Surgical Innovations That Enhance Smooth Transition
to Clinical Trials for Brain Cancer Patients
Arnold B. Etame, MD, PhD
Patients with brain cancers will invariably
require second-line of therapies following
failure with standard therapy. For these
patients, the selection of second-line
therapies is very important especially
since the cancer is more resistant at
that stage. Therefore, personalized
cancer-care strategies and clinical trials
are paramount for patients whose brain
cancers have progressed on standard
therapy. For these patients, the Moffitt Neuro-Oncology Program
is uniquely positioned to provide multiple treatment options from
a large list of clinical trials in conjunction with innovative surgical
approaches.
Surgery is an important component in treating patients with
brain cancers that are refractory to therapy. Through surgery,
we can characterize from a personalized-cancer-care perspective
the molecular changes that have occurred between the original
brain cancer and the now-resistant tumor. Usually resistant
brain cancers produce proteins, which counteract the effects
of chemotherapy and radiation. Such changes can then be
employed in guiding therapy. As an example, a new signaling
protein pathway for which there is a therapeutic solution can
be uncovered. In that scenario, patients can be treated with
agents that are unique to the biology of the cancer.
Surgery can also be critical for reducing tumor burden. Since the
new cancer is mostly resistant, surgery reduces the amount of
resistant disease that would require treatment thereby enhancing
response to therapy. As an example, glioblastoma is one of the
most lethal and resistant brain cancers for which there is a
significant demonstrable benefit that correlates with how much
tumor is removed in surgery. Therefore the paradigm has always
been maximum-safe resection.
Another important goal of surgery is functional preservation so
patients can easily transition to clinical trials after surgery.
If neurological function is compromised, patients might not be
able to withstand the rigors of clinical trials. Therefore, innovative
surgical approaches for brain cancers are warranted. The overall
goal is maximum-safe resection whereby the surgeon removes
what is safely possible.
Moffitt Cancer Center is leading the way with innovative
surgical strategies that facilitate safe removal of brain cancers.
We have a successful awake-brain-surgery program where over
75% of patients go home within 24 hours of removal of brain
tumors in critical areas of the brain. We also have a Tractography
Program, which allows surgeons to understand and avoid damage
to critical white matter bundles adjacent to the tumor (Figure 1).
Lastly we have an intracranial laser ablation program purposely
designed for resistant brain cancers in areas of the brain that
were once considered inoperable (Figure 2). Through a 3mm
incision, a laser probe is advanced to the tumor using MRI
guidance. Laser heat is then employed to destroy the tumor.
We have excellent results so far with this technique and patients
were all discharged home within 24 hours of surgery (Figure 3).
Thanks to technological advances in brain tumor surgeries as well
as advances in personalized cancer care, Moffitt Cancer Center
offers new hope for patients with resistant or difficult-to-treat
brain cancers.
Figure 1
Figure 2 Figure 3
8 NEURON NEWS | 2018 ISSUE MOFFITT.org
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