Six-year-old Isabella knows she had a “boo boo” in her head when she was a baby.
But she does not know about the three surgeries and multiple rounds of chemotherapy she underwent at Miami Children’s Hospital to help treat her brain tumor.
“It’s just too much information for her to take right now,” said Isabella’s mother, Lisette Diaz, of Pembroke Pines.
On the eve of July 4, 2007, Isabella was diagnosed with choroid plexus carcinoma, a rare tumor that develops in young children’s brain ventricles. She was 6 months old.
“I thought she was going to die,” said Diaz, 43. “When they told me she would have to go through intensive care, I thought, ‘Oh my God, she is gone.’ ”
Isabella is one of about 2,500 children diagnosed with a brain tumor every year in the U.S. Brain tumors are the second most common tumors in children after leukemia, said Dr. Antonello Podda, assistant professor of pediatrics and director of the Pediatric Neuro-Oncology Program at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.
“Brain tumors in children are difficult because they impact the whole neurological well-being,” said Dr. Ziad Khatib, director of neuro-Oncology at Miami Children’s Hospital.
The good news? Within a month, doctors at UM will treat their first patients with a vaccine designed to boost the immune system and help fight stubborn brain cancers. Doctors will give the vaccine to children with chemo-resistant tumors and to adults and teenagers diagnosed with glioblastoma multiforme, the most common and deadliest of malignant brain tumors in adults. Initially, the vaccine will only be administered at UM, but if it proves successful, doctors hope to make it available throughout South Florida.
At Joe DiMaggio Children’s Hospital in Hollywood, neurosurgeons use ultrasonic aspirators that remove tumors intertwined in the brain. The device vibrates the tumor at an ultrasonic frequency and then suctions it out.
Many South Florida hospitals also administer radiation that targets only the brain tumor and avoids healthy tissue. Proton beam radiation significantly minimizes the risk of neurological damage. Generally, doctors avoid using radiation on children younger than 3, Podda said.
“The rule is the later, the better,” he added.
That is why the soon-to-be-implemented dendritic cell vaccine is critical, doctors say. It not only avoids radiation for children, but may help those whose brain tumors who do not respond to chemotherapy. Based on science developed by Professor of Microbiology and Immunology Eli Gilboa, as well as on studies in Belgium of a similar vaccine administered to mice, this new treatment significantly boosts a patient’s immune system, said Dr. John Goldberg, assistant professor of clinical pediatrics at UM and director of Sylvester’s Pediatric Oncology Early Phase Clinical Trials Program.
In laboratories, dendritic cells, or immune cells drawn from the blood of a brain cancer patient, are taught how to fight cancerous cells and are returned to the patient through the vaccine.
“The problem with cancer is that it figures out a way to trick the immune system that it is OK to be there,” Goldberg said. “Cancer cells derive from normal cells so they look alike, and cancer cells figure out a way to hide from the immune system. One thing we are trying to do with this vaccine is to overcome those ways that cancer invades the immune system.”
While research on the vaccine continues, doctors have been treating children with brain tumors through high doses of chemotherapy.
Doctors gather, remove and freeze stem cells from a patient in a process called stem-cell rescue, said Khatib, the Miami Children’s Hospital neuro-oncology director. Once the stem cells have been removed, the doctors can administer high doses of chemotherapy to the patient.
After a short period of time, when the chemo effects have dissipated, the patient’s stem cells are returned to him or her through an IV infusion. Stem cells are important because they can develop into many different cells in the body, and repair existing cells.
“It’s a way of rescuing someone from losing those white blood cells that allow us to double and triple those doses of chemotherapy,” Khatib said. “Then, it’s a waiting game. We just wait for those white blood cells to start recovering.”
“It took about a week for her [white blood cell] count to start going up,” said Diaz of her daughter Isabella. “One day it just jumped overnight and that was it.”
The end of Isabella’s hospital stay and frequent visits for chemotherapy rounds came about one year after she was admitted.
At Joe DiMaggio Children’s Hospital, part of Memorial Healthcare System, child life specialists work with young patients and their families to relieve some of the stress.
“My role is to reduce the child’s fear and anxieties about treatment,” said Elisa Jones, a child-life specialist in oncology. “We accommodate our role to whatever age group we are working with by using medical puppets.”
These “medical puppets” are large dolls that Jones uses to explain to children the different procedures they will receive. Medical puppet Esperanza also has a brain tumor and therefore, scars on her head because she had surgery. And, she, too, has a port in her chest through which chemotherapy drugs are administered.
“And yes, Esperanza doesn’t have any hair because she had this medication called chemotherapy. But in the meantime she gets to wear this really cool bandana,” said Jones, explaining the medical play she does with her young cancer patients. “The children are able to express how they feel during this medical play.”
Recently, a 10-year-old boy who was treated for cancer eight years ago came back to Joe DiMaggio for a check- up. When he ran into Jones, he showed off his head, which is now clear from surgery scars.
“So I showed him the doll and took off the Velcro stitches she has, and I said ‘Look, her scars are off too,’ ” Jones said.
The scars are a result of the surgery, known as a craniotomy, often the first treatment for brain tumor patients.
“We have to be very careful not to neurologically devastate the patient,” said Dr. Dean Hertzler, pediatric neurosurgeon at Joe DiMaggio Children’s Hospital. “Children respond so much better to treatment than adults. They have a lot more plasticity of the brain and that resilience makes the outcomes that much better.”
For the Diaz family, Isabella is seemingly on the road to recovery. Annual MRI scans have shown no signs of her brain tumor reoccurring. If an MRI she will receive at age 10 shows no signs of a tumor, Isabella will be considered free from cancer.
“You almost have a lump in your throat going in for the MRIs and then you go through the process and the doctors tell you she is fine,” Diaz said. “Then, you are able to breathe again.”