“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 and the Alvin J. Siteman CancerCenter. “That’s going to be the most effective strategy, and that’s what we
Physicians in the department of neurosurgery employ neuronavigation
endoscopy, or brain GPS, 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.
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 Siteman.
"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 will further study
Other ongoing clinical trials at
Siteman are examining the effectiveness
of brain tumor vaccines
. One strategy calls
for collecting fresh tumor tissue in the
operating room and processing it in the lab.
Next, researchers collect dendritic cells
from a patient and activate them ex vivo
before they are reinfused into the patient in the form of a vaccine.
A similar approach,
only at Siteman and
a few other major
cancer centers, is
being used to develop
that use T cells rather
than dendritic cells.
of vaccine targets a
genetic mutation unique to glioblastoma,
the most common high-grade brain cancer
and the most aggressive. Early data 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
adverse side effects were, in most cases, no
worse than those of a flu vaccine, Tran says.
step forward. By studying a patient’s DNA,
researchers are learning which mutations
predict response to a particular drug.
Such advances, whether in genomics,
technology or basic science, could ultimately
mean more treatment options and better
outcomes, Kim says. “Parts of the tumor
cannot be treated with surgery, and we have
to tackle them using other means.”