A Remarkably Successful New Brain Cancer Treatment
Brain surgery is widely considered one of the most demanding, complex, and technologically advanced specialties, often ranked among the most difficult medical fields to enter, with training programs taking many years.
Brain surgery can be incredibly complex, with a risk of serious consequences. Even the most successful brain surgeries can result in complications post-surgery including hemorrhage, infections, brain swelling, seizures, and cerebrospinal fluid leaks. Even if the surgeon reports that surgery went well and was successful in addressing the objective, the patient is not out of danger.
When the brain surgery is intended to remove or treat an aggressive cancer within the brain, the stakes are even higher.
A recent study revealed an interesting side benefit to an advanced innovative surgical procedure that may lead to greater survival of patients with particularly challenging types of brain cancer.
A novel technique that has begun to revolutionize brain surgery is the use of specific types of lasers.
Lasers have been used by surgeons since 1962. Lasers can be used to cut tissue, instead of a scalpel. They can also be used to destroy tissue by heating it. This process is called ablation. It may be used on a cancerous growth or other tissue that needs to be removed.
This article is about the use of a laser surgical technique called Laser Interstitial Thermal Therapy (LITT). This technique is growing rapidly as a method used in brain surgery to destroy brain tumors or epilepsy-causing lesions.
Traditional brain surgery techniques often require craniotomies, where a section of the skull is cut open, then replaced after surgery with metal fasteners. This has been the best way for a surgeon to access the brain tissue for many decades. The size of the hole may vary from an inch to larger, depending on what kind of surgical instruments must be used inside the brain.
This is one clear advantage of using LITT. In most applications, the hole need only be as large as a pencil. This leads to fewer complications, faster healing, and usually an earlier release for the patient to go home.
A recent study has also revealed an unexpected advantage of using LITT surgery, especially for specific forms of brain cancer treatment.
There are over 125 known types of brain cancer. Brain cancers can be primary – originating in the brain. Or they can be metastatic – meaning the cancer originates somewhere else and spreads to the brain. Then cancers are classified as to the types of cells that are involved, the location, and the stage of development.
Major categories include gliomas (such as glioblastoma and astrocytoma), which form in support cells, and other types like medulloblastoma, meningioma, and lymphoma.
The study I referred to involved treatment of high-grade astrocytomas. These tumors are very aggressive. In the past, treatment efforts have centered on traditional brain surgery, radiation treatment, and chemotherapy.
Unfortunately, in spite of valiant efforts, most cases are fatal within a few months. Problems involve complications from traditional brain surgery and radiation treatment. Chemotherapy is limited due to the blocking of the drugs by the blood-brain barrier (BBB).
The blood-brain barrier is a very tightly-packed network of specialized cells that provides a protective barrier surrounding the brain. Water, gases (oxygen, carbon dioxide), as well as small cells can pass through, but larger cells, pathogens and toxins are blocked. Although this protects the brain well, it prevents drugs such as chemotherapy from reaching the brain.
LITT surgery was discovered several decades ago. But recent observations have thrust this surgical innovation to the forefront of scientific study and utilization.
Beyond the previously mentioned advantages of LITT over traditional surgery, another remarkable advantage has been revealed.
When the laser fiber is introduced into the astrocyte tumor, often located near the BBB, the laser energy is applied in a precise way to heat the target tissue (tumor) to the point that the cells are destroyed. This kills the tumor.
Obviously, the destruction of the tumor is a major objective of the treatment. Since the procedure is carried out under the observation of live MRI scanning, doctors were able to see that edema formed around the target of the laser treatment. They observed that this procedure inadvertently had the effect of causing the blood-brain barrier to allow passage of chemotherapy drugs that had previously been blocked.
Incredibly, this altered permeability of the BBB lasted from 2 up to 6 weeks after the LITT surgery.
“Patients with this type of advanced cancer have few remaining options and poor outcomes, and this approach could meaningfully extend their survival time and provide new hope for patients and their loved ones," explained David Tran, MD, PhD chief of neuro-oncology with Keck Medicine of USC in a press release.
This means it is now possible to treat astrocytomas and other tumors within the brain with effective chemotherapy, in particular, the drug pembrolizumab, which is effective in treating this tumor.
This is a groundbreaking, revolutionary improvement for some types of brain cancer treatment. In the study that was released only a couple of months ago, 42% of high-grade astrocytoma patients treated with LITT and pembrolizumab were still living at 18 months. This compared with 0% of patients treated with traditional treatments.
Even better, almost one third of these patients were still alive at 3 years after the procedure.
To read the original journal article, click here: https://dr-kestner.com/litt-astrocytoma-study
Dr. Mark Kestner
