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Back to Hamburgers and Roping Steers: New Treatment Gives Teenager Hope

Conquest - Fall 2009


By Sara Farris

It’s just two days before surgery and Daniel Porras, 15, is joking with his family as he waits for an appointment with his oncologist. When asked if he is nervous about his pending 10-hour surgery, Daniel shrugs and says he just wants to make sure he gets a Chick-fil-A sandwich before he is admitted.

Behind his dark brown eyes, smile and
larger-the-life personality, Daniel Porras
epitomizes a resilient spirit that keeps
him getting back on the horse and
fighting his disease.

Watching the teen interact with his family, one wouldn’t know that he is battling a rare and highly aggressive cancer called desmoplastic small round cell tumor (DSRCT). This soft tissue cancer primarily occurs as multiple tumors in the abdominal area and often resists standard chemotherapy and radiation.

DSRCT treated with standard therapy has a poor long-term survival outcome according to Daniel’s surgeon, Andrea Hayes-Jordan, M.D., assistant professor in the departments of Surgical Oncology and Pediatrics at
M. D. Anderson.

Wanting to improve the chance of survival for these patients, Hayes-Jordan recently translated an adult surgical procedure called continuous hyperthermic peritoneal perfusion (CHPP) so that it could be performed in children. She is the first and only surgeon performing this novel procedure on children in North America.

As part of the CHPP procedure, Hayes-Jordan surgically extracts as many tumors as possible before running heated chemotherapy agents through the abdominal area to kill remaining tumor cells. The heat and chemotherapy create a synergistic effect against the tumor.

“When regular surgery and chemotherapy are given, tumors of this kind usually return within four to five weeks,” Hayes-Jordan says. “However, with chemotherapy and the CHPP surgery, we are able to extend the disease-free time to several months. Patients receiving this surgery have more than a 70% chance of surviving for three years or more compared to the 20% survival rate of those who don’t receive the procedure.”

Not so eager at first

Although CHPP has a low risk for side effects in children, Daniel originally refused to undergo the surgery in 2007. Having already had surgery, chemotherapy and an autologous stem cell transplant (harvested from his own stem cells) in Lubbock and Fort Worth, Texas, he was not eager to have another surgery and more rounds of chemotherapy when he arrived at M. D. Anderson. However, a physician friend in League City, Texas, convinced Daniel and his family to go through with the operation.

“When your child is sick and you don’t have many options, you go with what you think is the best choice, and you give it your best shot,” Daniel’s mother, Laura, says.

Daniel came through this CHPP surgery with flying colors.

“I remember when I woke up from surgery that the first thing I wanted was a big hamburger. Unfortunately, they wouldn’t let me eat solid foods for a while,” Daniel says. “That burger was so good when I finally got to eat it.”

Andrea Hayes-Jordan, M.D., is the
first and only surgeon to perform
the procedure called continuous
hyperthermic peritoneal perfusion
on children.

In just a few days, Daniel was out of the hospital and set on returning to his normal routine. He went back to West Texas and continued to practice one of his favorite activities — team penning, a rodeo sport where he ropes steers on horseback with another roper.

Daniel stayed in remission for 1½ years, but in February of 2009, he relapsed. After additional chemotherapy, Daniel underwent his second CHPP surgery in June. Within a week of his surgery, the teen was up and about and ready to head home.

“Daniel is amazing,” says Holly Green, physician assistant at the Children’s Cancer Hospital at M. D. Anderson. “He has so much energy and personality. He rebounds quicker than most patients I know and continues to overcome his disease.”

Although Daniel still has a tough battle ahead of him, he continues to beat the odds, more than four years after his original diagnosis.

Rare treatment for rare cancer

Since Hayes-Jordan performed the first CHPP surgery in 2006, the number of cases she has treated for this rare disease has continued to grow. She has presented internationally on the novel surgery and is currently working with Memorial Sloan-Kettering Cancer Center in New York and the National Cancer Institute on a new study for DSRCT.

The study will offer pediatric patients at the Children’s Cancer Hospital at
M. D. Anderson and at Memorial Sloan-Kettering a new chemotherapy regimen followed by an initial surgery to remove the tumors. Then patients may choose between having the CHPP surgery, receiving an antibody therapy or receiving a T cell therapy.

“DSRCT is a disease we haven’t found a cure for yet, but it is really encouraging to see how these new therapies are making a significant impact on the lives of our patients,” Hayes-Jordan says. “Patients like Daniel are the drivers that encourage these collaborations on rare diseases, so that one day we can find a cure.”

Highlights

  • Always a Smile

    Daniel Porras has a lively spirit that always finds a way to shine through.

  • Taking a Break

    Daniel Porras relaxes for a moment outside the Robin Bush Child and Adolescent Clinic.

  • Picture This

    Holly Green, a physician assistant in the Children's Cancer Hospital at M. D. Anderson, enjoys looking through some photos with Daniel Porras.

  • Greeting for a Friend

    Daniel Porras strikes a pose for Sheila Brown, a child life specialist in the Robin Bush Child and Adolescent Clinic.

  • Dynamic Duo

    Daniel Porras and his physician, Andrea Hayes-Jordan, M.D., have formed a nice bond during his treatment.

  • On the Go

    Never one to sit still for long, Daniel Porras is backed by his support team of Andrea Hayes-Jordan, M.D., Holly Green and his parents.


© 2014 The University of Texas MD Anderson Cancer Center