Andrew Sloan, MD, Neurosurgeon at University Hospitals Cleveland Medical Center talks about a new treatment for brain cancer patients.
How many Americans are diagnosed every year with brain tumors?
SLOAN: Every year, there are about 84,170 Americans diagnosed with primary brain tumors. Then there are another class of brain tumors called metastatic brain tumors. Those are tumors that come from other organs, the lung, the breast, the kidney, etc. that travel to the brain. There are somewhere between 160,000 and 400,000 depending on how you think about that diagnosed every year of the metastatic brain tumors. The primary brain tumors are tumors that originate in the brain. Ask me that question again.
How many Americans are diagnosed each year with brain tumors?
SLOAN: There are two types of brain tumors, primary brain tumors, those are tumors that originate in the brain, and there are about 84,000 Americans diagnosed every year with primary brain tumors. There are two subgroups of those, the malignant brain tumors and there are somewhat over 25,000 diagnosed every year so these are basically brain cancers. Then there are about 59,000 benign brain tumors now, they’re benign in that they’re not cancers, but they can also cause lots of.
Approximately how many Americans are diagnosed with brain tumors each year?
SLOAN: There are basically two different categories of brain tumors. There are primary brain tumors. These are tumors that originate in the head and of those, there are about 84,000 diagnosed every year. There are basically two types of primary brain tumors. Malignant primary brain tumors, these are brain cancers, if you will, and somewhat over 25,000 are diagnosed every year. Then there are benign brain tumors, and there are about 59,000 of those every year. Now, they’re benign in that they are not cancer, they do not spread to other organs, but they can cause lots of problems and they can actually cause lots of deficits and disabilities to patients when they get them. There’s a second category of tumors called metastatic brain tumors. These are tumors that actually originate in cancers of other organs, the lung, the kidney, the GI tract, et cetera and those can travel to the brain. Those are called metastatic brain tumors.
Overall, how many brain tumors do you think collectively there are for Americans diagnosed?
SLOAN: I would say a conservative estimate would be two to 300,000 a year. Some would say as much as 485. Some would say, you know, it’s 250.
What’s the current treatment for a brain tumor?
SLOAN: There are different kinds of brain tumors and they’re all treated differently. So, let’s start with the primary brain tumors. The malignant primary brain tumors or cancers are usually either biopsied or removed surgically and then treated with radiation and or chemotherapy. The benign brain tumors sometimes can be watched. Sometimes they grow very slowly and you can just watch them if there’s not a lot of disability. Sometimes they’re treated with something called stereotactic radiosurgery. Sometimes they’re treated with operative resection followed by – with or without something called radiosurgery, which is a type of focused beam radiotherapy. In terms of the malignant metastatic tumors, they’re almost always treated – the classical treatment is brain radiotherapy, but that has a huge amount of toxicity to the brain and cognitive function. In recent years, we’ve been doing less and less of that, focusing more on something called radiosurgery – this type of focused radiosurgery for the smaller ones. The larger ones, often, we take out and then often treat with additional radiotherapy.
Explain a little bit about the GammaTile. What is it?
SLOAN: GammaTile is a small bio-collagen bioabsorbable collagen. GammaTile is a small piece of bioabsorbable collagen, and embedded is a small seed of cesium-131. Now, this is a radioactive substance that gives off radiation, but it only travels a certain distance and it’s got a very short half-life. So unlike radiation from outside the head, which is a classic radiation where there’s an entrance dose and an exit dose, so the beam goes in a linear fashion. Everything in the path of that beam gets roughly the same dose. These are put at the site of the resection at the time of surgery, and the dose only travels a certain distance. And it’s got a half-life of about of a little less than 10 days. So, after 10 days, half the dose is gone. After 30 days, about 88% of the dose is gone. And after 60 days, there’s less than 2% of the dose that’s still there.
What is the biomaterial that it’s made of?
SLOAN: It’s collagen, but it’s resorbed. This is the same material that we use in the or for sponges and to stop bleeding and so we’ve been using it for years, we know it’s not dangerous, we know it’s safe, we know it’s resorbed by the body. So that part is not new. The part that is new is that the embedded cesium-131 source. As I said that the radioactive particles decay very rapidly, in less than 10 days or a half-life of less than 10 days. So, it’s not like someone’s going to glow in the dark for a long time. There’s 10 days. After 10 days, that dose of radiation has been 50% of that dose has been delivered to the tumor.
Does this require any additional surgery to remove?
SLOAN: No, we don’t remove it. We do have to do surgery to place it, and usually we do that in patients that are having their tumor operated on so usually larger tumors that need surgery for operation according to the current standards. Then we’re starting to put GammaTile in some of those patients.
So which patients are the best candidates for this type of treatment?
SLOAN: I would say the best candidates are patients with recurrent high-grade meningiomas grade two, grade three meningiomas, patients with large brain metastasis that have-to-have surgery, and in some cases patients with recurrent high-grade gliomas recurrent primary brain tumors that need to have and that are candidates for more radiotherapy.
What are the benefits of the GammaTile treatment compared to others?
SLOAN: The benefit of GammaTile is that it’s basically surgery and radiation at the same time. So instead of doing surgery and then coming back and getting radiation, you get the surgery, and we implant these radioactive seeds and then you’re done. You don’t have to come back to the hospital, you don’t have to have lots of planning visits and treatment visits. So that can be a huge advantage for some patients.
Are there patients for whom this is not recommended?
SLOAN: The one downside is that, if you get these GammaTile, I think you’re not really a candidate for clinical trials. So, we have patients who come to us from all around the country for clinical trials, and those patients, I think you have to be careful because some of those GammaTile would exclude some of those patients from clinical trials.
Is there a specific type other than that?
SLOAN: I would say GammaTile is a great treatment for selected patients, particularly those who are not candidates for clinical trials. We’re very excited to have this as another tool in our anti-brain tumor armamentarium. I think this is a really exciting technology. This is really another tool in our fight against brain tumors.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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JEANNINE A. DENHOLM
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