Contact: Kathryn Holleman
The brain tumors Albert H. Kim, MD, PhD, sees are often the most difficult to treat. As a physician-scientist, he attacks them on two fronts – the operating room and the laboratory.
Dr. Kim is the newest member of the Washington University School of Medicine Department of Neurological Surgery. As a skull base and oncologic neurosurgeon, he often operates on tumors located deep in hard-to-access parts of the brain.
“Malignancies are always bad,” he says. “But with brain tumors, it’s as much about location as it is about being benign or malignant since the brain controls so much of what we do, controls so much of who we are.”
Advances in technology have made the surgery safer and more precise, says Dr. Kim. These include stereotactic guidance systems that act like GPS to guide surgeons through the brain, and surgical suites equipped with MRI machines which allow surgeons to make images during a procedure to make sure the maximum amount of tumor is removed without damaging brain tissue. Additionally, advances in mapping brain function, spearheaded here by neurosurgeons, have made tumor surgery safer.
Still, these procedures are often risky and are notoriously grueling for both the surgical team and the patient.
“But it’s important to emphasize that surgery is just one component of the whole problem,” Dr. Kim says. “[Brain tumor] is not just a surgery problem. It’s a medical oncology problem. It’s a radiation oncology problem. Also, often these patients have other pre-operative conditions that require the help of other smart people - internists and cardiologists, for instance - to make sure they can withstand the treatment.”
Despite the technological and treatment advances, however, many brain cancers are, essentially, not curable, he says.
Glioblastoma multiforme, for instance, is the most common and most aggressive of malignant brain tumors. Because the tumor’s borders are very indistinct, it’s difficult, if not impossible, for surgeons to remove every bit of it without damaging surrounding brain tissue.
“Cancer generally is just a very difficult, complex problem,” Dr. Kim says. “Of course a [brain tumor] cure would be great. But there are a lot of things we need to know, a lot of things we need to examine, a lot of things we need to test to cure brain tumors. An equally good goal perhaps would be to control these tumors.”
Turning brain tumors into a manageable, chronic disease by using currently available technologies, and then developing a drug to prevent regrowth or spread of the cancer cells “would be a great achievement,” he says.
And so, Dr. Kim approaches the problem on a molecular level in his lab.
“My focus in the past has been on development of the brain,” he said. “I want to take advantage of what we know about how the brain develops to confront malignant tumors of the brain.
For instance, by studying the biology of glioblastoma - “the worst player in the spectrum of tumors called gliomas” - he and other scientists hope to discover a window of susceptibility that will let them control the tumor and “make a real impact for these patients,” he says.
Dr. Kim trained in neurosurgery at Harvard Medical Center’s Brigham and Women’s Hospital, followed with a fellowship in skull base and cerebrovascular surgery at the University of Miami’s Jackson Memorial Hospital.
He was drawn to Washington University, he says, because of the Department of Neurosurgery’s long history of expertise in treating difficult tumors and “high density” of physician-scientists. Also, the resources and staff of Barnes-Jewish Hospital and the Siteman Cancer Center offer a full spectrum of care and support for patients and their families.
Dr. Kim looks forward to working in both the operating room and lab during the next few years. Increased funding and renewed interest in advancing understanding of the brain and treatment of brain tumors will lead to significant advances, he feels.
“As devastating a group of diseases as this is,” says Dr. Kim, “this is an exciting time. It’s a time of hope.”