UA Targets Fatal Brain Cancer In A New Way

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Radiation used inside tumors

By Carla McClain

Arizona Daily Star

A radical new treatment aimed at prolonging the lives of patients suffering fatal brain cancer has been used for the first time in Arizona, on two UA patients, doctors announced.

The treatment—placing a tiny balloon filled with radioactive material inside the patient’s brain—is expected to double the survival time of patients battling this most aggressive form of brain tumor

Only 20 medical centers in the United States so far have been approved to use the complex technology and highly radioactive materials required for the procedure.

The University of Arizona became one of those centers—and the only one in Arizona—in November, when the first patient, a 46-year-old man from Douglas, had the radioactive balloon inserted in his brain, to try to kill off his returning cancer.

A second patient—a 25-year-old Tucson woman—underwent the procedure in January.

"It’s an ingenious way of radiating the tumor from within the brain, instead of from the outside of the brain," said Dr. Dino Stea, the UA Radiation oncologist who has pioneered the technology in Arizona, working with Tucson neurosurgeon Dr. Abhay Sanan.

"That way, we get another good shot at these tumors—which always grow back—without damaging the healthy brain," Stea said.

"It’s not a home run—it doesn’t cure this cancer—but we think it will give our patients significantly longer survival with a good quality of life."

Both of Stea’s patients have a form of brain cancer known as glioblastoma, a disease that strikes 16,000 Americans every year.

About half of those patients—including the two UA patients—have extremely aggressive "high-grade" tumors. With standard treatment, they are expected to survive only about nine months to a year, studies show.

Both patients did undergo standard treatment after diagnosis—surgery to remove as much tumor as possible and to implant wafers at the tumor site.

That was followed by a grueling six weeks of daily conventional radiation—radiation beamed at the tumor site from outside the brain, to try to kill off the remaining microscopic cancer cells left in the brain.

Radiation delivered that way, externally, must travel through healthy brain tissue to reach the tumor, always risking some degree of brain damage, including memory loss, Stea said.

And in both cases, the cancer grew back within a year, as always happens with high-grade glioblastoma.

At that point, Stea and Sanan turned to the new balloon technology for these patients. Both underwent a second surgery, with Sanan removing the new tumor, then implanting the balloon in the tumor cavity. Several weeks later, Stea infused the balloon with an intensely radioactive iodine solution during a period of four days in the hospital.

In clinical trials leading to the recent approval of this technology, patients who got it survived an extra year, and suffered minimal side effects and no brain damage, Stea said.

"At this point, when the cancer returns, the healthy brain can tolerate no more radiation, but it was insufficient to kill the cancer," Stea said. "The balloon allows us to get more radiation directly to the tumor site, at a very high dose, but without risk to healthy tissue."

Now, three months after the balloon radiation, UA pioneer patient Paul Behrens, of Douglas, described the entire procedure as problem-free.

"The hardest part was being confined to the hospital room for the entire four days because my head was radioactive. My family had to stay 3 feet away from me," he said, laughing at the notion.

"I was kind of expecting my head to glow, or to get X-ray vision—that would be cool—but that didn’t happen."

Behrens said he suffered no pain, no cognitive deficits, and no negative side effect from the treatment.

"I give it a complete thumbs-up," he said. "It really beats those six weeks of radiation. That was tough. This was easy compared to that. It just went so well."

A man of good humor and deep faith, Behrens is well aware that he will likely live a longer life, but his cancer will not be cured.

"I have to discuss this with God—he’s the one who knows how much time I have. That’s how I look at it," he said.

"I’ll tell him what I would like, but then I’ll leave it in his hands."

[copied from our local daily newspaper, the Arizona Daily Star, Tucson, Arizona, USA, Saturday February 23, 2001 ]