Brain and central nervous system (CNS) tumors are the third-most common cancers among adolescents and young adults, ages 15-39, according to the American Brain Tumor Association (ABTA).
Usually, the standard treatment is brain surgery.
But a team of doctors at Nicklaus Children’s Hospital last month used magnetic-resonance guided ultrasound to treat a 21-year-old student with a brain tumor, essentially using the heat from high-intensity ultrasound waves to destroy the tumor. The student was able to leave the hospital the next day and return to classes, remaining seizure-free.
The procedure is part of a Food and Drug Administration-approved study examining whether benign brain tumors in children and young adults between 8 and 22, and who have recurring seizures, can be treated this way. Ten people are expected to be treated at Nicklaus using this system by October, said Dr. Travis Tierney, a pediatric neurosurgeon at Nicklaus Children’s Hospital.
The procedure doesn’t require surgery; instead, it uses intense heat to pinpoint and destroy the tumor. The patient is placed in an MRI scanner, where more than 1,000 tiny speakers are placed around the patient’s head. The speakers emit high-intensity ultrasound waves, which use heat to target and destroy the tumor. There is little impact to the scalp, skull or surrounding healthy brain tissue.
“It is like a magnifying glass and how you focus light on one point,” Tierney said. “We are focusing sound to do the same.”
The device could become an alternative to radiation, Tierney said. Because a child’s brain is still developing, radiation can produce another tumor later on or lead to cognitive decline in children.
The ideal candidate for the procedure has low-grade tumors, which have grown a little, or are starting to cause seizures or other problems in the brain.
Robotics is also being used to perform minimally invasive surgeries on patients suffering from brain tumors and other neurologic conditions. The ROSA robotic surgery system at Cleveland Clinic Florida is designed to mimic a human arm and perform surgery with very small instruments, some as thin as a needle.
“It helps to accurately pinpoint the tumor,” said Dr. Badih Adada, chairman of the department of neurosurgery and director of the neuroscience center at Cleveland Clinic Florida. “The robot also allows you to free your hands.”
The ideal candidate for the procedure is a patient with an aggressive tumor, which is in a deep area of the brain that is hard to reach, Adada said.
Cleveland Clinic Florida has performed the procedure for nearly a year, and patients have experienced a decrease in complications such as infection and bleeding, Adada said. The procedure, known as laser ablation, also reduces a patient’s hospital stay. Patients stay overnight and can often go home the next day.
Doctors at Sylvester Comprehensive Cancer Center at the University of Miami are using Tumor Treating Fields (TTFields) for brain cancer. Electrodes are placed on the head, which creates an electro field that can stop tumor cells from dividing and growing, said Dr. Deborah Heros, professor of neuro-oncology at Sylvester.
The FDA-approved procedure was found to be as effective as chemotherapy during clinical trials. The procedure is offered to recurrent and newly diagnosed tumor patients. It can also be used following chemotherapy completion to boost the chances of survival, Heros said, or be used for those who can’t tolerate or don’t want chemotherapy.
“It provides patients with longer life or better quality of life,” Heros said.
Sylvester also participated in an international research study for brain cancer that injects a virus directly into the tumor, and along with an oral drug, attacks the cancer cells, Heros said. Sylvester was one of 67 medical centers in the world that participated in the study.
Ideal patients for this procedure, which has not yet been approved by the FDA, would be those who have recurring tumors. Patients are being monitored and data reviewed from the clinical trials.
“Although not FDA-approved, the procedure has been recognized by the FDA and given ‘breakthrough therapy designation’ and ‘fast-track designation’ because of promising results,” said Heros, who hopes to use the procedure for newly diagnosed tumor patients.
The procedure doesn’t require surgery; instead, it uses intense heat to pinpoint and destroy the tumor.