Aspiring chef Todd Barnes in the kitchen of his Oakland apartment.

Cancer-free for 24 years

A new treatment developed at Children's Hospital 24 years ago helped Todd Barnes survive liver cancer. The Oncology team's new treatment has a 95% survival rate.

Twenty-four years ago, at Children’s Hospital & Research Center Oakland, Todd Barnes beat a hepatoblastoma so aggressive, after one round of surgery and chemotherapy it came back, metastasizing in his lungs.

But new treatment methods developed at Children’s helped him survive.

Those methods, called “protocols,” have also led to a dramatic survival rate of 95 percent for children with hepatoblastoma who were fully treated at Children’s. That’s significantly greater than the national average of 69.2 percent for this type of pediatric liver cancer.

Todd was 7 months old when he was diagnosed and nearly 4 when his treatment was complete. He still remembers the 5th-floor playroom and walking around with an IV pole by his side. A scar on his chest reminds him of the Broviac (explanation) that was once inserted there.

"I feel really fortunate," he said. “My health is good, I’m still a fast healer, and I have people who love me.”

Todd is now 28, a strapping six-foot, two-inch-tall athlete who especially enjoys cycling and hockey. He has traveled the world, including Thailand, Fiji and the Virgin Islands and is interested in cooking and working with children.

Right now he works at Trattoria Laurellinos in Oakland and is considering returning to college to complete a BA in psychology.

Just Keep Treating; Don't Give up on Patients

While the overall numbers may be small (25), James Feusner, MD, director of Children’s Oncology program, confidently compares Children’s data from 1976 through October 2008 with National Cancer Institute data collected for about 100 patients by the Surveillance, Epidemiology and End Results (SEER) program from 1999 to 2005.

“We may not be the biggest pediatric cancer program, but we’ve made some significant contributions to clinical cancer care,” said Dr. Feusner, a 30-year veteran of Children’s Oncology program. “We recognized that with this kind of cancer, a pulmonary recurrence doesn’t have to be fatal. Just keep treating. We don’t give up on patients if they develop pulmonary metastases.”

After the cancer came back—into Todd’s lungs—a second surgery, in his lungs, was performed. This was followed by a second course of chemotherapy.

Compared to other kids his age at Children’s Hospital, Todd showed he could tolerate more aggressive chemotherapy.

Todd was first child to receive continuous infusion protocol
With his parents’ consent, Todd was the first child at Children’s to receive continuous infusion of high dosages of cisplatinum and doxorubicin together, two very powerful anti-cancer drugs. The protocol used by Dr. Feusner’s team succeeded in shrinking the remaining tumors.

Eventually Todd was cancer clear.

These days Todd lives in an Oakland house he shares with two pets: a Jack Russell puppy named Ophelia and an albino corn snake named Supernova.

Two More Things Learned about Hepatoblastoma

Dr. Feusner said he and his staff have also discovered two other significant things about hepatoblastoma.

• When the type of hepatoblastoma is “small cell,” the usual treatment regimens don’t work. A different approach is needed. Such a protocol is now being piloted in a national study that began in September.
  
  
• An association was found between prematurity at birth and a greater probability of hepatoblastoma occurrence. The more premature the birth of a baby, the greater the risk of hepatoblastoma.

Dr. Feusner has contributed to more than 180 publications about pediatric cancer, including papers, abstracts and book chapters.

He also teaches what he’s learned to Children’s residents on Oncology rotations: “Careful clinical observations can still uncover useful results applicable to improving treatments and outcomes,” said Dr. Feusner.

Todd Barnes is the living proof.

For a referral, or more information about oncology treatment at Children’s Hospital
Oakland, a member of the national Children’s Oncology Group, call 510-428-3372.

This story, written and photographed by senior writer Tom Levy, was first published in the October 2009 issue of Children’s Hospital’s PEDSnews magazine.