Advances in brain tumor therapies offer speedier recoveries

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Spring 2013

Surgery remains a mainstay treatment for brain tumors, but advances in technology and new clinical trials mean patients have more treatment options–some noninvasive–and quicker recoveries.

“We have to attack brain cancer from all sides using different approaches,” says Albert Kim, MD, PhD, a Washington University neurosurgeon at Barnes-Jewish Hospital. “That’s going to be the most effective strategy, and that’s what we offer here.”

Physicians at the Siteman Cancer at Barnes-Jewish Hospital and Washington University employ neuronavigation, or brain GPS, endoscopy for minimally invasive surgeries and other advanced tools. They’re also developing and using next-generation brain tumor technology, including:

  • Improved brain mapping that allows neurosurgeons to monitor and protect critical brain areas while a patient is anesthetized. Older technology allowed mapping only during awake craniotomies.
  • Intraoperative MRI, which allows surgeons to identify diseased brain tissue before surgery is completed. In the past, a follow-up MRI was performed a day or so after surgery and, based on those results, some patients required a second surgery.

Washington University neurosurgeons also use an MRI-guided laser treatment that can reach deep-seated tumors traditionally thought to be inoperable and achieve successful outcomes. The procedure is especially helpful for patients with medical comorbidities that make open surgery too risky. It also improves the effectiveness of chemotherapy on brain tumors, says David Tran, MD, PhD, a Washington University neuro-oncologist at Barnes-Jewish Hospital.

“By heating up the tumor using this device, you can also disrupt the blood-brain barrier,” he says. “So we’re using the device to achieve cytoreduction but also to increase delivery of chemotherapy.”                                   

A clinical trial expected to begin this spring will further study the technology.

Other ongoing clinical trials at Siteman will study the effectiveness of brain tumor vaccines. One strategy calls for collecting fresh tumor tissue in the operating room and processing it in a lab into a “soup.”. Next, researchers collect dendritic cells from a patient and activate them ex vivo using the tumor soup before they are reinfused into the patient in the form of a vaccine. A similar approach, currently available only at a few major cancer centers, is being used to develop personalized vaccines that use T cells rather than dendritic cells.

Another type of vaccine targets a genetic mutation unique to glioblastoma, the most common high-grade brain cancer and the most aggressive. Early data from these vaccine drugs shows that patients who received the vaccine in addition to the current standard therapy live more than twice as long as patients who received standard therapy alone. The side effects were, in most cases, no worse than those of a flu vaccine, Tran says.

Genomic sequencing offers another step forward. By studying a patient’s DNA, researchers are learning which mutations will predict for responses to a particular drug.

Such advances, whether in genomics, technology or basic science, could ultimately mean more treatment options and better outcomes, Kim says.

“There are parts of the tumor that cannot be treated with surgery, and we have to tackle them using other means,” he says.