Cooking brain tumors

With a laser, a doctor cooked a cancerous brain tumor in one man, and now the patient is cancer free. 

Cancerous brain tumors are the most difficult to treat. They spread fast and kill more than 13,000 people every year. Without surgery, there’s little hope, but now doctors have found a way to get rid of cancer in the brain.

To learn more about this treatment, please read the doctor’s interview below:

Gene Barnett, M.D., Director of the Brain Tumor and Neuro-Oncology Center at the Cleveland Clinic, talks about a new technology that uses lasers to heat and kill a tumor from the inside out.

How many brain tumor patients do you treat each year?

Dr. Gene Barnett: I personally treat a few hundred a year and the center itself has around 7,000 patient visits a year.

What is the AutoLITT procedure?

Dr. Barnett: AutoLITT is a new technology that uses lasers to literally cook a tumor from inside out. It's done using advanced technology that allows us to put a laser probe deep into the brain with great precision and then while there, heat the tumor in different directions and monitor that heating process as we go using special MRI techniques that measure the temperature and show us what part of the tumor is really cooked, while also allowing us to spare the normal brain tissue nearby.

Before the AutoLITT, was there a greater risk of damaging the brain?

Dr. Barnett: That's correct. The laser technologies themselves aren't new -- they've been around for a couple decades, but they were primitive and not monitored the way that this technology allows us to do. Also, we weren't able to steer the laser beam in such a way that we could adapt to different shapes and sizes of tumors that well.

Is the MRI one of the key points of this procedure?

Dr. Barnett: One of a number of technological advances is using what we call MRI thermometry to measure the cooking as it happens, as well as special computerized software that predicts what areas are killed.

Does this eliminate the need for any other type of medication or chemotherapy or radiation?

Dr. Barnett: It really would depend upon the tumor. The tumor that we've been dealing with so far is something called glioblastoma, and in that particular situation, this is one of a number of different treatments that are all used together in order to try and control that type of tumor. I foresee in the near future, however, that we will be using this on a number of different tumors, where perhaps this by itself will be enough to control or kill the tumor.

What are some of the symptoms that patients with this type of tumor have? 

Dr. Barnett: In many ways, the symptoms for glioblastoma depend upon where it is in the brain, but they may include headaches, seizures or loss of certain brain functions, such as speech, movement, sensation, and vision.

Does the procedure let you get deeper in the brain?

Dr. Barnett: Yes, this actually involves just passing a three millimeter probe down deep into the brain and we can reach areas that are very difficult, if not impossible, to safely reach with conventional surgery. This procedure really offers the benefit of surgery to many patients who otherwise couldn't get it.

Once the tumor is killed, is it ever removed?

Dr. Barnett: The body has mechanisms to slowly remove that dead tissue over a period of weeks to months.

Is this something that you think is the start of bigger things as far as removing and killing brain tumors?

Dr. Barnett: I think this offers the benefits of surgery to a whole group of patients who otherwise couldn't safely get surgery, so I think that for many patients, this is going to be a major advance. This is much less invasive than even our most minimally invasive open operations. Most of the patients have been ready to go home within a day or two after the procedure. Typically, with conventional surgery it's anywhere from two to four days, so this laser procedure drops it by about 50 percent.

Are the results of this procedure much better?

Dr. Barnett: The results are much better than we could've achieved, because you really wouldn't have been able to do surgery on those patients.

By killing this tumor, are you giving these people more of a chance to survive?

Dr. Barnett: In many cases, it's an individual result, and certainly, right now we do have some limitations because it's a brand-new device and we have been doing this in a clinical trial. For instance, right now, we are limited to one pass of this through the brain and anything we can reach with that. Later this year, we anticipate being able to access the tumor through multiple passes in which case, we'll be able to treat even larger tumors with more complex shapes.

Can the procedure be used for other types of cancer?

Dr. Barnett: There is the potential to use this in other parts of the body, such as the liver and perhaps the pancreas, but that's outside of the scope of what I do, but may well be things that are done by others down the road.

Is there any risk to this procedure that traditional surgery doesn't pose?

Dr. Barnett: Any surgery of the brain poses some risks. The risks from this procedure are similar, qualitatively, and actually probably smaller, quantitatively, than from open surgery. The principal risk of this is some swelling around the area that we kill for the first week or two, but that's managed with medication.

Is there any risk of killing excess tissue?

Dr. Barnett: So far, the software that predicts what regions are killed versus protected has been very good, and although our experience is limited, I'm pretty optimistic that we should be able to protect those critical parts of the brain pretty well.

What was it like to be the first person in the United States to do this procedure on a human being?

Dr. Barnett: It was exciting, and at the same time, a daunting responsibility to make sure that we got this right and we were applying this new technology properly.

How did you practice for this procedure?

Dr. Barnett: I spent a good amount of time with the company, with their pre-clinical testing, making sure that I understood how the device worked and how it was applied.

Is it currently being offered all over the country?

Dr. Barnett: Right now, the only two institutions that are offering it are the Cleveland Clinic and the University Hospitals Case Medical Center, both here in Cleveland.

Did you train other surgeons on how to perform this procedure?

Dr. Barnett: Right now, I'm the only one here who does this, although I envision that as time goes on, more and more of us will be doing this, and also, now that the device is FDA cleared, we'll begin to see this emerge at other hospitals.

Do you tell the patient that they're the first to have a new procedure?

Dr. Barnett: I absolutely do. In fact, the first person we did this on was told that they were the first and were eager to proceed. Everyone has known that it's an early experience with this, and that there have only been a handful of patients treated with this, really two handfuls.

How was the outcome of the first patient? 

Dr. Barnett: The patient did very well. Unfortunately, the tumor progressed elsewhere a few months down the road.

During the procedure, are you basically cooking these tumors?

Dr. Barnett: That's more or less what we're doing, but we're doing it in a very controlled, precise way.

What type of laser do you use in the procedure?

Dr. Barnett: It is called a diode laser, which means it's a solid state laser. It's actually invisible, but it produces infrared heat, which then causes the tissue next to it to heat up. 

If you would like more information, please contact:

Cleveland Clinic

1-888-273-1409

To sign up for a free weekly e-mails on Medical Breakthroughs, visit www.ivanhoe.com.

If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Melissa Medalie at mmedalie@ivanhoe.com.

Ivanhoe Broadcast News

2745 W. Fairbanks Ave.

Winter Park, FL 32789

http://www.ivanhoe.com

Melissa Medalie, Supervising Producer

Medical News

mmedalie@ivanhoe.com

Direct Line: (407) 691-1516

Viewer Line: (407) 740-0789 ext. 579

For more information, contact John Cherry at (407) 691-1500, jcherry@ivanhoe.com. 

Ivanhoe Broadcast News

2745 W. Fairbanks Avenue

Winter Park, FL 32789

(407) 740-0789

http://www.ivanhoe.com