WCL: Brain tumor breakthroughs at Northwestern

Brain tumors afflict more than 700,000 people. There are more than 120 different types ? and some are always fatal.

But new strides in brain surgery and a dramatic new way of dealing with brain tumors is helping prolong patients' life spans.

Dr. Andrew Parsa, neurosurgeon at Northwestern Memorial Hospital, is creating a vaccine from the tumor itself to help the immune system target and suppress the cancer.

Here's a summary of what they are doing at Northwestern:

Vaccine Therapy for Brain Cancer
Northwestern is the lead site for a landmark clinical trial to investigate if a vaccine made from a patient's own brain tumor is effective in slowing tumor progression and extending survival for people with glioblastoma multiforme (GBM), the deadliest form of brain cancer. The study is the largest randomized brain tumor vaccine trial ever funded by the National Cancer Institute (NCI) and is chaired by Andrew T. Parsa, MD, PhD, chair of neurological surgery at Northwestern Memorial Hospital.

Glioblastoma is often resistant to standard therapies and median survival is approximately 15 months from the point of first diagnosis. As Parsa explains it, this research does not present a cure for brain tumors, but instead a potential way to convert the cancer into a chronic disease ? something comparable to diabetes that you may be able to live with and control with medication. A successful trial could lead to the vaccine potentially being approved to treat recurrent brain tumors, making it one of only a few approved therapeutic cancer vaccines. Vaccine therapy, which is rapidly emerging as a potential treatment for many types of cancers, has the potential to offer safer and less toxic cancer therapies that can be personalized to each individual patient. Recently released results from an earlier phase of this research showed that patients who received the vaccine in addition to standard treatment lived longer than those who received standard treatment only.

More specifically, 50 percent of the patients enrolled in the trial lived for two years, an encouraging result for a cancer that often kills patients within one year. The encouraging results have spurred further research of the vaccine, including studying its effectiveness on patients who have a recurrent tumor.

Awake Brain Mapping
Northwestern neurosurgeon Dr. Matthew Tate is one of the leading experts in awake brain mapping surgery. During this surgery, a patient with a brain tumor is kept awake during to guide the surgeon so that map the motor and sensory areas to avoid damaging these critical areas of the brain. This helps avoid permanent damage after the operations and allows the surgeon to remove as much of the tumor as possible.

Adaptive Hybrid Surgery
Skull base tumors, while often benign, present a challenge for surgeons because they are often located in precarious locations that make surgical resection challenging and risky for leaving lasting damage to key parts of the brain.

Rather than taking out as much tumor as possible, surgeons are using this new approach to be more thoughtful about what tumor to remove and what to leave behind to target with radiation therapy. This approach is a balancing act between removing more tumor ? putting the patient at greater risk for surgical complications ? and resecting less, which requires the patient to undergo more potentially toxic radiation.

"The concept in essence is finding that sweet spot, where you've taken out enough tumor to relieve symptoms, while leaving a small target for radiation that can be controlled easily," said Dr. Andrew Parsa, one of the pioneers of this surgical approach.