007, and chairman ofthe medical board of Baylor Dallas in 2008.Dr. Preskitt is a regent of the American Collegeof Surgeons and has served on several committees,including the Executive Committee of theCommission on Cancer.2 Baylor Charles A. Sammons Cancer Center at Dallas

The New Cancer Center UnveiledWith goals of reducing cancer to achronic disease and ultimately finding acure, Baylor University Medical Centerat Dallas announced that it is developingNorth Texas’ first dedicated cancerhospital along with a new outpatientcancer center that will be the largest inNorth Texas. The new 450,000-squarefootcancer center is scheduled to openin 2011. Work on the dedicated cancerhospital will begin in 2010 with completionscheduled for 2013.“When completed in 2013, it will be ourgoal to be a nationally and internationallyrenowned cancer care destination,building on Baylor Dallas’ commitmentto providing advanced cancer treatmentsand leading the charge of improvementin cancer care through research,” saidJoel Allison, president and CEO ofBaylor Health Care System.An aerial view shows the planned location ofthe new 10-story outpatient cancer centeron the south side of the Baylor Dallas campus(at the top of the illustration above). Theexisting Collins building will be renovatedinto a 120-bed inpatient cancer center. Anew circular sky bridge will connect all ofthe buildings housing cancer services.Collins HospitalSammons TowerBuilding Hope: Taking Cancer Care to the Next Level 3

The 120-bed inpatient cancer hospital will be the first in North Texas and only the second in Texas.The outpatient cancer center and inpatientcancer hospital are a $350 millioninvestment.“Baylor Dallas has historically been theleader in cancer care in North Texas,and we feel a great responsibility to offerthe best cancer care in the country,”said John B. McWhorter, the hospital’spresident and senior vice president atBaylor Health Care System. “We wantpeople to be cared for in a compassionatemanner. And we want to continue tobe the destination center for cancer carefor citizens of North Texas.”Based on feedback from patients,families, physicians, and staff, the newcancer center will be a patient-centeredfacility designed to anticipate needsthroughout the continuum of care.Activities of the Virginia R. CvetkoPatient Education Center will be expanded,and additional complementarymedicine programs will be offered,including programs for massage,acupuncture, music, and art.In addition to the comprehensive cancerservices already offered at Baylor Dallas,the outpatient cancer center will offereasy access and convenient parking; acomfortable and calming atmosphere;a new chapel; an urgent care clinicespecially for cancer patients; an outdoorhealing garden providing a peacefulrespite; and a patient navigation program4 Baylor Charles A. Sammons Cancer Center at Dallas

News CoverageThe September 26th announcement of Baylor Dallas’ new cancer facility receivednational attention. Baylor made news across the country, including an appearance onthe big screen in New York City’s Times Square.Dallas Mayor Tom Leppert and Texas Governor Rick Perry were featured speakers atthe announcement. Under the governor’s leadership, voters recently approved a $3billion bond package to establish the Cancer Prevention and Research Institute ofTexas, which will create and expedite innovation in the area of cancer research andprevention. “We’re moving closer to the cure, we’re moving closer to the day whencancer’s deadly role in our society, in our lives, has been eliminated,” Governor Perrystated.to help guide patients through theircancer journey.“We’re entering a new era in cancer careat Baylor Dallas,” said Marvin J. Stone,MD, director of the Baylor Charles A.Sammons Cancer Center. “We’ve madeenormous progress during the past 32years, but now we’re ready to rise tothe next level, paralleling the strikingadvancements we’ve seen in the field,”he said.Baylor conducted a thorough analysis ofnational cancer rates, as well as regionaland local needs, in planning the newcancer center and cancer hospital. InTexas, 97,281 new cancer cases wereprojected to be diagnosed in 2008,according to the Texas Cancer Registry.In Dallas County, 8,451 new cancercases were projected in 2008. Accordingto the American Cancer Society, thelifetime risk of developing cancer is 1 in2 for men and 1 in 3 for women.Announcement of the new cancer center in Times Square, New York City.The new cancer center will allow fora more comprehensive, personalizedmedicine program, including areasof research such as targeted therapy.Targeted therapy allows physicians toanalyze a patient’s genes and determinewhat type of treatment will work best forthat particular patient. The new cancercenter will also allow clinicians to engagein further cancer research, focusing onbreakthroughs that directly affect patients,whether through a more accuratediagnosis or more effective treatment. Inaddition, clinical trial participation willbe expanded beyond the more than 150studies already offered to Baylor patients.Building Hope: Taking Cancer Care to the Next Level 5

Profile: Donna BowersWhen Donna Bowers talks about theplans and vision for the new cancer facilitiesat Baylor University Medical Centerat Dallas, she is not just speaking as thevice president of the oncology programfor Baylor Health Care System. Rather,her words carry a deeper meaning—notonly as a proud, long-time Baylor employee,but as a cancer survivor herself.Like many Baylor employees, Ms.Bowers’ life journey revolves around thehospital. She began her career in themedical records department at BaylorDallas, now known as health informationmanagement (HIM), while still inhigh school. She went on to obtain herbachelor’s degree in health informationmanagement at Texas Woman’s Universitywhile continuing to work full-timeat Baylor. At age 19, while still attendingcollege full-time, she was named eveningmanager for the HIM department.Upon graduation from Texas Woman’sUniversity, she returned to the day shift,taking over HIM responsibilities forthe Baylor Charles A. Sammons CancerCenter, and met her husband, Steven6 Baylor Charles A. Sammons Cancer Center at Dallas

Bowers, MD. After a short stint living in Colorado, the couple moved back toDallas to attend law school at Texas Wesleyan Law School and to begin a family.In 1992, she worked at Baylor Dallas as associate director of HIM and then spent 5years as the director leading the department. In 2001, she moved into administrationat Baylor Dallas. She became vice president of oncology for Baylor Health CareSystem in 2005. She jumped at the chance to oversee the design and building ofthe new cancer facilities at Baylor Dallas and develop the oncology strategy for thesystem, but this was more than a career opportunity—this was a chance to give backin a very personal way.In 1999, during her rise to career success, Ms. Bowers, then 38, director of HIM andmother to 4-year-old Josh and 5-year-old Carli, felt a lump during a breast self-exam.When she didn’t feel any changes after a week, she began rounds of doctor visits. “Iwas told there was a 99% chance it was cancer,” she said. “I told them those weren’tvery good odds, but that is how sure they were. Once my breast cancer diagnosis wasconfirmed, I chose to undergo a mastectomy. I also had 6 months of chemotherapyand radiation and reconstructive surgery.”Ms. Bowers, cancer free for 9 years, looked for a way to give back to those whohelped her during her fight. It came with her chance to help develop the new cancerfacilities at Baylor Dallas and through a system-wide initiative to grow the oncologyservice line. “I knew I could truly understand what a patient needed when they cameinto the organization,” she said. “We did numerous focus groups with patients andtheir families to find out what they wanted, and each time I knew what they said wasright because that is what I would want as a patient. It offered validity—I could feelit too.”“The outpatient center will be 450,000 square feet and definitely designed aroundthe patients and their families,” she said. “We will keep it very beautiful and elegant—a timeless elegance. We also want it light, bringing in as much of the outdoors aswe can.”The new cancer hospital will also have many of the features that patients and theirfamilies want. “We will have bigger patient rooms with more access for familymembers, more eating places, and special places like the healing gardens,” said Ms.Bowers. “We are also focusing more on the caregivers. We become very attached toour patients and it can be an emotionally difficult job. We want to provide a placefor healing, calming, and spirituality for everyone involved in the cancer journey.”“At Baylor Dallas and across the system, we lead the Dallas–Fort Worth area inproviding quality cancer care,” said Ms. Bowers. “I know that as an administrator,but also as a patient. There is no place in the area I would rather be treated for cancerthan at Baylor. We will soon have the physical space to allow us to offer all of theservices our patients trust us to have, including quality and compassionate care,research and clinical trials, education, support, chapel, specialized cancer treatmentprograms, integrated services, specialty boutique, and all other amenities that ourpatients need and want in a beautiful environment focused on the cancer patient andtheir families.”“The oncology service line across Baylor is growing and developing,” she added.“Most Baylor facilities offer cancer care to patients. We are working with each facilityto develop new oncology services as well as expand the quality services currentlyprovided. Cancer touches all of us in some way. Baylor Health Care System is theplace to go for quality, compassionate, and innovative live-saving treatments. ForBaylor, the patient and their families come first, and the growth and development isdedicated to them.”Building Hope: Taking Cancer Care to the Next Level 7

Building Hope Through Specialized CareBlood and Marrow TransplantUnit UpdateSymposiumOn Saturday, April 5, 2008, BaylorDallas sponsored “Hematopoietic StemCell Transplantation: Past, Present,and Future,” a day-long symposiumon blood and marrow transplantationmedicine. The symposium, attended by97 physicians, nurses, social workers,and other health care professionals, wasdesigned to provide a comprehensiveoverview of blood and marrow transplantationmedicine over the last 25years and current and new approaches tohematopoietic cell transplantation andcellular therapy. The program addressednew developments in hematopoietictransplantation biology.The program was chaired by Joseph W.Fay, MD, and Edward D. Agura, MD,acted as moderator. Along with an introductionby Marvin J. Stone, MD, andclosing remarks by Dr. Fay, presentationswere given by international leaders inthe field, including Rainer F. Storb,MD, Bruce R. Blazar, MD, Fred R.Members of the accreditation team for the Foundation for the Accreditation of Cellular Therapy (FACT). Standing, left to right: Laura Brougher,RN, BSN, OCN; Lowell Anderson-Reitz, RN, MS, ANP, AOCN; Shawnette Graham, RN, BSN, OCN; and Deb Spitzer, RN, MSN, OCN. Seated:Pam Carnevale, MHSA; Edward Agura, MD; Jane Golinski, MT(ASCP), BB; and Josephine Murphy, MT(ASCP).8 Baylor Charles A. Sammons Cancer Center at Dallas

Appelbaum, MD, John R. Wingard,MD, and Karolina Palucka, MD.FACT AccreditationIn 1998, Baylor Dallas’ Blood and MarrowTransplantation Program receivedits initial accreditation from the Foundationfor the Accreditation of CellularTherapy (then known as Foundation forthe Accreditation of Hematopoietic CellTherapy). The program has maintainedFACT accreditation since that time.On July 8, 2008, Baylor receivednotification that the program earnedreaccreditation for 3 years. The accreditationapplies to all services and facilitiesinspected by FACT, specifically adultautologous and allogeneic hematopoieticprogenitor cell transplantation, bonemarrow and peripheral blood cellulartherapy product collection, and cellulartherapy processing.Graft-Versus-Host Disease ClinicMany complications can be associatedwith a blood and marrow transplant.One of the most difficult to treat is graftversus-hostdisease (GVHD). To combatthis disease, Baylor Charles A. SammonsCancer Center at Dallas established amultidisciplinary clinic.GVHD occurs after an allogeneictransplant, when a donor’s immune cellsattack the recipient’s body. The acuteform often appears within 100 days oftransplant and may cause a skin rash,cramping, nausea, diarrhea, or a suddenrise in liver function test results. Inchronic cases, which tend to occur muchlater following bone marrow transplantation,symptoms can mimic othermedical problems, making diagnosisdifficult. Common symptoms includechanges in the patient’s skin, dry eyes,mouth dryness and pain, weight loss,and low blood counts.“We simply cannot predict whichpatient will present with GVHD,” saidEstil Vance, MD, hematologic oncologiston the medical staff at Baylor Dallas.“This disease can be disabling. The comprehensivecare provided by a multidisciplinaryteam like the one at Baylor Dallasenables patients to make remarkablegains and enjoy a better quality of life.”James Chippendale (left front in red parka) and the Love Hope Strength Foundationteam at the base camp of Mount Everest.One Patient’s Journey: James ChippendaleJames Chippendale of Dallas was diagnosed with acute myelogenous leukemia in2000. After three rounds of intense chemotherapy, radiation, and a bone marrowtransplant at Baylor, Mr. Chippendale came back healthier, stronger, and ready tojoin the battle against leukemia.Mr. Chippendale, president of CSI Entertainment Insurance headquartered inDallas, teamed with musician and cancer survivor Mike Peters of The Alarm, analternative rock band from Wales, to found the Love Hope Strength Foundation(LHSF) in 2006. The foundation works to raise funds through innovative concertsand climbs—including climbs to the top of the Empire State Building andthe base camp of Mount Everest. “The efforts of so many have allowed LHSF toprovide critical funding for cancer centers worldwide so that all people have accessto information, quality cancer treatment, and medication and, therefore, have thebest chance for survival,” said Mr. Chippendale.LHSF raised approximately $700,000 its first year and hosts chapters in theUnited States, Australia, the United Kingdom, and Peru.Building Hope: Taking Cancer Care to the Next Level 9

Brenda Bailey, RN, BSN, OCN, CCRNThe Best Are at BaylorThe Texas Nursing Associationand the Dallas–Fort Worth NurseExecutives’ annual list of “Great 100Nurses” in the Metroplex includedone of Baylor Charles A. SammonsCancer Center at Dallas’ own in2008: Brenda Bailey, RN, BSN,OCN, CCRN, blood and marrowtransplant unit supervisor.Of the 100 nurses honored for beingrole models in leadership, serviceto the community, compassion as acaregiver, and significant contributionsto nursing, 20 work withinBaylor Health Care System. “Wordscannot express the honor that I feelwith this recognition,” Ms. Baileysaid.Breast Cancer UpdateBreast MRI for Breast ImagingBreast magnetic resonance imaging(MRI) is an additional procedure thataids in the detection of breast cancerat Baylor University Medical Center atDallas. The advanced technology ofthe breast MRI unit works in concertwith both the dedicated breast biopsyconsole and the computer-aided detectiontechnology. Also, breast MRI aidsin differentiating between benign andmalignant lesions and is key in confirmingthe extent of the disease.This advanced technology allows breastMRI-guided biopsies to be performedwith great accuracy and ease and reducesthe overall biopsy exam time. With breastMRI-guided biopsy, most women can resumenormal daily activity immediately.10th Anniversary of HereditaryCancer Risk Program2008 marked the Hereditary CancerRisk Program’s 10th anniversary. Since1998, this service has provided cancerrisk assessment and genetic counseling toTable 1. Results of Genetic Testing in 1555 Patients, 1998–2008Category Result n N (%)Positive Mutation 142 204 (13%)p53 1Single site 56Ashkenazi multisite 5Negative Comprehensive 1039 1243 (80%)Single site 71Ashkenazi multisite 30Comprehensive and LRP 25Comprehensive and BART 39Comprehensive and p53 5Previous variant amended 33Single site–polymorphism 1Other genetic variant Uncertain significance 70 93 (6%)Favor polymorphism 17And negative BART 5And negative p53 1Pending 15 15 (1%)Total 1555participants at risk for breast and/or ovariancancer. Genetic testing for BRCA1and/or BRCA2 is offered if indicated bythe pedigree analysis.The program meets all guidelines establishedby the American Society of ClinicalOncologists, in which cancer predispositiontesting should be offered when(1) the person has a strong family historyof cancer or very early onset of disease;(2) the test can be adequately interpreted;and (3) the results will influence themedical management of the patient orfamily member.Since 1998, the program has seen 1,692high-risk individuals (1,659 women and33 men), and 1,555 (92%) chose to havegenetic testing. Families learn about theHereditary Cancer Risk Program throughcommunity education programs, Internetresources, and physician referrals. Testingresults are shown in Table 1.10 Baylor Charles A. Sammons Cancer Center at Dallas

Building Hope One Patient at a TimePatient Navigation ProgramIn 2008, the Baylor Charles A.Sammons Cancer Center at BaylorUniversity Medical Center at Dallaslaunched a patient navigation programas part of its ongoing commitment toprovide advanced cancer patient care.The program, led by Cynthia RobinsonHawkins, RN, offers cancer patientsand their families guidance throughoutStreamlining Treatment for Cancer Patients1Physicianreferralor self-referralto Baylor2Navigatorcontactspatient togatherinformation,demographics,insurance, etc.3Navigatorcontactspatient to relayappointmentinformation;provide patientwith details,directions,campus mapNavigatorreviews patientinformation;interfaces withphysician on theBaylor Dallasmedical staff todiscuss caseand arrangeappointments4 5the continuum of care. Patient navigatorscan expedite access to services bycoordinating logistics, appointments,educational resources, and other services.The patient navigators serve as part ofthe care team alongside the physician,nurse, social worker, and other allied staffoffering referring physicians a point ofcontact for information, communication,and follow-up. The navigator is there toNavigatormaintainsregular contactwith patientduringtreatments,appointments,return visits6Navigatorprovidesongoingfollow-up withreferringphysician7Navigatorsendsfollow-up letterto patient twoweeks aftertreatmentbegins8Navigatorcontactspatient asneeded aftertreatments, forfollow-upassist referring physicians in getting theirpatients care from initial appointmentthrough diagnosis, treatment, and recovery.This program alleviates stress andhelps simplify the organization of carefor the patients and their loved ones.Virginia R. Cvekto PatientEducation CenterHugs, tears, laughter, creativity, andrelaxation all come together to helpcancer patients and their caregivers healat the Virginia R. Cvetko Patient EducationCenter at Baylor Sammons CancerCenter. For almost 30 years, the CvetkoCenter has been an important resourcefor cancer patients and their loved ones.The center bears the name of cancerpatient Virginia Cvetko, and her beliefthat there is life and hope with cancerremains the center’s guiding principle.The Cvetko Center offers Internet accessand information about cancer and associatedhealth issues in patient educationand resource rooms. The resource roomsoffer cancer medical guides, inspirationalbooks, cookbooks, videos, and DVDs.Refurbished wigs may be available at nocost to patients in need who are undergoingcancer treatment.Whenever possible, the Cvetko Centercollaborates with community organizationsto provide a greater offering ofprograms. Many Cvetko Center activitiesare cosponsored by the American CancerSociety (ACS). One long-time and verysuccessful program is the Cancer SurvivorsNetwork program. In this program,cancer survivors visit patients currentlyundergoing treatment for cancer toprovide support and to listen. In 2008,1,140 visits were made by dedicatedvolunteers.ACS also collaborates on the Look Good. . . Feel Better program, a quarterly programthat teaches women make-up andhair tips during chemotherapy treatment.In addition, Cvetko Center social workerswork with ACS to obtain equipment forpatients and transportation to and fromtheir treatment appointments.The ACS also regularly has a representativepresent in the lobby of BaylorSammons Cancer Center providingBuilding Hope: Taking Cancer Care to the Next Level 11

patients with information and the ACSPersonal Health Manager, an informationresource for patients.Cancer Support, Education, andSpecial ProgramsEducation and support are the cornerstonesto the many programs offeredthrough the Cvetko Center. The centeroffers seven ongoing disease-specificgroups along with many special diseasespecificprograms throughout the year.In addition, the Cvetko Center providescomplementary care programs suchas Journaling for Health and ExpressYourself, a program that helps patientsand their families express emotions andanxiety through art. More than 3,450participants attended the ongoingand special programs presented by theCvetko Center in 2008, an increase of20% over 2007.Celebrating Cancer Survivorsand Barrett LectureshipThe Virginia R. Cvetko Patient EducationCenter and US Oncology togethersponsored Baylor Dallas’ celebration ofNational Cancer Survivors Day, June 2through 6, 2008. Refreshments andinformation were available in the lobbyof the Baylor Sammons Cancer Centerall week. Tables were staffed by CvetkoCenter volunteers and staff, as well asrepresentatives from many local cancersupport organizations, including theAmerican Cancer Society, Gilda’s ClubNorth Texas, and the Leukemia andLymphoma Society. Information wasavailable on survivorship issues, earlydetection and prevention, and the manysupport groups and programs offered atBaylor Sammons Cancer Center and inthe Dallas area.In conjunction with the celebration, theannual Charlotte Johnson Barrett Lectureshipwas held on June 5. This year’sguest speaker, Cornelius O. “Skip” GranaiIII, MD, asked, “Are commonly heldbeliefs—dogs bark, cats meow, birds livein the sky—and unquestioned answersalways fact?” Dr. Granai believes that patientscount on doctors to hold a certainplace in their lives. “Perceived for Birds”explored the needs of patients and physiciansand the vital relationship betweenthe two. In addition to the noon lecture,Dr. Granai met with oncology staff onthe fourth floor of Hoblitzelle Hospital,the sixth floor of Roberts Hospital, andthe Blood and Marrow Transplant Unit.Waldenström’s MacroglobulinemiaProgramThe Cvetko Center hosted a specialprogram on myeloma and macroglobulinemiaon August 23, 2008, in collaborationwith the Leukemia and LymphomaSociety of North Texas. The programfeatured Marvin J. Stone, MD, medicaldirector of Baylor Sammons CancerCenter at Dallas. Dr. Stone presented“Myeloma and Macroglobulinemia:Similarities and Differences.” His presentationwas followed by “Update onWaldenström’s Macroglobulinemia andMultiple Myeloma” presented by StevenP. Treon, MD, PhD, program directorfor the Bing Center for Waldenström’sResearch at Dana-Farber Cancer Institutein Boston. The program was attended bymore than 50 people, including membersof the Waldenström’s MacroglobulinemiaSupport Group and the North TexasMyeloma Support Group.At the Barrett Lectureship, left to right:speaker Skip Granai III, MD, C. Allen Stringer,Jr., MD, and Marvin J. Stone, MD.12 Baylor Charles A. Sammons Cancer Center at Dallas

Neil Senzer, MD, and C. Allen Stringer, Jr.,MD, at the Ovarian Cancer SurvivorCelebration.Survivor Celebrations for OvarianCancer and Breast CancerOn September 22, 2008, the centerhosted the Second Annual Ovarian CancerSurvivor Celebration. The celebrationincluded an update from the NationalOvarian Cancer Coalition and a presentationby Neil Senzer, MD, entitled“Current Ovarian Cancer Research.”The presentation was followed by lunchfor the more than 160 people present.The First Annual Breast Cancer SurvivorCelebration was held on October 14,2008. Ebony Steele, nationally knownsyndicated radio host and breast cancersurvivor, shared her experience withbreast cancer and emceed the event.John Pippen, MD, was the featuredspeaker with his presentation, “ExcitingNew Targeted Therapies for BreastCancer.” The event drew more than 140participants.Complementary Care WorkshopAgain this year, the Cvetko Center andthe Healing Environment at BaylorUniversity Medical Center presented“Complementary Methods for Healthand Relaxation,” a half-day workshopfor oncology patients, families, andprofessionals. The event was held onNovember 15, 2008, with Mark A.Casanova, MD, giving the keynoteaddress, “Enhancing Quality of LifeFocusing on the Whole Person.” Breakoutsessions covered art, touch therapies,Tai Chi, Qigong, and organic versusnatural foods. Almost 100 peopleattended this year’s program.Promoting Prevention andCancer ScreeningsBaylor Dallas hosted a community prostatecancer screening on September 20,2008. The free screening was for men50 years and older and men 40 and olderin high-risk groups (African Americans,Hispanics, and those with a family historyof prostate cancer). Of the 271 menscreened, 10% had abnormal prostatespecificantigen levels.Ebony Steele, Pam Carnevale, MHSA, manager of the Cvetko Center, and John Pippen, MD,enjoying the Breast Cancer Survivor Celebration.It’s a Guy Thing, a morning devotedsolely to men’s health, was on Saturday,June 7, 2008. The free event drew morethan 125 attendees from the community.Baylor Dallas also served as a host site fora free community melanoma/skin cancerscreening on May 10, 2008. Among the222 people who were screened, physiciansfound three cases of melanoma,15 cases of basal cell carcinoma, and sixcases of squamous cell carcinoma.Kitchens Lectureship: Musicand the MindOn March 18, 2008, Dr. Richard Kogangave the Lloyd Wade Kitchens Lecture atinternal medicine grand rounds. The titleof Dr. Kogan’s presentation was “Musicand the Mind: George Gershwin.” Dr.Kogan has had an active career both as aconcert pianist and psychiatrist. He hasbeen praised for his “exquisite playing”by the New York Times. He won firstprize in the Chopin Competition ofthe Kosciuszko Foundation and hasperformed throughout the world asa recitalist and orchestral soloist. Dr.Kogan is a graduate of Juilliard Pre-College, Harvard College, and HarvardMedical School. He is affiliated withWeill-Cornell Medical School as directorof its Human Sexuality Program.The lecture was given in memory of Dr.Kitchens, who remained at Baylor forhis entire career, practicing with TexasOncology, PA. Dr. Kitchens also servedas medical director of the Virginia R.Cvetko Patient Education Center from1980 until his death in 2001. He wasan accomplished pianist, and GeorgeGershwin was one of his favoritecomposers.Building Hope: Taking Cancer Care to the Next Level 13

Profile: Andrew JankeWorking with the CvektoCenter to Help CancerSurvivorsThe impact of a cancer diagnosis on one’ssoul never goes away. Andrew Janke, a27-year-old Dallasite and a testicularcancer survivor, has discovered this firsthand. He’s determined to help others whohave successfully gone through cancertreatment find answers to their questionsand form a cancer survivor’s network.When he was 23, Mr. Janke discovered asuspicious lump on his testicle. His primarycare physician immediately referredhim to a urologist on the medical staffat Baylor University Medical Center atDallas. “After my appointment,” Mr.Janke said, “I really had no reaction.I went to work and sat in the parkinggarage for 15 minutes thinking, ‘Hedidn’t just say that I have cancer, did he?’”Mr. Janke underwent a radical inguinalorchiectomy, a procedure to remove theentire testicle, 3 days after his diagnosisby the urologist. A biopsy of the tissue toverify the type of testicular cancer helped14 Baylor Charles A. Sammons Cancer Center at Dallas

determine a follow-up treatment plan. “Within 2 weeks of my initial operation,” saidMr. Janke, “I underwent the first of four rounds of chemotherapy.”During his chemotherapy treatments, his girlfriend—now fiancée—and family andfriends were all there to support him. His brother moved in to help him with everydaychores, and his parents, who live in Tennessee, rotated visits. “My folks wouldcome when my chemo treatments were the heaviest. It was so nice to know someonewas at my apartment, that I wasn’t alone,” he remembered.Following his chemotherapy treatment, a successful second operation took placebecause the cancer had spread to his lymph nodes. Six months after being diagnosed,he began to recover. “The tests show I’m cancer free now,” said Mr. Janke. But somehow,Mr. Janke can’t quite believe, deep in his soul, that that’s truly the case.address their fear of recurrence, psychosocial issues, long-time side effects, and qualityof life issues,” explained Pam Carnevale, Cvetko Center manager. “Physicians,social workers, dietitians, and chaplains will all take active roles in this program tohelp develop a cancer survivor’s network.”To help with funding to get the program off the ground, Mr. Janke organized alocal car show with the proceeds going to the Cvetko Center. “I’ve always enjoyedanything with four wheels,” laughed Mr. Janke. “I’ve always been a big Chevy fan.”With help from local vendors, he registered 30 cars for his car show, which wascarefully timed to coincide with National Cancer Survivor’s Day in June 2008.While he’s required to have frequent checkups for the rest of his life, he’s found thatmuch of the support network he had when he was going through treatment is nolonger there. “Once I finished my second operation and was back on my feet, noone mentioned ‘it’ anymore,” he commented. “I felt like people heard I’m ‘cancerfree’and thought, ‘Okay, it’s no longer a big deal.’” What Mr. Janke wants people tounderstand is that even though someone is determined by physicians to be “cancerfree,”it is still a very big deal. “There are all sorts of side effects that come about aftercancer treatment,” he said. “Three years later I still have a lot of questions: Is thisnormal? Does this mean the cancer is coming back? There are always questions thatcrop up.”To help himself and others like him deal with the issues and questions that face survivorsof cancer, Mr. Janke volunteered to work with the Virginia R. Cvetko PatientEducation Center at Baylor Dallas to develop a transition program called Life AfterCancer. “This program will help people who’ve gone through cancer treatmentAndrew Janke, left, with Cvetko Center and event staff at the car show organized to raisemoney for the Life After Cancer program.Building Hope: Taking Cancer Care to the Next Level 15

Building Hope Through Quality Improvement EffortsCommission on Cancer AccreditationIn 2008, the Baylor Charles A. Sammons Cancer Center received renewal of accreditationfrom the Commission on Cancer. The Teaching Hospital Cancer Program atBaylor Dallas was awarded approval with commendation for the next 3 years. Thereare 36 standards in the accreditation process, of which nine are eligible for a commendationrating. Baylor received seven commendations on the survey.Approximately one-fourth of the nation’s hospitals treating cancer patients receiveCommission on Cancer approval. Only 31% of teaching hospital cancer programsreceive approval without contingencies.Cancer Registry UpdateBy Laura Siciliano, RN, OCNThe year 2008 was one of achievementas well as growth and development forthe Baylor University Medical CenterCancer Registry. The registry staff grewin 2008 with the addition of DeliaMoncada, CTR, cancer registry supervisor,and registrars Lydia Vega, CTR,Elizabeth Teter, RHIA, and AliciaMoreno, RN, CTR. Two members ofour staff, Takisha Brown and Gary Vogt,were successful in obtaining credentialingas certified tumor registrars.The goals of the cancer registry focuson accuracy and efficiency of data collection,abstracting, casefinding, andfollow-up. The priority goals achievedin 2008 were abstracting data within 5months of date of initial patient contact,increasing and maintaining follow-uppercentages above the required Commissionon Cancer standards, and submittingerror-free data to the NationalCancer Data Base’s Annual Call for Datafor the years 2002 and 2007 prior to theNovember 4 deadline.The registry continues to facilitate andparticipate in the Hospital RegistryWebinar Educational Series conductedby the North American Association ofCentral Cancer Registries. In addition,two registry staff members attended theannual Texas Tumor Registrars Associationeducational conference in SanAntonio. A monthly physician-driven“lunch and learn” program has beenimplemented to meet the needs ofthe cancer registrar in answering keysite-specific questions. The kickoff ofthis program began with Dr. GrangerScruggs, who guided staff memberson a tour of the radiation oncologydepartment followed by a review ofthe charting process, which led to anunderstanding of the intricacies of theradiation treatment planning and deliveryprocesses.In October 2008, Baylor SammonsCancer Center hosted its seventhannual Regional Cancer Registry EducationalConference entitled “Value ofQuality Data: Focus on Head and Neckand Central Nervous System Cancers.”Over 60 cancer registrars from aroundthe state attended the all-day sessionfeaturing physicians on the medical staffat Baylor as speakers who covered topicsfrom diagnosis through treatment ofthese cancers.Summary of 2007 CancerRegistry DataBy R. Pickett Scruggs, MDDuring reporting year 2007, the CancerRegistry at Baylor University MedicalCenter at Dallas abstracted 3,137 analyticalcases (cases in which patients werefirst diagnosed or initially treated atBaylor Dallas). Females accounted for59% of the patients. Data on age andstage are summarized in Figures 1 and 2.The top five sites of diagnosis were similarto those of the previous year. Theseincluded breast (690), lung (291), colorectal(248), prostate (203), and liver/biliary (152). Comparing 2007 datawith 2006 data showed that colorectal,prostate, and liver/biliary cases remainedvery similar in number. The numberof breast cases increased by 87 (14%).Contributing to this increase was therelocation of the breast imaging centerto a new location on the Baylor Dallascampus. The Darlene G. Cass Women’sImaging Center is larger and more easilyaccessible to patients. In addition, BaylorDallas began operating a full-service16 Baylor Charles A. Sammons Cancer Center at Dallas

Figure 1. Age by Gender of 3,137 Analytic Cases90–9980–8970–7960–6950–5940–4930–3920–2910–190–90% 2% 4% 6% 8% 10% 12% 14% 16%FemaleMalebreast imaging center in North Dallas.Baylor Dallas has a well-known and veryactive medical and surgical digestivedisease service, which contributed toan increase of more than 100% in thenumber of esophageal cancers reported.Baylor Dallas is in Texas Health ServiceRegion 3, with 117 reporting facilitiesin 19 counties. A comparison of BaylorDallas’ 2007 registry data with data onexpected new cases in Region 3 for 2007revealed that Baylor Dallas saw almost13% of all cancers in the region. BaylorDallas’ cancer registry reported 46% ofthe new cases of liver, 24% of pancreas,17% of breast, 18% of esophageal, 19%of thyroid, 18% of kidney, and 19% ofgynecologic cancer in the region.Baylor Dallas’ top 10 sites are comparedwith estimated new cases from theNational Cancer Data Base in Figure 3.The distribution of cases at Baylor Dallasis similar to the national distribution,with the exception of prostate, lung, andbladder cancers, which made up a smallerpercentage of overall Baylor Dallas cases,whereas breast, liver, and pancreas cancersmade up a greater percentage of cases.Figure 2. 2007 Analytic Cases by General Stage16001400149312001000800600400537487Figure 3. Baylor Dallas Top 10 Sites Compared to National StatisticsBaylor Dallas Top 10 USA National Top 10BreastProstateLungLungColon/RectumBreastProstateColon/RectumLiverBladderPancreasNon-Hodgkin’s Lymphoma2000212In Situ Localized Regional Distant Benign UnknownStage**From SEER: Surveillance, Epidemiology, and End Results Program186227Corpus UteriKidneyNon-Hodgkin’s LymphomaLeukemiaMelanomaKidneyLeukemiaCorpus UteriBuilding Hope: Taking Cancer Care to the Next Level 17

SexGeneral StagePrimary Site Total Male Female In Situ Local Regional Distant Benign UnknownAll Sites 3137 1297 1840 212 1493 537 487 186 222Baylor UniversityMedical Center at Dallas2007 Analytic CasesHead and Neck 44 32 12 1 15 18 5 1 4Lip 2 2 0 0 0 0 0 0 2Tongue 20 15 5 0 8 10 2 0 0Oropharynx 1 1 0 0 0 0 0 0 1Hypopharynx 2 1 1 0 0 2 0 0 0Other 19 13 6 1 7 6 3 1 1Digestive System 691 421 270 15 319 174 94 12 77Esophagus 41 31 10 5 17 10 3 0 6Stomach 46 32 14 1 19 7 8 5 6Colon 136 70 66 1 60 42 22 1 10Rectum 112 60 52 2 55 33 9 0 13Anus/Anal Canal 16 10 6 3 6 3 2 0 2Liver 152 121 31 0 100 22 16 2 12Pancreas 129 67 62 1 42 39 26 1 20Other 59 30 29 2 20 18 8 3 8Respiratory System 310 158 152 2 121 75 89 2 21Nasal/Sinus 2 1 1 0 2 0 0 0 0Larynx 13 9 4 1 3 5 1 0 3Lung/Bronchus 291 145 146 1 112 70 88 2 18Other 4 3 1 0 4 0 0 0 0Bone 14 9 5 0 8 3 2 1 0Connective/Soft Tissue 20 12 8 0 12 5 1 0 2Skin 73 40 33 4 48 11 5 1 4Melanoma 65 34 31 4 43 9 5 0 4Other 8 6 2 0 5 2 0 1 0Breast 690 11 679 139 414 116 14 2 518 Baylor Charles A. Sammons Cancer Center at Dallas

SexGeneral StagePrimary Site Total Male Female In Situ Local Regional Distant Benign UnknownFemale Genital 283 0 283 20 143 53 42 7 18Cervix Uteri 32 0 32 2 22 5 1 0 2Corpus Uteri 127 0 127 0 85 27 7 1 7Ovary 89 0 89 0 23 19 34 5 8Vulva 28 0 28 15 12 1 0 0 0Other 7 0 7 3 1 1 0 1 1Male Genital 213 213 0 0 168 30 5 0 10Prostate 203 203 0 0 162 28 3 0 10Testis 9 9 0 0 6 2 1 0 0Other 1 1 0 0 0 0 1 0 0Baylor UniversityMedical Center at Dallas2007 Analytic Cases(Continued)Urinary System 175 127 48 31 108 22 10 1 3Bladder 59 45 14 28 23 8 0 0 0Kidney/Renal 113 80 33 2 83 14 10 1 3Other 3 2 1 1 2 0 0 0 0Brain and CNS 149 60 89 0 26 3 3 114 3Brain (Benign) 9 4 5 0 0 0 0 9 0Brain (Malignant) 43 24 19 0 24 3 3 10 3Other 97 32 65 0 2 0 0 95 0Endocrine 107 28 79 0 56 17 3 22 9Thyroid 83 21 62 0 56 17 2 0 8Other 24 7 17 0 0 0 1 22 1Blood and Bone Marrow 156 86 70 0 0 0 156 0 0Leukemia 98 51 47 0 0 0 98 0 0Multiple Myeloma 41 24 17 0 0 0 41 0 0Other 17 11 6 0 0 0 17 0 0Lymphoma 114 63 51 0 39 5 53 0 17Hodgkin’s Disease 8 3 5 0 4 0 4 0 0Non-Hodgkin’s 106 60 46 0 35 5 49 0 17Unknown Primary 77 31 46 0 5 0 4 22 46Other/Ill-Defined 21 6 15 0 11 5 1 1 3Building Hope: Taking Cancer Care to the Next Level 19

Patient Care EvaluationStudy: 10-Year Experiencewith Prostate Brachytherapyat Baylor Sammons CancerCenterBy Barry N. Wilcox, MD, FACRO,and Janet Reynolds, CTRProstate cancer afflicts one in six menin this country. Approximately 186,320cases will be diagnosed in 2008. Outsideof skin cancer, it is the most commoncancer diagnosed in men and the secondleading cause of cancer death, behindlung cancer. In 2008, 28,660 men willdie of this disease, accounting for 10%of all cancer-related deaths in men. 1Patients with prostate cancer have avariety of treatment options availableto them, especially if they have earlydisease. The choices are watchful waiting(primarily in selected older patients orthose with significant health problems),surgery, and radiation. New treatments,such as cryotherapy, are being explored;however, long-term follow-up data arelimited.Dr. Barry Wilcox and Janet ReynoldsProstatectomy is the definitive surgicaloption. It can be done in several ways:radical retropubic prostatectomy, radicalperineal prostatectomy, laparoscopicradical prostatectomy, or robotic-assistedlaparoscopic radical prostatectomy.Radiation therapy can be administeredusing either external beam radiation orbrachytherapy (internal radiation) and,in certain circumstances, as a combinationof both. When used appropriately,all three approaches are effective.External beam radiation can be deliveredby a number of different techniques:three-dimensional conformal radiationtherapy (the planned dose conformsto a tumor with a convex surface);intensity-modulated radiation therapy(the planned dose conforms to a tumorwith a concave component to its surface,e.g., the interface of the prostate with therectum); image-guided radiation therapy(using the previous techniques withdaily visualization of the prostate tomore accurately track organ movement);stereotactic body radiation therapy(delivering a smaller number of high-dosetreatments requiring image guidance);or conformal proton beam radiationtherapy (minimizing radiation tosurrounding organs).Brachytherapy is radiation given withinor next to the tumor from an internalsource rather than from an externalsource. Arguably, despite all the advancesin external beam technology, this representsthe most conformal way to deliverradiation to the prostate. It can bedone using permanent implantation ofinterstitial seeds (using I-125 or Pd-103)or temporary implantation of high-20 Baylor Charles A. Sammons Cancer Center at Dallas

dose-rate seeds (using Ir-192). Whenused as a single modality treatment,there are restricted stage- and pathologydependentcriteria of applicability.The Baylor BrachytherapyExperienceBaylor University Medical Center atDallas was one of the first cancer centersin Northeast Texas to offer prostatebrachytherapy beginning in February1997. As a consequence, a significantclinical experience with the procedurehas developed. The 400 patients treatedover this decade have a 5.5-year medianfollow-up. All the cases were done eitherby Neil Senzer, MD, or Barry Wilcox,MD, collaborating with a urologist onthe Baylor Dallas medical staff. WhileI-125 was the preferred isotope at ourinstitution, 13% of the cases were donewith Pd-103 (based on tumor growthrate selection factors) during the earlyyears of the experience. All patientsoffered implants alone were low risk,defined as patients with a Gleason score≤6, a prostate-specific antigen (PSA)level ≤10, and clinical stage ≤T2b. A fewpatients with Gleason scores of 7 wereallowed to have the implant alone iftheir predominant pathology was grade3 (3+4) rather than poorly differentiatedgrade 4 (4+3) and if they had minimalunilateral disease on biopsy specimen.Some patients received preimplantationexternal beam radiation of 45 Gray (Gy)to the pelvis; however, this group ofpatients had intermediate-risk or highriskdisease.The registry data show that the medianage at diagnosis and treatment was67 years. Eighty-eight percent of thepatients were Caucasian, 8% were AfricanAmerican, and 3% were Hispanic.Of the 400 patients, 314 (79%) hadbrachytherapy without the addition ofsupplemental external beam radiation.The median PSA level was 6.1, and 79%of tumors were either well or moderatelydifferentiated (18 were well differentiated,299 were moderately differentiated,and 83 were poorly differentiated).Thirty-five percent of patients receiveda short-term (mean, 4 months) courseof androgen blockade, usually to shrinkthe gland below 60 cc but sometimes todefer treatment for other reasons, such asallowing time for a treatment decision,waiting for isotope availability, or travel.The average-size gland at implant was 38cc, and the median target dose was 145Gy for I-125 and 115 Gy for Pd-103.Those who received external beam radiationwere then implanted with I-125 toa dose of 110 Gy.Our technique included a pubic archand ultrasound volume study from whicha dosimetric preplan was rendered. Overthe ensuing decade, various incrementalimprovements were adopted as technologicadvances permitted. These includedcomputer preoperative dosimetry,postoperative dosimetry (day of theprocedure), conversion from an analogueto digital transducer, and use of strandedseed sources rather than loose seeds.ResultsSurvival. The actuarial survival rate forthe 400 patients treated at the BaylorSammons Cancer Center with brachytherapyis shown in Figure 1. Thedisease-specific survival for these patientswas 99%, with only four of 400 patientsexpiring from their disease, while a fifthpatient with active prostate cancer expiredsecondary to lung cancer (Table 1).Figure 1. Baylor Dallas Observed (Actuarial) 5-Year Survival in Stage IIProstate Cancer Patients Treated with Brachytherapy100%90%80%70%60%50%40%30%20%10%0%Diagnosis 1 Year 2 Years 3 Years 4 Years 5 YearsBuilding Hope: Taking Cancer Care to the Next Level 21

Table 1. 5-Year Status of 400 Patientswith Prostate Cancer Treated withBrachytherapyEvidence ofStatus Prostate Cancer No. (%)Alive No 349 (87%)Yes 5 (1%)Died No 39 (10%)Yes 5 (1%)Unknown 2 (0.5%)Table 2. Recurrences Occurring1–10 Years after Brachytherapy forProstate Cancer in 400 PatientsRecurrence No. (%)None 385 (96%)Local 5 (1%)Biochemical 5 (1%)Distant Metastasis 5 (1%)Using statistical extrapolation, theprojected 10-year actuarial survival ratewas 90%. Further analysis of the recurrencesat Baylor Dallas suggested thatonly 1.5% to 2.5% had local-only recurrences,which confirms excellent localcontrol of this disease with this technique(Table 2). Our rate of a transientPSA rise after implantation, what isreferred to as “PSA bounce,” was 3%.This rate is lower than that reported insome series and can probably be attributedto our older patient population.Side effects and complications. Sideeffects from radiation are well documentedand, with the exception offatigue, are confined to the pelvic area.This is a consequence of bladder andrectal irritation. All of our patients experiencedgrade 1 to 2 urinary and rectalsymptoms. These symptoms generallylasted 4 to 6 months after implantation.Late urinary complications such as persistentobstruction or retention (grade 3) 2from brachytherapy occurred in 4% ofthe patients. There were no grade 4 complications.Of the 13 patients afflicted,a transurethral resection of the prostate(TURP) was required in 11, while 2patients required prolonged use of anindwelling Foley catheter or intermittentself-catheterization. Two patients becameincontinent after the TURP procedure,which is consistent with the 18% to 25%risk 3 in published reports. Of the twopatients who had catheterizations ratherthan TURP, one was able to regain continencethrough bladder training, whilethe other did not. In total, only threepatients experienced permanent urinaryincontinence—a rate of 0.75%.Grade 3 rectal complications, which canmanifest in persistent or recurrent bleedingrequiring surgical correction, are alsoa concern for anyone contemplatingprostate brachytherapy. In our series,such complications occurred in only fourpatients (1%). This percentage is belowthat of some published studies, whichshow a rate of 5% to 11%. 4,5 No grade 4complications (fistulas/colostomy) werereported.The rate of potency preservation,unfortunately, was not consistentlydocumented prior to or following implantation,but historically it has beenabout 50% to 80% depending on whichseries is being reported. These numbersare often subject to patient selection bias(potent patients gravitate toward physiciansthat publish good numbers) andage bias (not actuarially adjusted to thenatural decline in potency that occurswith aging). Further complicating collectionof this data is the fact that manyTable 3. Subsequent Cancers Occurring1–10 Years after Brachytherapy forProstate Cancer in 400 PatientsCancer TypeNo.Bladder 3Colon/rectum 3Kidney 1Leukemia 2Lung 3Melanoma 1Oral cavity 1Pancreas 1Stomach 1older patients refuse to answer thesequestions or answer them inconsistentlydepending on who is present with themin the room.Risk of radiation-induced cancer.Much is known about complicationsrelated to rectal bleeding; less is knownabout the risks of inducing a secondarycancer from radiation. Table 3 documentssome of the subsequent cancers that havedeveloped in this group of patients.It has been postulated that someonewho has developed one cancer may bepredisposed genetically or from exposurehistory to developing other cancers.Many cancers share similar risk factors.22 Baylor Charles A. Sammons Cancer Center at Dallas

It is also well documented that ionizingradiation can induce some cancers yearsto decades later. Our own data showfour cancers found in the pelvic area,which include three bladder cancers andone rectal cancer. Since the minimumtime requirement for attributing an inducedcancer to radiation is 5 years afterradiation exposure, only one case wouldsatisfy the time requirement (a bladdercancer) and be reasonably attributed toradiation treatment due to its location.This translates into a risk of 1 in 400.Given the prevalence of bladder cancersin men of this age group, this may possiblyoverestimate the risk.Comparison of Resultswith National BenchmarksWe compared the results of our experiencewith stage II prostate cancertreatment to that of the large NationalCancer Data Base (NCDB) for prostatecancer survival. NCDB, a joint programof the Commission on Cancer and theAmerican Cancer Society, is a nationwideoncology outcomes database formore than 1,400 Commission-approvedcancer programs in the United Statesand Puerto Rico. Some 75% of all newlydiagnosed cases of cancer in the UnitedStates are captured at the institutionallevel and reported to the NCDB. TheNCDB data show a 5-year observed(actuarial) survival rate of 89% nationally6 (Figure 2) compared with 91% forour brachytherapy patients (Figure 1).ConclusionOur results in treating prostate cancerwith brachytherapy compare wellwith those of the 1,400 Commissionapprovedcancer programs reporting tothe NCDB registry. Baylor SammonsCancer Center has achieved an experienceunique to the Northeast Texas areain its volume, duration, and follow-up.The results reaffirm the effectivenessof brachytherapy, the appropriatenessof selection criteria, and the qualityof application as practiced at BaylorSammons Cancer Center. In the future,our experience will continue to provideinsight on the long-term results of theprocedure as well as elucidate how thecontinual incremental improvementsthat have been adopted impact outcomes.A good cancer registry is essentialFigure 2. NCDB Prostate Cancer Observed (Actuarial) Survival by Stage100%90%80%70%60%50%40%30%20%10%0%Diagnosis 1 Year 2 Years 3 Years 4 Years 5 YearsStage I Stage II Stage III Stage IVn=11,863 n=268,174 n=33,037 n=20,493for an advanced cancer center andenormously beneficial in helping todetermine where opportunities forimprovement lie. It is also invaluable incompiling national trends and statisticsand serves as a benchmark for comparisonof a cancer center’s results with thoseof other accredited centers throughoutthe nation. 7AcknowledgmentsWe would like to thank Dr. Neil Senzerfor his valuable input and acknowledgehis efforts in starting the brachytherapyprogram at Baylor Dallas. Also, we expressour gratitude to Joshua Fine, MD, JohnWare, MD, Michael Goldstein, MD,Myron Fine, MD, George Hurt, MD,James Sandin, MD, Bob Schoenvogel,MD, Ben Schnitzer, MD, and SteveFrost, MD, along with the many otherurologists and internists who referredtheir patients to our center and providedfollow-up information for this project.Finally, we want to thank our dedicatedbrachytherapy nurses, Carol Motley, RN,and Robin Wilks, RN, for their professionalismand selfless dedication.Building Hope: Taking Cancer Care to the Next Level 23

Notes1. American Cancer Society. Cancer Facts &Figures 2008. Atlanta, GA: American CancerSociety, 2008.2. All toxicities are expressed using the RadiationTherapy Oncology Group/EuropeanOrganisation for Research and Treatment ofCancer Late Radiation Morbidity ScoringScheme.3. Kollmeier MA, Stock RG, Cesaretti J, StoneNN. Urinary morbidity and incontinencefollowing transurethral resection of theprostate after brachytherapy. J Urol 2005;173(3):808–812.4. Mueller A, Wallner K, Merrick G, Ford E,Sutlief S, Cavanagh W, Butler W. Perirectalseeds as a risk factor for prostate brachytherapy-relatedrectal bleeding. Int J RadiatOncol Biol Phys 2004;59(4):1047–1052.5. Kao J, Stone NN, Lavaf A, Dumane V,Cesaretti JA, Stock RG. 125 I monotherapyusing D90 implant doses of 180 Gyor greater. Int J Radiat Oncol Biol Phys2008;70(1):96–101.6. American College of Surgeons. NationalCancer Data Base/Commission on CancerSurvival Reports. Chicago: ACS, 2008.7. Our experience with brachytherapy alone(i.e., without external beam radiation) comparedwith the results of published data frommajor brachytherapy cancer canters willbe the subject of a future publication sincethe Commission on Cancer accreditationprocess requires comparison of site-specificresults of our cancer center with results fromNCDB.Future Developments for Prostate Cancer at SammonsThe Baylor Sammons Cancer Center, along with the Mary Crowley CancerResearch Center, Texas Oncology, US Oncology, and the National CancerInstitute, offer a number of protocols for prostate cancer. Clinical trials havecontinued to evolve based on new insights and technologies. Given that thecure rate for low-risk prostate cancer patients treated with radiation or surgeryis above 80% at 10 years and that prostate cancer typically afflicts men in theiradvanced years, most, but not all, of the new and innovative studies tend tofocus on intermediate-risk or high-risk patients, patients who have metastaticdisease at presentation, or patients in whom conventional treatment has failed.As a result, exploring new or innovative treatments for low-risk prostate cancerpatients poses an ethical dilemma. Is it reasonable or even ethical, for example,to try something novel and unconventional when well-established, relatively safetreatments that are highly effective are available? This is really for the patient todetermine.Patients who want to try a new approach or explore adding a new adjunctivetherapy to the more established treatments have choices at Baylor SammonsCancer Center. For example, stereotactic body radiation therapy is now beingoffered to patients with early stage disease. In this approach, patients are givenfive high-dose fractions of very precisely focused radiation rather than the typical8- to 9-week daily course of treatment. Early data suggest that stereotactic bodyradiation therapy may be as effective as standard radiation therapy and haveacceptable side effects. Other improvements in the treatment of prostate cancerwith radiation will take place as we increase our understanding of preservationof erectile function, determine who has micrometastatic disease at presentation,and improve our imaging and increase our dose conformality with the implementationof “dose painting.”24 Baylor Charles A. Sammons Cancer Center at DallasAdjuvant treatments—such as giving radiation with selenium, celecoxib, docetaxel,or a vaccine—are currently being studied in clinical trials. In addition,investigational drugs, such as abiraterone acetate, have shown favorable results inmetastatic prostate cancer and are now being considered for study in earlier-stagedisease.

Building Hope Through ResearchPersonalized MedicineThe Center for Personalized Medicine,which began in 2001 and is ledby Damien Chaussabel, PhD, bringstogether modern blood banking technology,novel genome analysis, and advanceddata mining tools. From one small tubeof blood, Dr. Chaussabel’s group canmeasure the expression level of 48,000different gene transcripts.What began as an ambitious plan hasdeveloped into an international programin which scientists and physicians fromBaylor Health Care System collaborateon studies with their peers from aroundthe globe.Not only can this research help diagnosediseases, but it also can be used to see ifa patient is responding to therapy andmedication. “We have made tremendousprogress over the last 7 years in identifyingthe unique ‘signatures’ of manydiseases and translating this informationinto useful clinical data,” explainedJacques Banchereau, PhD, director ofthe Baylor Institute for ImmunologyResearch. “By knowing the signatureof a specific illness and what a healthysignature should be, we can monitor theeffectiveness of a treatment plan.”Therapeutic Cancer VaccinesBaylor Research Institute and the MountSinai School of Medicine are collaboratingto develop therapeutic cancer vaccinesfor patients with lymphoma andmyeloma. Additionally, the researcherswill investigate ways to better diagnoseautoimmune disorders such as arthritisand lupus.Unlike traditional vaccines used toprevent diseases, the therapeutic vaccinesbeing created by Baylor Research Instituteand Mount Sinai will be designed aspersonalized cancer treatments using cellsfrom the patient’s own immune system.To develop the vaccines, Baylor researcherswill cultivate dendritic cells, a class ofwhite blood cells that initiate and controlthe body’s overall immune responseagainst foreign invaders, and manipulatethem to attack the cancer. BaylorInstitute for Immunology Research hasmade significant advances in the studyof dendritic cells. It is currently applyingthis technique to develop and test vaccinesfor other diseases, such as malignantmelanoma, breast cancer, and dangerousinfectious diseases.Early Detection for LungCancerThe Baylor Sammons Lung CancerCenter has joined the InternationalEarly Lung Cancer Action Program, agroup of lung cancer experts dedicated toachieving early diagnosis, treatment, andeventual cure of lung cancer.Richard Wood,MD, medicaldirector of theBaylor SammonsLung Cancer Centerand a physicianon the medicalstaff at BaylorDr. Richard WoodDallas, said this is asignificant step to establish early detectionthrough low-dose computed tomography(CT) screening as an accepted practice.“We’re trying to move the paradigmtoward earlier detection of lung cancer,instead of waiting until a patient presentswith symptoms of the disease,” Dr. Woodsaid. “The key is to find the people whoare asymptomatic. Patients who havesmoked 20 years or more or who havehad heavy exposure to second-handsmoke or occupational exposure toasbestos, beryllium, uranium, or radonare primary candidates.”The Baylor Sammons Lung CancerCenter started enrolling patients for thisstudy in 2008. CT scans are provided ata reduced cost to high-risk patients, andthe center is tracking the results.“While CT screening for lung canceris still considered experimental, we aredocumenting our findings and will continueto push for insurance companies tocover the cost,” Dr. Wood said.Aquatic Exercise for BreastCancer PatientsBaylor’s commitment to research forpatients does not end in the laboratory.A study led by Michael Grant, MD,examines the potential effectiveness ofaquatic exercise therapy for breast cancerpatients suffering from lymphedema, aBuilding Hope: Taking Cancer Care to the Next Level 25

Site Tumor Conference Case ReportsBy Marvin J. Stone, MDWhen the Baylor Charles A. Sammons Cancer Center opened on May 1, 1976, one siteconference on gynecologic oncology was already in place. There was also a “tumor board.”Many physicians felt that the older concept of a tumor board, where a small group of physiciansheard about patients with a variety of different types of cancer, was outmoded. Newadvances in multidisciplinary and combined-modality approaches created the need forseparate committees for the major sites. Each site tumor committee in turn was responsiblefor organizing and running a site tumor conference.Back row, left to right: Elaine Lagow, RN, BS, CNA, CCRC, Linda Miller, and Nancy Hawkins,RN, MEd, with Carol Cruz, the 300th participant in the Ovarian Study.condition characterized by inflammationof a limb due to an excess collection oftissues and fluids. Approximately 15% to20% of breast cancer survivors developlymphedema as a result of their cancertreatments.The effectiveness of aquatic therapy isbased on the idea that water pressurehelps compress the swollen limb and aidsthe movement of blood and fluids. Inaddition, water exercises relax muscles,decrease impact on joints, and promotedeep breathing, which collectivelydecrease pain and allow participants tohave better exercise experiences.Early Detection of OvarianCancerBaylor Sammons Cancer Center is participatingin a multicenter trial focusedon early detection of ovarian cancer inlow-risk women. This 3-year study looksat postmenopausal women aged 50 to74 who have at least one ovary and arecancer free, having had no chemotherapyor radiation therapy for at least a year.The goal for the Baylor site is to accrue600 patients over a 3-year period. Sincethe study started in December 2007,310 women have joined.The site tumor conferences have developed into successful endeavors. Baylor Sammons CancerCenter now holds 220 multidisciplinary and educational site-specific conferences each year,with case discussions of about 700 patients. Individual conferences focus on bone and softtissue, breast, chest, skin, head and neck, the endocrine system, the gastrointestinal system,neurology, urology, gynecology, and hematopoietic diseases. Attendance has grown each year tomore than 6,000 attendees in 2007, including representatives from multiple medical disciplinesas well as fellows, residents, interns, nurses, and allied health professionals. Continuing medicaleducation credit is provided.All conferences are sponsored, planned, and implemented by Baylor Sammons Cancer Centersite tumor committees, which report to the cancer center medical committee. These conferenceshave become the “nuts and bolts” of the cancer center and oncology activities at Baylor.They directly contribute to high-quality patient care and learning at multiple levels.I know of no other cancer center or institution that conducts a similar scope of regularmultidisciplinary oncology conferences. The success of our conferences is a result of activeparticipation by numerous physicians. These conferences continue to thrive because of theenthusiasm and devotion to clinical excellence of many members of our medical staff.Baylor University Medical Center Proceedings began publishing one case report in eachquarterly issue, starting in April 2008. The first three published cases were as follows:• Adair CF, Preskitt JT, Joyner KL, Dobson RW. Enlarged thyroid gland with normalthyroid function tests. Proc (Bayl Univ Med Cent) 2008;21(2):179–182.• Mittal A, Felter D, Shiller SM, McCollum AD, Lamont JP, Mallat D. Gastrointestinalbleeding and cutaneous nodules. Proc (Bayl Univ Med Cent) 2008;21(3):331–334.• Oh J, Karunanayake M, Stringer CA Jr. Invasive endometrial lesion in a patient withmental retardation. Proc (Bayl Univ Med Cent) 2008;21(4):426–429.26 Baylor Charles A. Sammons Cancer Center at Dallas

2008 Publications1. Abair T, Card P, O’Shaughnessy J. Highlightsfrom: The 33rd European Society ofMedical Oncology Congress: September2008; Stockholm, Sweden. Clin BreastCancer 2008;8(6):481–486.2. Adair CF, Preskitt JT, Joyner KL, DobsonRW. Enlarged thyroid gland with normalthyroid function tests [site tumor conferencereport]. Proc (Bayl Univ Med Cent)2008;21(2):179–182.3. Albain KS, Nag SM, Calderillo-Ruiz G,Jordaan JP, Llombart AC, Pluzanska A,Rolski J, Melemed AS, Reyes-Vidal JM,Sekhon JS, Simms L, O’Shaughnessy J.Gemcitabine plus paclitaxel versus paclitaxelmonotherapy in patients with metastaticbreast cancer and prior anthracycline treatment.J Clin Oncol 2008;26(24):3950–3957.4. Antoniou AC, Spurdle AB, SinilnikovaOM, Healey S, Pooley KA, Schmutzler RK,Versmold B, Engel C, Meindl A, ArnoldN, Hofmann W, Sutter C, Niederacher D,Deissler H, Caldes T, Kämpjärvi K, NevanlinnaH, Simard J, Beesley J, Chen X; KathleenCuningham Consortium for Researchinto Familial Breast Cancer, Neuhausen SL,Rebbeck TR, Wagner T, Lynch HT, IsaacsC, Weitzel J, Ganz PA, Daly MB, TomlinsonG, Olopade OI, Blum JL, Couch FJ,Peterlongo P, Manoukian S, Barile M, RadiceP, Szabo CI, Pereira LH, Greene MH,Rennert G, Lejbkowicz F, Barnett-GrinessO, Andrulis IL, Ozcelik H; OCGN, GerdesAM, Caligo MA, Laitman Y, KaufmanB, Milgrom R, Friedman E; SwedishBRCA1 and BRCA2 study collaborators,Domchek SM, Nathanson KL, Osorio A,Llort G, Milne RL, Benítez J, Hamann U,Hogervorst FB, Manders P, Ligtenberg MJ,van den Ouweland AM; DNA-HEBONcollaborators, Peock S, Cook M, Platte R,Evans DG, Eeles R, Pichert G, Chu C,Eccles D, Davidson R, Douglas F;EMBRACE, Godwin AK, Barjhoux L,Mazoyer S, Sobol H, Bourdon V, EisingerF, Chompret A, Capoulade C, Bressac-dePaillerets B, Lenoir GM, Gauthier-VillarsM, Houdayer C, Stoppa-Lyonnet D;GEMO, Chenevix-Trench G, Easton DF;CIMBA. Common breast cancer-predispositionalleles are associated with breastcancer risk in BRCA1 and BRCA2 mutationcarriers. Am J Hum Genet 2008;82(4):937–948.5. Arnold CN, Nagasaka T, Goel A, ScharfI, Grabowski P, Sosnowski A, Schmitt-Gräff A, Boland CR, Arnold R, Blum HE.Molecular characteristics and predictorsof survival in patients with malignantneuroendocrine tumors. Int J Cancer2008;123(7):1556–15646. Ballen KK, King RJ, Chitphakdithai P, BolanCD Jr, Agura E, Hartzman RJ, KernanNA. The national marrow donor program:20 years of unrelated donor hematopoieticcell transplantation. Biol Blood MarrowTransplant 2008;14(9 Suppl):2–7.7. Barve M, Bender J, Senzer N, CunninghamC, Greco FA, McCune D, Steis R, KhongH, Richards D, Stephenson J, GanesaP, Nemunaitis J, Ishioka G, Pappen B,Nemunaitis M, Morse M, Mills B, MaplesPB, Sherman J, Nemunaitis JJ. Inductionof immune responses and clinical efficacyin a phase II trial of IDM-2101, a 10-epitope cytotoxic T-lymphocyte vaccine, inmetastatic non-small-cell lung cancer. J ClinOncol 2008;26(27):4418–4425.8. Becerra CR, Verma UN, Tran HT, TavanaD, Williams NS, Frenkel EP. Phase I doseescalation study with irinotecan, capecitabine,epirubicin, and granulocyte colonystimulatingfactor support for patientswith solid malignancies. Am J Clin Oncol2008;31(3):219–225.9. Boland CR. The molecular biology ofgastrointestinal cancer: implications fordiagnosis and therapy. Gastrointest EndoscClin N Am 2008;18(3):401–413.10. Boland CR, Koi M, Chang DK, CarethersJM. The biochemical basis of microsatelliteinstability and abnormal immunohistochemistryand clinical behavior in Lynchsyndrome: from bench to bedside. FamCancer 2008;7(1):41-52.11. Brim H, Mokarram P, NaghibalhossainiF, Saberi-Firoozi M, Al-Mandhari M,Al-Mawaly K, Al-Mjeni R, Al-Sayegh A,Raeburn S, Lee E, Giardiello F, Smoot DT,Vilkin A, Boland CR, Goel A, Hafezi M,Nouraie M, Ashktorab H. Impact of BRAF,MLH1 on the incidence of microsatelliteinstability high colorectal cancer in populationsbased study. Mol Cancer 2008;7:68.12. Burdick JS. Intraductal papillary mucinousneoplasms. Gastrointest Endosc Clin N Am2008;18(3):523–533.13. Davis GL, Dempster J, Meler JD, OrrDW, Walberg MW, Brown B, Berger BD,O’Connor JK, Goldstein RM. Hepatocellularcarcinoma: management of an increasinglycommon problem. Proc (Bayl UnivMed Cent) 2008;21(3):266–280.14. Dhodapkar MV, Dhodapkar KM, PaluckaAK. Interactions of tumor cells with dendriticcells: balancing immunity and tolerance.Cell Death Differ 2008;15(1):39–50.15. Dirix LY, Ignacio J, Nag S, Bapsy P, GomezH, Raghunadharao D, Paridaens R, JonesS, Falcon S, Carpentieri M, Abbattista A,Lobelle JP. Treatment of advanced hormone-sensitivebreast cancer in postmenopausalwomen with exemestane alone or incombination with celecoxib. J Clin Oncol2008;26(8):1253–1259.16. Eager R, Harle L, Nemunaitis J. Ad-MDA-7; INGN 241: a review of preclinicaland clinical experience. Expert Opin BiolTher 2008;8(10):1633–1643.17. Fazel P, Ganesa P, Mennel RG, Austin NA.The ectopic adrenocorticotropic hormonesyndrome in carcinoid tumors. Proc (BaylUniv Med Cent) 2008;21(2):140–143.18. Fini L, Hotchkiss E, Fogliano V, GrazianiG, Romano M, De Vol EB, Qin H, SelgradM, Boland CR, Ricciardiello L. Chemopreventiveproperties of pinoresinol-richolive oil involve a selective activation of theATM-p53 cascade in colon cancer cell lines.Carcinogenesis 2008;29(1):139–146.19. George S, Hutson TE, Mekhail T, Wood L,Finke J, Elson P, Dreicer R, Bukowski RM.Phase I trial of PEG-interferon and recombinantIL-2 in patients with metastatic renalcell carcinoma. Cancer Chemother Pharmacol2008;62(2):347–354.20. Ginsburg A. Cancer-related depression andpotential pharmacologic therapies. Proc(Bayl Univ Med Cent) 2008;21(4):439–441.21. Gralow J, Rugo H, Gradishar W,O’Shaughnessy JA, Jahanzeb M, Perez E,Tripathy D. Novel taxane formulations inthe treatment of breast cancer: a thoughtleader discussion and consensus roundtable.Clin Breast Cancer 2008;8(1):33–37.22. Haugen AC, Goel A, Yamada K, Marra G,Nguyen TP, Nagasaka T, Kanazawa S, KoikeJ, Kikuchi Y, Zhong X, Arita M, ShibuyaK, Oshimura M, Hemmi H, Boland CR,Koi M. Genetic instability caused by lossof MutS homologue 3 in human colorectalcancer. Cancer Res 2008;68(20):8465–8472.23. Hecht JR, Mitchell E, Chidiac T, ScrogginC, Hagenstad C, Spigel D, MarshallJ, Cohn A, McCollum D, Stella P, DeeterR, Shahin S, Amado RG. A randomizedphase IIIB trial of chemotherapy, bevacizumab,and panitumumab compared withchemotherapy and bevacizumab alone formetastatic colorectal cancer. J Clin Oncol2008 Dec 29 [Epub ahead of print].Building Hope: Taking Cancer Care to the Next Level 27

24. Hutson TE. Renal cell carcinoma:what does the future hold? BJU Int2008;102(1):5–6.25. Hutson TE. Sunitinib (SUTENT) forthe treatment of metastatic renal cellcarcinoma. Expert Rev Anticancer Ther2008;8(11):1723–1731.26. Hutson TE, Figlin RA. Experimentaltherapy for advanced renal cell carcinoma.Expert Opin Investig Drugs 2008;17(11):1693–1702.27. Hutson TE, Figlin RA, Kuhn JG,Motzer RJ. Targeted therapies for metastaticrenal cell carcinoma: an overview oftoxicity and dosing strategies. Oncologist2008;13(10):1084–1096.28. Hutson TE, Vukelja S, Atienza D, AwasthiS, Delaune R, Deutsch M, Dien PY,Gregory TF, Kolodziej MJ, Muscato JJ,Raju RN, Ruxer RL Jr, Mull S, Ilegbodu D,Hood K, Nicol S, Berry W. Phase I study ofa 3-drug regimen of gemcitabine/cisplatin/pemetrexed in patients with metastatic transitionalcell carcinoma of the urothelium.Invest New Drugs 2008;26(2):151–158.29. Jones SE. Considerations in treatmentchoice for metastatic breast cancer. BreastCancer 2008;15(1):35–39.30. Jones SE. Metastatic breast cancer: thetreatment challenge. Clin Breast Cancer2008;8(3):224–233.31. Jones S, Stokoe C, Sborov M, Braun M,Ethirajan S, Kutteh L, Pippen J, Patel M,Paul D, Blum JL, Holmes FA, Myron MC,Cantrell J, Hartung NL, Look RM, DiSalle E, Davis JC, Ilegbodu D, Asmar L.The effect of tamoxifen or exemestane onbone mineral density during the first 2 yearsof adjuvant treatment of postmenopausalwomen with early breast cancer. Clin BreastCancer 2008;8(6):527–532.32. Karanes C, Nelson GO, Chitphakdithai P,Agura E, Ballen KK, Bolan CD, Porter DL,Uberti JP, King RJ, Confer DL. Twentyyears of unrelated donor hematopoieticcell transplantation for adult recipientsfacilitated by the National Marrow DonorProgram. Biol Blood Marrow Transplant2008;14(9 Suppl):8–15.33. Kauff ND, Domchek SM, Friebel TM,Robson ME, Lee J, Garber JE, Isaacs C,Evans DG, Lynch H, Eeles RA, NeuhausenSL, Daly MB, Matloff E, Blum JL, SabbatiniP, Barakat RR, Hudis C, Norton L,Offit K, Rebbeck TR. Risk-reducingsalpingo-oophorectomy for the preventionof BRCA1- and BRCA2-associated breastand gynecologic cancer: a multicenter,prospective study. J Clin Oncol 2008;26(8):1331–1337.34. Kuhn JA, Fisher T, Livingston S. Innovationsin surgical oncology at Baylor UniversityMedical Center. Proc (Bayl Univ MedCent) 2008;21(1):33–36.35. Laheru D, Lutz E, Burke J, Biedrzycki B,Solt S, Onners B, Tartakovsky I, NemunaitisJ, Le D, Sugar E, Hege K, JaffeeE. Allogeneic granulocyte macrophagecolony-stimulating factor-secreting tumorimmunotherapy alone or in sequence withcyclophosphamide for metastatic pancreaticcancer: a pilot study of safety, feasibility,and immune activation. Clin Cancer Res2008;14(5):1455–1463.36. Lamborn KR, Yung WK, Chang SM, WenPY, Cloughesy TF, DeAngelis LM, RobinsHI, Lieberman FS, Fine HA, Fink KL,Junck L, Abrey L, Gilbert MR, Mehta M,Kuhn JG, Aldape KD, Hibberts J, PetersonPM, Prados MD; North American BrainTumor Consortium. Progression-free survival:an important end point in evaluatingtherapy for recurrent high-grade gliomas.Neuro Oncol 2008;10(2):162–170.37. Laport GG, Sandmaier BM, Storer BE,Scott BL, Stuart MJ, Lange T, Maris MB,Agura ED, Chauncey TR, Wong RM, FormanSJ, Petersen FB, Wade JC, Epner E,Bruno B, Bethge WA, Curtin PT, MaloneyDG, Blume KG, Storb RF. Reduced-intensityconditioning followed by allogeneichematopoietic cell transplantation for adultpatients with myelodysplastic syndromeand myeloproliferative disorders. Biol BloodMarrow Transplant 2008;14(2):246–255.38. Larsen F, Menter A, Cockerell CJ, WilcoxBN. Verrucous linear (segmental) psoriasisof the right leg responding to radiationtherapy. J Drugs Dermatol 2008;7(10):969–971.39. Loesch D, Asmar L, McIntyre K, DoaneL, Monticelli M, Paul D, Vukelja S,Orlando M, Vaughn LG, Zhan F, BoehmKA, O’Shaughnessy JA. Phase II trial ofgemcitabine/carboplatin (plus trastuzumabin HER2-positive disease) in patients withmetastatic breast cancer. Clin Breast Cancer2008;8(2):178–186.40. Mi Z, Holmes FA, Hellerstedt B, PippenJ, Collea R, Backner A, Bush JE, GallionHH, Wells A, O’Shaughnessy JA. Feasibilityassessment of a chemoresponse assay topredict pathologic response in neoadjuvantchemotherapy for breast cancer patients.Anticancer Res 2008;28(3B):1733–1740.41. Mittal A, Felter D, Shiller SM, McCollumAD, Lamont JP, Mallat D. Gastrointestinalbleeding and cutaneous nodules [site tumorconference report]. Proc (Bayl Univ MedCent) 2008;21(3):331–334.42. Motzer RJ, Bukowski RM, Figlin RA,Hutson TE, Michaelson MD, Kim ST,Baum CM, Kattan MW. Prognosticnomogram for sunitinib in patients withmetastatic renal cell carcinoma. Cancer2008;113(7):1552–1558.43. Motzer RJ, Escudier B, Oudard S, HutsonTE, Porta C, Bracarda S, Grünwald V,Thompson JA, Figlin RA, Hollaender N,Urbanowitz G, Berg WJ, Kay A, LebwohlD, Ravaud A; RECORD-1 Study Group.Efficacy of everolimus in advanced renalcell carcinoma: a double-blind, randomised,placebo-controlled phase III trial. Lancet2008;372(9637):449–456.44. Nagasaka T, Goel A, Notohara K, TakahataT, Sasamoto H, Uchida T, Nishida N,Tanaka N, Boland CR, Matsubara N.Methylation pattern of the O6-methylguanine-DNAmethyltransferase gene in colonduring progressive colorectal tumorigenesis.Int J Cancer 2008;122(11):2429–2436.45. Nagasaka T, Koi M, Kloor M, Gebert J,Vilkin A, Nishida N, Shin SK, SasamotoH, Tanaka N, Matsubara N, Boland CR,Goel A. Mutations in both KRAS andBRAF may contribute to the methylatorphenotype in colon cancer. Gastroenterology2008;134(7):1950–1960.46. Nemunaitis JJ. Are vaccines making acomeback in non-small-cell lung cancer? JClin Oncol 2008;26(9):1402–1403.47. Nemunaitis JM, Nemunaitis J. Potential ofAdvexin: a p53 gene-replacement therapyin Li-Fraumeni syndrome. Future Oncol2008;4(6):759–768.48. Nishida N, Nagasaka T, Nishimura T,Ikai I, Boland CR, Goel A. Aberrantmethylation of multiple tumor suppressorgenes in aging liver, chronic hepatitis,and hepatocellular carcinoma. Hepatology2008;47(3):908–918.49. O’Brien JC. Advances in the care of headand neck cancer patients at Baylor UniversityMedical Center. Proc (Bayl Univ MedCent) 2008;21(1):27–32.50. O’Shaughnessy JA, Brufsky AM. RiBBON1 and RiBBON 2: phase III trials of bevacizumabwith standard chemotherapy formetastatic breast cancer. Clin Breast Cancer2008;8(4):370–373.51. Oh J, Karunanayake M, Stringer CA Jr.Invasive endometrial lesion in a patient withmental retardation [site tumor conferencereport]. Proc (Bayl Univ Med Cent)2008;21(4):426–429.28 Baylor Charles A. Sammons Cancer Center at Dallas

52. Rana S, Maples PB, Senzer N, NemunaitisJ. Stathmin 1: a novel therapeutic target foranticancer activity. Expert Rev AnticancerTher 2008;8(9):1461–1470.53. Reardon DA, Fink KL, Mikkelsen T,Cloughesy TF, O’Neill A, Plotkin S, GlantzM, Ravin P, Raizer JJ, Rich KM, Schiff D,Shapiro WR, Burdette-Radoux S, DropchoEJ, Wittemer SM, Nippgen J, Picard M,Nabors LB. Randomized phase II study ofcilengitide, an integrin-targeting arginineglycine-asparticacid peptide, in recurrentglioblastoma multiforme. J Clin Oncol2008;26(34):5610–5617.54. Rezvani AR, Norasetthada L, Gooley T,Sorror M, Bouvier ME, Sahebi F, Agura E,Chauncey T, Maziarz RT, Maris M, ShizuruJ, Bruno B, Bredeson C, Lange T, Yeager A,Sandmaier BM, Storb RF, Maloney DG.Non-myeloablative allogeneic haematopoieticcell transplantation for relapsed diffuselarge B-cell lymphoma: a multicentreexperience. Br J Haematol 2008;143(3):395–403.55. Rezvani AR, Storer B, Maris M, Sorror ML,Agura E, Maziarz RT, Wade JC, ChaunceyT, Forman SJ, Lange T, Shizuru J, LangstonA, Pulsipher MA, Sandmaier BM, Storb R,Maloney DG. Nonmyeloablative allogeneichematopoietic cell transplantation in relapsed,refractory, and transformed indolentnon-Hodgkin’s lymphoma. J Clin Oncol2008;26(2):211–217.56 . Richards D, McCollum D, Wilfong L,Sborov M, Boehm KA, Zhan F, Asmar L.Phase II trial of docetaxel and oxaliplatin inpatients with advanced gastric cancer and/or adenocarcinoma of the gastroesophagealjunction. Ann Oncol 2008;19(1):104–108.57. Richey DS, Welch BJ. Concurrent primaryhyperparathyroidism and humoral hypercalcemiaof malignancy in a patient withclear cell endometrial cancer. South Med J2008;101(12):1266–1268.58. Rini BI, Michaelson MD, Rosenberg JE,Bukowski RM, Sosman JA, Stadler WM,Hutson TE, Margolin K, Harmon CS,DePrimo SE, Kim ST, Chen I, George DJ.Antitumor activity and biomarker analysisof sunitinib in patients with bevacizumabrefractorymetastatic renal cell carcinoma. JClin Oncol 2008;26(22):3743–3748.59. Rotta M, Storer BE, Sahebi F, Shizuru JA,Bruno B, Lange T, Agura ED, McSweeneyPA, Pulsipher MA, Hari P, Maziarz RT,Chauncey TR, Appelbaum FR, SorrorML, Bensinger W, Sandmaier BM, StorbRF, Maloney DG. Long-term outcome ofpatients with multiple myeloma after autologoushematopoietic cell transplantationand nonmyeloablative allografting. Blood2008 Nov 17 [Epub ahead of print].60. Selgrad M, Koornstra JJ, Fini L, Blom M,Huang R, Devol EB, Boersma-van Ek W,Dijkstra G, Verdonk RC, de Jong S, GoelA, Williams SL, Meyer RL, Haagsma EB,Ricciardiello L, Boland CR. JC virus infectionin colorectal neoplasia that developsafter liver transplantation. Clin Cancer Res2008;14(20):6717–6721.61. Selgrad M, Malfertheiner P, Fini L, GoelA, Boland CR, Ricciardiello L. The role ofviral and bacterial pathogens in gastrointestinalcancer. J Cell Physiol 2008;216(2):378–388.62. Sequist LV, Martins RG, Spigel D,Grunberg SM, Spira A, Jänne PA, JoshiVA, McCollum D, Evans TL, MuzikanskyA, Kuhlmann GL, Han M, GoldbergJS, Settleman J, Iafrate AJ, Engelman JA,Haber DA, Johnson BE, Lynch TJ. Firstlinegefitinib in patients with advancednon-small-cell lung cancer harboringsomatic EGFR mutations. J Clin Oncol2008;26(15):2442–2449.63. Sonpavde G, Fleming MT, Hutson TE,Galsky MD. Trial design for metastaticcastration-resistant prostate cancer. J ClinOncol 2008;26(21):3647–3648.64. Sonpavde G, Galsky MD, Hutson TE.Current optimal chemotherapy foradvanced urothelial cancer. Expert RevAnticancer Ther 2008;8(1):51–61.65. Sonpavde G, Hutson TE. Novel antiangiogenicagents in the treatment of refractoryrenal cell carcinoma. Clin Genitourin Cancer2008;6(3):s29–s36.66. Sonpavde G, Hutson TE, Berry WR, BoehmKA, Asmar L. Phase II trial of sunitinibfor the therapy of progressive metastaticcastration-refractory prostate cancer afterprevious docetaxel chemotherapy. ClinGenitourin Cancer 2008;6(2):134–137.67. Sonpavde G, Hutson TE, Rini BI. Axitinibfor renal cell carcinoma. Expert Opin InvestigDrugs 2008;17(5):741–748.68. Sonpavde G, Hutson TE, Sternberg CN.Pazopanib, a potent orally administeredsmall-molecule multitargeted tyrosinekinase inhibitor for renal cell carcinoma.Expert Opin Investig Drugs 2008;17(2):253–261.69. Sonpavde G, Ross R, Powles T, SweeneyCJ, Hahn N, Hutson TE, Galsky MD,Lerner SP, Sternberg CN. Novel agents formuscle-invasive and advanced urothelialcancer. BJU Int 2008;101(8):937–943.70. Sorror ML, Storer BE, Sandmaier BM,Maris M, Shizuru J, Maziarz R, Agura E,Chauncey TR, Pulsipher MA, McSweeneyPA, Wade JC, Bruno B, Langston A,Radich J, Niederwieser D, Blume KG,Storb R, Maloney DG. Five-year follow-upof patients with advanced chronic lymphocyticleukemia treated with allogeneichematopoietic cell transplantation afternonmyeloablative conditioning. J ClinOncol 2008;26(30):4912–4920.71. Steen S, Nemunaitis J, Fisher T, Kuhn J.Circulating tumor cells in melanoma: areview of the literature and description of anovel technique. Proc (Bayl Univ Med Cent)2008;21(2):127–132.72. Steen S, Stephenson G. Current treatmentof soft tissue sarcoma. Proc (Bayl Univ MedCent) 2008;21(4):392–396.73. Stone MJ. Waldenström’s macroglobulinemia.In Land F, ed. Encyclopedic Reference ofMolecular Mechanisms of Disease. Heidelberg,Germany: Springer-Verlag, 2008.74. Thompson JL, Duffy J. Nutrition supportchallenges in hematopoietic stemcell transplant patients. Nutr Clin Pract2008;23(5):533–546.75. Tong AW, Fulgham P, Jay C, Chen P, KhalilI, Liu S, Senzer N, Eklund AC, Han J,Nemunaitis J. MicroRNA profile analysis ofhuman prostate cancers. Cancer Gene Ther2008 Oct 24 [Epub ahead of print].76. 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Building Hope Through PhilanthropyNorth Texas is expected to see a 21%increase in the number of cancer patientsin the next 5 years. To meet that growingneed, Baylor Health Care System is buildingthe area’s premier dedicated cancercenter at Baylor University MedicalCenter at Dallas. The new cancer centerwill include a 10-story, 450,000-squarefootoutpatient building and renovationof Collins Hospital and Sammons Towerat a cost of $350 million. Baylor HealthCare System Foundation is spearheadingthe campaign to raise the funds to makethis project a reality.$5 Million Gift for BloodCancer ResearchThe Pauline Allen Gill Foundationrecently gave $5 million in memoryof Pauline Gill Sullivan to support thenew cancer center at Baylor UniversityMedical Center at Dallas. Nancy Seay,president of the Pauline Allen GillFoundation, helped orchestrate thegift, which will support hematologicalresearch at Baylor Dallas and establishThe Pauline Allen Gill DistinguishedChair in Hematological CancerResearch.Pauline Gill SullivanMrs. Sullivan’s oncologist, BrianBerryman, MD, will be instrumentalin establishing the program. “Throughthe generosity of the foundation andthe family of Pauline Gill Sullivan,physicians and researchers at Baylor willbe able to conduct more clinical trialsfor patients with hematological cancers,helping us identify the most effectivetreatments for these diseases and,ultimately, bringing advanced care toBaylor patients,” stated Dr. Berryman.Darlene G. Cass and keynote speaker Geralyn Lucas at the Celebrating Women luncheon,which raised $2.2 million to battle breast cancer.2008 Celebrating WomenBaylor Health Care System Foundationhonored women fighting breast cancerat the ninth annual Celebrating Womenluncheon on October 16, 2008, at theHilton Anatole in Dallas. The eventraised $2.2 million for breast cancerresearch, community outreach, andexpanded technology for early detectionand treatment throughout Baylor HealthCare System.More than 1,350 guests heard stories ofwomen’s struggles with the disease fromkeynote speaker Geralyn Lucas, author ofWhy I Wore Lipstick to My Mastectomy.The Circle of Care Award, which honorscommunity heroes active in the fightagainst breast cancer, was given to Nancyand David Burgher and Highland HillsUnited Methodist Church Senior PastorSheron C. Patterson.30 Baylor Charles A. Sammons Cancer Center at Dallas

Dr. Thomas Hutson, Tony Romo, and Carolyn Berry at the EveryMan dinner, which promoted prostate cancer awareness and raised money tosupport expanded technology, research, and community outreach.The Foundation will host its 10thannual Celebrating Women luncheonon October 22, 2009, at the HiltonAnatole. Actress Christina Applegatewill be the featured speaker.Gift for Imaging CenterTechnologyDavid Winter, MD, president of theDiscovery Foundation, announced thatthe board of directors approveda $350,000 grant for new technology inthe Darlene G. Cass Women’s ImagingCenter. The Discovery Foundation grantwill allow Baylor to acquire positronemission mammography, or PEM, whichuses a high-resolution gamma camera.Sometimes referred to as molecular breastimaging, this technology can pick upsubtle differences in the appearance oftumor versus normal tissue. Conventionalmammography can have a falsenegativerate of up to 10%—partly dueto dense breast tissues obscuring thecancer and the large overlap between theappearance of tumor and normal tissue.PEM will help reduce the instances offalse-negative readings. Baylor will be thefirst imaging facility in the Southwest tohave this technology.EveryMan Event for ProstateCancerOn April 30, 2008, Ramiro and TonyRomo joined Baylor Health Care SystemFoundation at the first EveryMan dinnerat the Ritz-Carlton Hotel in Dallas.Ramiro Romo, who was diagnosed withprostate cancer in 2007, addressed the250 guests attending the event designedto promote awareness of prostate cancerand raise money to support expandedtechnology, research, and communityoutreach. Panelists Steven Frost, MD, andPick Scruggs, MD, provided details aboutthe importance of early detection andavailable treatment options. Thomas Hutson,DO, PharmD, shared insights intothe comprehensive research program atBaylor Health Care System and its visionfor the future. Matthew Shuford, MD,also provided attendees an opportunityto interact directly with the da Vinci ®surgical robot, used for advanced surgicalprocedures such as prostatectomies.The Foundation will host EveryMan2009 on May 13, 2009, at the Ritz-Carlton.Former New York City Mayor RudyGiuliani will be the keynote speaker.Building Hope: Taking Cancer Care to the Next Level 31

Telephone DirectoryReferralsBaylor Sammons Cancer Center at DallasPatient Navigation Program (214) 820-3535Baylor Physician ConsultLine1-800-9BAYLORBaylor Patient HelpLine1-800-4BAYLORAdministrationCancer Center AdministrationAlan M. Miller, MD, PhDDirector/Chief of Oncology (214) 820-2881Marvin J. Stone, MD, Director of OncologyMedical Education, Quality, and Safety (214) 820-3445Donna Bowers, JD, RHIA, CHP,Baylor Health Care SystemVice President/Oncology (214) 820-2800Sylvia Coats, Director of Administration (214) 820-3433Ryan T. Seymour, MBA, RHIA,BHCS Director/Oncology (214) 820-6322John McWhorter, MHA, President,Baylor University Medical Center at Dallas (214) 820-4141Texas Oncology, PA (214) 370-1000R. Steven Paulson, MD, President andChairman of the BoardJoni Mokry, RN, OCN, Practice DirectorBaylor Health Care System Foundation (214) 820-3136Department of OncologyAlan M. Miller, MD, PhD, Chief (214) 820-2881DivisionsGynecologic Oncology (214) 370-1300C. Allen Stringer, Jr., MD, DirectorMedical Oncology and OtherInternal Medical Subspecialties (214) 370-1000Robert G. Mennel, MD, DirectorOncologic Pathology (214) 820-2251Daniel A. Savino, MD, DirectorRadiation Oncology (214) 370-1400R. Pickett Scruggs, III, MD, DirectorSurgical Oncology (214) 826-6270John T. Preskitt, MD, DirectorCancer Center ProgramsGraft-vs-Host Disease Clinic (GVHD) (214) 370-1500Blood and Marrow TransplantInpatient Services (214) 820-2619Blood and Marrow TransplantOutpatient Center (214) 370-1500National Marrow Donor Program (214) 820-4279Darlene G. Cass Women’s Imaging Center (214) 820-2430• Diagnostic mammography• Screening mammography• Other breast imagingW. H. & Peggy Smith Baylor SammonsBreast Center (214) 820-9600• Breast cancer prevention research trials• Breast Care for a Lifetime • Breast health education• Personal risk evaluationCutaneous Lymphoma Clinic (214) 370-1500Hereditary Cancer Risk Program• Breast and ovarian (214) 820-9600• Gastrointestinal (214) 820-2692Liver and Pancreas Disease Center (214) 820-1756Lung Cancer Center (214) 820-6767Lymphedema Program (214) 820-1931• Lymphedema prevention and treatment servicesRadiosurgery Center (214) 820-7285ResearchBaylor Institute for Immunology Research (214) 820-7450Jacques Banchereau, PhD, DirectorBaylor Research Institute (214) 820-2687Michael A. E. Ramsay, MD, PresidentBreast Cancer Prevention Research Trials (214) 820-9600Joyce A. O’Shaughnessy, MD, DirectorCancer Immunology Research Laboratory (214) 820-4123Marvin J. Stone, MD, DirectorMary Crowley Medical Research Center (214) 370-1870John Nemunaitis, MD, Executive Medical DirectorNational Surgical AdjuvantBreast and Bowel Project (214) 820-9600Michael D. Grant, MD, DirectorUS Oncology/Texas Oncology Research (214) 370-1000Joanne L. Blum, MD, PhD, Site LeaderSupport ServicesErnie’s Appearance Center (214) 820-8282• Prostheses and specialty care items for cancer patientsScreenings1-800-4BAYLOR• Skin/melanoma (May)• Prostate cancer (Sept)Smoking Cessation Program (214) 820-9791• Martha Foster Lung Care CenterVirginia R. Cvetko Patient Education Center (214) 820-2608• Barrett Lectureship• Community resource referrals• Individual counseling• Nutrition education/support• Patient/family education and support programs:> Amyloid Support North Texas> Blood and Marrow Transplant Inpatient Support Group> Breast Cancer Support Group> Carcinoid Cancer Texas Survivors> North Texas Myeloma Support Group> Oncology Inpatient Support Group> Ovarian Cancer Support Group> Prostate Cancer Education and Support Group> Support for People with Oral and Head and Neck Cancer> Virginia R. Cvetko Living with Cancer Series> Waldenström’s Macroglobulinemia Support Group• Patient resource centers/oncology libraries> 6 Collins Hospital> 6 Roberts HospitalWorth Street Valet Parking (214) 820-8077Patient Transport (214) 818-640032 Baylor Charles A. Sammons Cancer Center at Dallas

Location MapsHall StreetBaylorCollege ofDentistryRobertsHospitalTruettHospitalJunius StreetBaylor SammonsCancer CenterLot 23Gaston AvenueHoblitzelleHospitalWadleyTowerBarnettTowerLot 25 UndergroundParking Garage 8Garage 30UndergroundParking Garage 3CoveredParkingLot 4ParkingGarage 5Lot 46ParkingGarage 6(Staff)Washington AvenueI-35EDALLAS N. TOLLWAYI-35ELEMMONWOODALL RODGERS FWY.US 75 N. CENTRAL EXPY.LIVE OAKWASHINGTONGASTONHASKELLPEAKWORTHLIVE OAKI-30GASTONCARROLLWORTHMAINPEAKFITZHUGHHALLMALCOLM XLot 12HASKELLFuture Siteof the NewCancer CenterWorth StreetBass HallBaylorSchool ofNursingLot 14ELMCOMMERCEDOWNTOWN DALLASI-30FIRSTBAYLOR UNIVERSITYMEDICAL CENTERAT DALLAS CAMPUSSTATE FAIRGROUNDSROBERT B. CULLUMSelf ParkingValet ParkingI-30BAYLOR SAMMONSCANCER CENTERI-45MALCOLM XI-35EUS 175Baylor Sammons Cancer Center is located on the campus ofBaylor University Medical Center at Dallas and is accessiblefrom U.S. 75 (North Central Expressway)/I-45 and 1-30.Valet parking is available at the front entrance and other nearbylocations. Self parking is conveniently located adjacent to theBaylor Sammons Cancer Center.

Baylor UniversityMedical Center at Dallas3500 Gaston AvenueDallas, Texas 752461-800-4BAYLOR(214) 820-3535BaylorHealth.com/DallasCancerBaylor Health Care System wantscancer patients in North Texas tohave access to advanced cancerprevention, screening, diagnosis,treatment and research—close tohome where they can be supportedby their loved ones. Baylor HealthCare System Foundation supportsthat vision, and to that end, it israising funds for Baylor’s new, $350million cancer center project. Tolearn more about giving opportunities,please contact the Foundationat (214) 820-3136 or Foundation@BaylorHealth.edu.