New procedure helps brain tumor patients

Operating on what was once considered inoperable, a procedure for people with deadly brain tumors also removes a part of the brain.

Erik Humphrey says, "I didn't see myself being an older man, I didn't plan on 40."

He was diagnosed with a grade-three brain cancer and developed a tumor the size of two golf balls.

"I was waiting to die. I thought, all I knew is it was bad."

Living with this for more than three years is rare.

However, Dr. Kris Smith of Barrow Neurological Institute recommended Erik try something that could give him more time called subpial resection.

It focuses on functional divisions in the brain called the gyri.

Dr. Smith says, "When a tumor occurs, it usually occurs in this type of glioma, within one gyrus."

The aggressive technique removes not just the tumor, but the entire gyrus involved.

"My belief is that you have to be as aggressive as possible getting to that natural border. If a gyrus is already infiltrated and sacrificed, just take the whole thing, don't leave any of it behind."

Dr. Smith says the subpial approach and months of daily radiation, coupled with a year of treatment with a powerful new chemo drug called Temodar, can give people like Erik a better chance at a longer life.

It has been nine years, three times as long as Erik's best survival odds predicted.

Though the brain surgery cost him some of the movement in his left arm and leg, to him, it is a small price to pay for more time.

Dr. Smith is one of the only doctors in the United States using the subpial resection approach to fight malignant brain tumors.

He is currently teaching the technique to surgeons from around the world.

RESEARCH SUMMARY

BACKGROUND: Glioma is a broad term of brain and spinal cord tumors that comes from glial cells. Glial cells are the main brain cells that can develop into cancer. The symptoms, prognosis, and treatment of a malignant glioma can vary depending on the person's age, the exact type of tumor, and the location of the tumor within the brain. These tumors tend to grow or infiltrate into the normal brain tissue, which makes surgical removal very difficult and even impossible for some patients. This makes the prognosis for many patients very dim. 42% of all brain tumors, even benign tumors, are gliomas, 77% of malignant brain tumors are gliomas. (Source: www.medscape.com, www.webmd.com).

SYMPTOMS: Symptoms of a glioma are similar to other malignant brain tumors and vary depending on the area of the brain affected. The most common symptom is headache -- affecting about half of all people with a brain tumor. Other symptoms can include seizures, memory loss, and physical weakness, loss of muscle control, visual symptoms, language problems, cognitive decline, and personality changes. These symptoms may change, according to which part of the brain is affected. Symptoms may worsen or change as the tumor continues to grow and destroys brain cells, compresses parts of the brain, and causes swelling in the brain and pressure in the skull. A person may be unaware that they have tumor as the symptoms can be somewhat deceiving. (Source: www.webmd.com).

CAUSES: The only known risk factor for malignant gliomas is prior radiation to the brain. Family history accounts for less than 5% of causes for developing these tumors. Some genetic disorders increase the risk of development of these tumors in children but rarely in adults. There are no lifestyle risk factors linked to malignant gliomas. This includes alcohol, cigarette smoking, or cell phone use.(Source:www.webmd.com).
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NEW TREATMENT: Traditional treatments for glioma patients include surgical removal of the tumor, or chemo and radiation therapy. Unfortunately, gliomas can grow back very quickly so although treatments may initially appear to be working, once treatments are stopped the tumors can resurface. Now, an approach that has been common in other countries is also being used by one doctor in the United States. An alternative approach call subpial resection commonly used to treat seizures is also used to treat gliomas. The results attained from removal of the glioma have shown great success in some patients.

"My belief is that surgeons should make every attempt to remove these kinds of brain tumors all the way to their natural borders if possible. I believe you should go right to those edges and peel the tumor and the brain off of the pia and remove it to its boundaries," Dr. Kris Alan Smith, a Neurosurgeon at the Barrow Neurological Institute, said. "Even with this technique however, I recognize that there is a deep margin within the brain that will still harbor some infiltrative tumor cells. But with the most aggressive surgical removal possible, the adjunctive therapies, like radiation and chemotherapy, have a much higher chance of working because they're working on a far smaller number of cells." (Source: www.indiasurgerytour.com, www.mayoclinic.org, interview with Ivanhoe Broadcast News).

FOR MORE INFORMATION, PLEASE CONTACT:

Carmelle Malkovich
Public Relations
St. Joseph's Hospital and Medical Center
(602) 406-3319
Carmelle.malkovich@chw.edu


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