Glioblastoma, the type of brain cancer that U.S. Sen. John McCain has is known to be aggressive and so difficult to irradicate that it is considered incurable, according to area oncologists.
But advances in brain imaging and surgery as well as radiation and chemotherapy have turned brain cancer from a quick death sentence into a disease that can often be far more effectively treated than in the past.
“You can increase the patient’s life expectancy as well as improve the quality of their life,” said Dr. Ronald Hale, medical director of radiation oncology for Kettering Health Network.
Hale said the biggest drivers in modern brain cancer treatment advances are “imaging technology, the ability to see where the tumor is,” better radiation techniques and the invention of a chemotherapy pill known as Temozolomide.
That pill resolved one of the key issues for treating brain cancer - the brain-blood barrier that prevented many chemotherapy agents from getting into the brain, said Dr. Ania Pollack, a neuro-oncologist at Premier Health.
For tumors like McCain’s, the standard treatment is surgery to remove as much of the glioblastoma as possible, followed by radiation and then chemotherapy.
But glioblastomas, which form in the brain rather than spread from elsewhere, grow quickly and are known to hide in the tissue. Even if removed, they usually come back, typically after 12 to 18 months, Hale said.
Crainiotomy - surgically opening the skull - remains the first line of defense for diagnosing and removing as much of a brain tumor as possible, Hale said. The ability to do surgery, and to be effective, depends on the size of the tumor, its location, where it is as far as critical areas of the brain and the patient’s overall condition, he said.
The majority of the time doctors can get all or some of the tumor out, but in 20 percent of cases doctors can only do a surgical biopsy. It is in those cases, and ones where tumors recur, where doctors use lasers or radiation to get at the tumor.
At Kettering doctors use the NeuroBlate System, which involves making a pencil-sized hole in the skull and using a probe to deliver laser light energy to heat and destroy the tumor.
Surgeons also use a gamma knife, which delivers a high dose of radiation targeted at smaller tumors. For larger tumors Kettering doctors use the Versa HD advanced linear accelerator system, also a form of radiation therapy, Hale said.
Cancer treatment at both Kettering and Premier now includes a new device called Optune, which the patient wears on his or her head for about 18 hours a day. Ceramic electrodes send out rapidly alternating electric current that keeps cancer cells from dividing, said Pollack.
She said brain cancer patients who wore Optune and took Temozolomide after surgery and radiation had mean survival rates of 20.9 months, compared to 16 months for those who took the pill but did not use Optune.
Five months may not seem like a long time to a healthy person, but to someone with terminal cancer “it’s a life time,” Pollack said.
The extra months or years that modern treatment methods give a cancer patient allow the person a chance to celebrate holidays, see the arrival of spring, or go the the graduation or wedding of a loved one, Hale said.
Both doctors said now is an exciting and hopeful time to be an oncologist because of the rapid advances being made in treatment.
“The next major advance that we’re going to see - that we’re actually seeing - is the ability to control the signalling from cell to cell. So to be able to shut down and reprogram cancer cells to stop reproducing,” Hale said.
“We’re at the doorstep of it. We’re seeing some of the early drugs come out that are doing just this.”