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How Siteman is leading the way in personalized brain tumor treatment

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Washington University School of Medicine
Greg Zipfel, MD, the Ralph G. Dacey Distinguished Professor of Neurological Surgery and Chairman of Neurological Surgery, is... Greg Zipfel, MD, the Ralph G. Dacey Distinguished Professor of Neurological Surgery and Chairman of Neurological Surgery, is shown here in an operating room at Barnes-Jewish Hospital.

If you or a loved one have recently been diagnosed with a brain tumor, you likely feel a great deal of fear and have many questions. The brain is the epicenter of who we are, so it is entirely natural to feel afraid in the face of such uncertainty. At Siteman, our specialists provide world-class personalized brain tumor treatment to achieve the best possible outcomes.

How is personalized brain tumor treatment different from more common protocols?

More common brain tumor treatment protocols consist of surgery, radiation therapy and chemotherapy that target cancer based on the type, stage and where it’s found in the body. There are many different tumor mutations that exist. Siteman therefore personalizes brain tumor treatment by tailoring therapy for each patient based on the distinct features of their tumor. Our experts take into account the physiologic, molecular and genetic properties of every individual brain tumor. This allows them to create treatment plans that are highly customized, rather than one-size-fits-all.

Do you have fears and concerns about your brain tumor diagnosis? You’re not alone

A brain tumor diagnosis can be terribly frightening. The brain is what makes us who we are: it controls our thoughts, feelings, personalities and memories. Some common fears brain tumor patients have include:

  • Undergoing surgery
  • Losing physical or cognitive capabilities
  • Dying

At Siteman, our exceptional Washington University neuro-oncologists, radiation oncologists, surgeons and scientists are here to provide you with outstanding care and compassionate support throughout your brain tumor treatment journey.

Are brain tumors curable without surgery?

Surgery may be difficult in some cases. For instance, the tumor may be in a spot the surgeon can’t reach or it may be near a vital structure. These types of tumors are sometimes inoperable. However, our nationally renowned neurosurgeons use advanced technologies that allow them to develop treatment plans for tumors that other centers would consider inoperable.

Prior to determining whether these brain tumors require surgery, neurosurgeons may perform a stereotactic needle biopsy to obtain a tissue sample. Experts will examine this sample under a microscope to determine whether it’s cancerous or benign. If surgery isn’t an option, your treatment team may recommend radiation therapy or targeted therapy instead.

Surgery for brain tumor treatment

Our experts perform a variety of surgical procedures for brain tumor treatment:

  • Pre-operative brain mapping and imaging: brain mapping involves identifying problems in critical areas of the brain, like those that control speech and motor skills. Brain mapping is crucial for neurosurgeons to obtain a detailed image of areas targeted for surgery. It also plays a key role in minimizing the risks of surgical damage to healthy areas of the brain. In addition to a patient’s 1-hour routine scan, neurosurgeons often map the brain using functional magnetic resonance imaging (fMRI). This is done in one 15-minute session while the patient lies in the scanner at rest.
  • Intraoperative MRI: the surgical team can perform surgery once they obtain data from the tumor images, including the MRI for GPS-like navigation in the OR and the fMRI. However, as the surgical team is removing the tumor, the brain shifts and the navigation map becomes inaccurate for tumor margins. The surgical team then turns to real-time intraoperative MRI (iMRI) to obtain updated information to successfully carry out the surgery. In some cases, our experts will also use fluorescent dyes to illuminate tumor cells during surgery. This makes it easier to remove even more cancer cells.
  • MRI-guided laser interstitial therapy: our neurosurgeons are among the first in the nation to use an MRI-guided, high-intensity laser probe specifically designed to treat inoperable brain tumors. This laser “cooks” cancer cells deep within the brain while sparing healthy brain tissue. In this procedure, a small hole the diameter of a pencil is drilled through the patient’s skull. Neurosurgeons then use real-time MRI to guide the laser through the brain and into the tumor. Once inside the tumor, the laser emits highly focused heat energy to kill cancer cells.
  • Minimally invasive endoscopy: endoscopic endonasal skull-base surgery can treat many tumors of the skull base. In this procedure, the surgical team advances an endoscope through the nasal cavity to view the anatomy and perform the surgery. Minimally invasive endoscopy doesn’t involve any incisions and the procedure leaves no scars on the patient’s face or head.

Can brain tumors be cured completely?

If your brain tumor is benign and isn’t causing problems, your doctor may recommend surveillance through regular MRIs instead of surgery. If surgery is the best treatment option for a benign tumor, it usually will not come back. Sometimes, though, tumors may grow back and become cancerous. For those who have malignant tumors, treatment can remove or destroy the tumor. In some cases, tumors may never go away completely, even after treatment.

Living with a brain tumor

Learning how to live with a brain tumor can be difficult. However, there are treatment options to ease the symptoms:

  • Your treatment team may give chemotherapy to keep the cancer under control (maintenance chemo) or only when the cancer becomes active again.
  • Palliative care focuses on relieving the physical and emotional symptoms related to brain tumors, but doesn’t treat the tumors themselves. The goal of palliative care is to make life the most comfortable it can be at any time.

In addition to these options, there are things you can do on your own to make life more enjoyable. Complementing treatment with exercise and a healthy diet can help combat fatigue. It can also keep the body strong to cope with treatment side effects. Adopting healthy lifestyle practices can help you heal and recover from treatment more easily.

If you are learning how to live with a brain tumor, there is no “right” way to feel about the difficulties you are facing. Some days you may feel cheerful, while other days you may feel like your world is falling apart. There are many challenges that come with settling into a new “normal.” Despite those challenges, brain tumor patients often report feeling that they have found new meaning in their lives.

The Siteman approach to brain tumors

The Brain Tumor Center at Siteman comprises Washington University experts in the following fields:

  • Neurosurgery
  • Medicine (in the Division of Oncology) and radiation oncology departments
  • Pathology & immunology
  • Otolaryngology
  • Neurology
  • Radiology
  • Endocrinology
  • Pediatric specialists affiliated with Siteman Kids at St. Louis Children’s Hospital

With so many experts in different areas of medicine working together in the same place, our brain tumor patients benefit from new treatments that result in better outcomes.

Since its founding in 1999, Siteman has been leading the fight against cancer in the nation through innovative research and exceptional care. Washington University researchers pioneered the development of genomic testing for personalized brain tumor treatments. Our experts genetically analyze tumor tissue and combine genetics, epigenetics and clinical information to tailor treatment to individual patients.

Washington University researchers have been at the forefront of groundbreaking brain tumor research to improve treatments. Some of this research has found that lasers can help fight brain tumors, administering chemotherapy in the morning may extend patient survival and individual tumors are likely to respond differently to targeted therapies.

The role of immunotherapy in personalized brain tumor treatment

Washington University Physicians are trailblazers in using genomic analysis to develop personalized brain tumor treatment plans. Genomic analysis involves studying a sample of DNA to look for mutations that generated the tumor or affect the way a patient responds to treatment. Because everyone’s DNA is different, brain tumor mutations vary from patient to patient. This is why personalized brain tumor treatment is so crucial. A treatment that works for one brain tumor patient may not work for another.

Immunotherapy is a type of treatment that uses drugs to boost the body’s immune system to help it find and destroy cancer cells. Some immunotherapy treatments work by stopping or slowing the growth of cancer cells. Others help the immune system destroy cancer cells or stop cancer from spreading to other parts of the body. Your treatment team may recommend immunotherapy alone or in conjunction with other treatments.

Immunologically “cold” and “hot” tumors

Many central nervous system tumors – particularly glioblastomas – are immunologically “cold.” This means that they contain few lymphocytes, which are immune cells that attack tumors. “Cold tumors” have immunosuppressive tumor environments (TME), while “hot tumors” have TME that lymphocytes can infiltrate. Although immunotherapies don’t work against cold tumors, ongoing clinical trials aim to find ways to effectively turn them into hot tumors. When a cold tumor becomes hot, the tumor becomes visible to the immune system and thus susceptible to attack.

Immunotherapy options for brain tumors

  • Vaccines: cancer cells have different ways of eluding the immune system, which makes creating effective vaccines difficult. Researchers are conducting more and more clinical trials to improve vaccines and ultimately make them a safe and viable treatment option for brain tumors.
    • Washington University medical oncologist Tanner Johanns, MD, PhD is leading the development of NeoVax, an innovative immunotherapy vaccine. The vaccine uses a patient’s own neoantigens to activate T cells to identify and infiltrate the tumor. Personalized neoantigen vaccines are tumor-specific and patient-tailored.
    • Additionally, dendritic cell vaccines (including DCVax-L and DCVax-Direct) have shown success in treating cancer.
  • Checkpoint inhibitors: normal cells in the body have certain proteins (“checkpoint proteins”) on their surface that the immune system recognizes as not dangerous. As a result, the immune system leaves them alone. Tumor cells can sometimes trick the immune system by producing their own checkpoint proteins. This prevents the immune system from recognizing them as dangerous and attacking them. Checkpoint inhibitors are drugs that block these checkpoint proteins and make the tumor cells visible to the immune system. Once this happens, tumor cells can be destroyed. The downside to checkpoint inhibitors is that in addition to attacking tumor cells, they may also attack healthy cells. This can lead to a variety of autoimmune side effects.

Our brain tumor treatment team

At Siteman, we are committed to providing only the most exceptional care to each and every patient. Our multidisciplinary team comprises providers who specialize in many different types of medicine, ensuring that your brain tumor will be targeted from every angle. By having a team of specialists with expertise in so many areas working together on your case, you will enter your fight against cancer with the best possible chances for a positive outcome.

Here are the different experts who will make up your treatment team:

  • Medical oncologists
  • Radiation oncologists
  • Neurosurgeons
  • Radiologists
  • Neurologists
  • Pediatric hematologists/oncologists
  • Endocrinologists
  • Pathologists
  • Otolaryngologists
  • Psychologists

Meet some of the doctors on our team:

Albert Kim, MD, PhD

Albert-kim

Dr. Kim is Director of the Siteman Brain Tumor Center, Surgical Director of the Pituitary Center, Professor of Neurosurgery, Genetics and Developmental Biology at Washington University School of Medicine, and Co-Leader of the Neurorestorative Therapy Group at the Hope Center for Neurological Disorders. His clinical expertise is brain tumors, skull-base tumors and Gamma Knife radiation therapy. Dr. Kim is a nationally recognized brain tumor surgeon and researcher who uses multidisciplinary approaches, from genetics and biochemistry to cell biology and preclinical in vivo brain tumor models, to discover new brain tumor treatments.

Milan G. Chheda, MD

milan-chheda

Dr. Chheda is Associate Professor of Medicine in the Division of Oncology at Washington University School of Medicine. His clinical expertise is brain tumors and neurologic complications of cancer. Dr. Chheda is a renowned neuro-oncologist whose research focuses on identifying and characterizing the genetic and epigenetic events that induce cancer and maintain tumors.

You’ve been diagnosed with a brain tumor. Now what?

If you have received a brain tumor diagnosis, you may be experiencing a wave of emotions including fear, anger and sadness. Siteman providers are here to support you every step of the way throughout your cancer journey. With our exceptional physicians, psychological services and survivorship care, we are committed to caring for your body, mind and wellness, even after treatment ends.

If you are experiencing symptoms and are worried that they might point to a brain tumor, please make an appointment with your primary care provider. If you have received a brain tumor diagnosis and are looking for a second opinion, or if you are exploring treatment options, Siteman is here for you. Please call us at 800-600-3606 to schedule an appointment.