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Sunday, December 1, 2002



Queen’s leading
with brain treatment

The radiation therapy
helps terminal cancer
patients live longer


By Helen Altonn
haltonn@starbulletin.com

The Queen's Medical Center is among the first hospitals nationally to perform a cutting-edge radiation procedure that can extend the life of terminal brain cancer patients.

Scott Dube, a senior medical physicist at Queen's, said the procedure "essentially doubles the survival time for recurrent patients." He said the average survival for a patient undergoing brain surgery with chemotherapy is about 7.5 months, and with the new GliaSite procedure it is about 16.5 months.

Queen's, the first medical facility licensed in Hawaii to do the procedure, is collaborating with other hospitals such as Kaiser Medical Center to offer the GliaSite therapy, approved last year by the U.S. Food & Drug Administration.

Three Kaiser Permanente patients with malignant brain tumors, all in their 60s, were the first to benefit.

The first patient was treated in mid-October.

"This is exciting because it represents a new treatment for patients with recurrent brain tumors, who have very few options left," said Dr. John Lederer, Queen's medical director for radiation therapy.

Dr. Bernard Robinson, a neurosurgeon who heads Kaiser's Neuroscience Department, said, "I just saw one of my patients I thought would be dead before Christmas and she's enjoying her family. She'll be around until Christmas and even maybe until the next one."

Kaiser's neurosurgeons learned of the new treatment during weekly radioneurology and radiosurgery conferences at Queen's, Robinson said. "We shop around to get the best treatment for the patient. It just happened that this modality is available rather than resign a patient to death."

Lederer noted that "Queen's is ... delighted to be among the first hospitals in the country to offer this important new therapy for people with malignant brain tumors."

The procedure involves delivering a high dose of liquid radiation, called Iotrex, directly to the tumor. It is used to treat newly diagnosed, metastatic and recurrent brain tumors.

Until GliaSite, doctors ran out of options to treat many patients with recurrent malignant tumors and they would die in three to nine months after surgery, Robinson said.

The new brachytherapy technique, involving a radioactive implant directly at the tumor site, can extend their lives an average of a year or more, depending where the tumor is located, he said.

"Here is a device that treats an area you can't see within a safe margin," rather than only what can be seen of a tumor with a CAT scan or MRI (magnetic resonance imaging), Robinson said. "It makes a little more sense to do that."

Lederer said Queen's is able to offer the latest medical treatments to Hawaii cancer patients because of its team of specially trained radiation oncologists, nurses, physicists and therapy specialists. They are licensed by the Nuclear Regulatory Commission for the GliaSite procedure.

In the first three cases, surgery was done on the patients at Kaiser to remove the tumors and insert uninflated balloon catheters in the tumor sites.

Dr. Alfred Bowles Jr., neurosurgeon with special training in brain tumors, did the surgery for the first patient, a man from Maui with two tumor recurrences after his original surgery in December 2000.

Robinson did the two additional cases in rapid succession, both women from Oahu, one with a recurring tumor and the other having brain surgery for the first time.

After recovering from the surgery (about three days), the patients were transferred to Queen's, where Lederer's team injected liquid radiation into the balloon.

Dube said the catheter goes deep into the brain with the balloon at one end and an injection port at the other end, right below the skin.

"When it's time to put the radioactive source in, we just take the needle, poke through the skin to the injection port and inject at a fairly slow rate, maybe 10 minutes."

The liquid fills and inflates the balloon and is left there for about four days, targeting places where cancer may linger in the cavity where the tumor was removed, Dube explained.

The liquid was extracted with a syringe in three to seven days and the patients were returned to Kaiser for removal of the balloon catheters.

He said some hospitals have used radioactive wires or seeds in the brain to treat tumors, which are complicated procedures technically.

"This GliaSite thing is wonderful because it's easy to do," he said. "Neurosurgeons put catheters in the brain all the time. It's very easy for community hospitals to do this."

Robinson said the technique is too new to make conclusions and each patient is different. But he said, "On the basis of what I see right now, with the few patients we've done, especially the ones with recurrence we thought would be gone, it gives us some optimism."



Queen's Medical Center



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