Just over a year ago, Shawn Monti visited the doctor thinking he was suffering from sinus headaches.
When his medication didn’t work, tests revealed that Monti, 47, had something that wouldn’t be so easy to cure. The husband and father of five was diagnosed with glioblastoma — an incurable and cancerous brain tumor that grows quickly.
According to the American Cancer Society, there is less than a 1 percent chance a person will develop a malignant brain tumor in his or her lifetime (about 1 in 140 for a man and 1 in 180 for a woman). But certain types of brain cancer, particularly glioblastomas, have relatively low five-year survivor rates because they are supported by a large network of blood vessels that feed them.
In South Florida, the University of Miami Miller School of Medicine and Memorial Hospital are conducting trials and experimenting with technology to improve the lives of patients with brain cancer.
Awake Craniotomy and Sodium Fluorescein
After hearing he would only live six months, Monti, who lives in Palm Beach County, found his way to Dr. Ricardo Komotar, a neurologist and co-director of surgical neurooncology at UM’s Sylvester Comprehensive Cancer Center. Komotar removed as much of the tumor as he could during surgery.
When the tumor reappeared, as most brain tumors do, it was positioned next to the motor strip that controls the body’s movements. The tumor’s position made surgery dangerous — one wrong move and Monti could be paralyzed. Thus, Komotar did the second surgery with Monti awake, giving him only a local anesthesia.
“If you do that surgery asleep, you can very easily take out tissue that’s in the motor strip and leave him paralyzed,” he said.
In addition, Komotar injected Monti with sodium fluorescein, a dye that is given intravenously 30 minutes before surgery. The dye leaks into the tumor, differentiating it from healthy brain tissue.
“In many tumors it’s very hard to distinguish what’s normal and what’s abnormal,” he said. “This is a great technique, which really maximizes how much tumor you take out and how much healthy tissue you leave behind.”
During Monti’s surgery, doctors used a small electrical stimulator to determine whether the tissue they wanted to remove was functional or not.
“If when you stimulate with a little bit of electricity, he moves, then that means a piece of tissue is involved in his movement. You don’t take that out,” he said.
To destroy tumors in difficult-to-reach areas of the brain, Komotar and others are using laser ablation, which involves inserting a miniscule laser probe into a person’s brain through a small hole drilled into the skull. Doctors then “cook” the tumor from the inside by using radio-frequency energy.
“You can access tumors that are otherwise inoperable,” he said.
The procedure reduces hospital stays and is minimally invasive; surgery lasts about an hour and patients are generally back home within 24 hours, he said.
Brain Cancer Vaccine
At Memorial Hospital in Broward, Dr. Atif Hussein, an oncologist, has been conducting a trial for the past year on a vaccine created from a patient’s tumor tissue.
“The strategy has the potential to kill whatever cancer is in the body,” he said.
Here is how the trial works: Dendritic cells, which help the immune system recognize a foreign body and destroy it, are extracted from the patient and mixed with the tumor tissue in a lab. The patient is then injected with the mixture.
The hospital is also performing a trial for a second vaccine involving a protein found in cells called heat shock protein.
Hussein called these cells “chaperones,” that is, they make sure other cells are well behaved. Like the dendritic cell vaccine, the heat shock proteins are mixed with cancer tissue from a patient’s brain tumor, creating a vaccine.
“The vaccine will destroy the heat shock protein so the cancer cell will not have a chaperone and it will die,” said Hussein.
Although Hussein is hopeful the trials will be successful, he called brain cancer “one of the worst” cancers, adding that the average survival rate is about a year and a half.
“This cancer changes the human being; it takes the dignity out of people,” he said. “But if I can prolong their survival a few years, they may benefit from surgery that comes down the line.”
After two brain surgeries and constant chemotherapy during his one-and-a-half year battle with recurrent brain tumors, Monti has kept up his spirits.
“I was just waiting to die,” he said. “But I got irritated with that and I decided I wasn’t just going to die, but I was going to try.”
Monti is undergoing chemotherapy, taking medication and weekly injections and looking to start a new treatment soon.
When asked about what he expects for his future, Monti laughed.
“I’m gonna live forever,” he joked. “I have five children, I gotta be here for them. I’ll do whatever I can, till I can. That’s the attitude.”
Symptoms of possible brain cancer
The American Brain Tumor Association says it is difficult to experience symptoms associated with brain tumors, but people with tumors may suffer from any of the following:
Sensory and motor loss
Deep venous thrombosis (blood clots)
Behavioral and cognitive changes
Source: American Brain Tumor Association