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New brain tumor treatment may reduce time in therapy, side effects

By JOY BUCHANAN
UNC School of Medicine

CHAPEL HILL -- Doctors at the University of North Carolina at Chapel Hill are studying a new brain tumor treatment that could reduce both a patient’s time in therapy and the side effects from radiation and chemotherapy.

The three-step treatment for gliomas, a type of malignant brain tumor, combines surgery, radiation and chemotherapy in localized areas of the brain for the first time. The treatment was developed by Dr. Matthew G. Ewend, chief of neuro-oncology and assistant professor of surgery in UNC’s School of Medicine, and Dr. Lav K. Goyal, assistant professor of radiation oncology. The treatment’s aim is to improve quality of life by reducing treatment time and returning patients to their daily routines while providing the most aggressive glioma therapy available, Ewend said.

"The new treatment is exciting because it concentrates a majority of the therapy right where the tumor often reoccurs. We have used localized radiation and localized chemotherapy independently before, but this is the first time that they’ll be used together," he said.

The study will last about two years; the hope, Ewend said, is to treat between 10 and 15 patients with the new method in the next year. UNC and the Semmes-Murphey Clinic in Memphis, Tenn., are the only centers using this new treatment.

With the new treatment, patients first undergo surgery to remove as much of the tumor as possible. Then, doctors insert a balloon catheter filled with a radioactive liquid into the tumor area. The catheter and radioactive liquid make up the GliaSite Radiation Therapy System, developed by Proxima Therapeutics Inc. For the next three-to-seven days, the catheter delivers radiation to the tissue surrounding the cavity. This is important, Ewend said, because 80 percent of tumors reappear within two centimeters of the original tumor location.

Doctors then remove the catheter and put chemotherapy wafers into the cavity. The Gliadel wafers are produced by Guilford Pharmaceuticals.

The wafers are absorbed in about three weeks, and the patient then begins oral chemotherapy just four-to-six weeks after surgery.

The new treatment takes about half as long as traditional treatments. It also may reduce side effects associated with radiation and chemotherapy because the treatment is administered directly to the

original tumor site – an important feature of the new treatment, Ewend said.

Traditional treatments for malignant brain tumors typically require surgery followed by a seven-week course of radiation before a patient begins chemotherapy. Traditional brain tumor treatments can take up to four months and, with traditional treatment, patients have few remaining options if tumors reappear. However, the new treatment allows patients to receive traditional external radiation therapy if their tumors reoccur, Ewend said.

"Our goal is to get the best therapy to where the tumor is without exposing healthy parts of the brain," he added.

Study participation will be limited to adult patients undergoing treatment for localized, malignant brain tumors. Patients with tumors spread throughout the brain will be excluded from the study, Ewend said.

His hope, he added, is that the study will show the new treatment to keep tumors away longer, treat people faster and return people to their normal lifestyles faster and healthier.

"With the new protocol, we can get a lot of treatment done relatively quickly," he said. "The clinical outcomes with GliaSite radiation system and with the chemotherapy wafers to date have been positive, justifying the effort to combine these two local therapies.

"We feel that using GliaSite with chemotherapy wafers as a first-line course of therapy could improve the quality of life for patients who would otherwise undergo six weeks of external beam therapy. For brain cancer patients, being able to prolong life, even by a few months, with as good a quality of life as possible, is a victory. "

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Note: Contact Ewend at (919) 966-1374 or ewend@med.unc.edu
School of Medicine contact: Leslie Lang, (919) 843-9687 or llang@med.unc.edu