Saturday, July 17, 2004

Chemo wafers used to treat brain tumor directly

By Tim Bonfield
Enquirer staff writer

Dr. Ronald Warnick shows computer images of areas inside the head where tumors have been removed and radioactive seeds and wafers have been deposited.

It wasn't a cure, but a new treatment for brain tumors performed by doctors at the Mayfield Clinic was still a gift to Indiana residents Randy and Jean Williams.

A gift of time.

Time to witness a son's marriage. Time to welcome three grandchildren to the world. Time make a smooth transfer of control of a family machine-tool business.

"When the doctors first told us that Randy had a brain tumor, I thought that five years from then I would be a widow,'' Jean says. "But it has been five years since he was diagnosed, and my husband is right here."

Randy and his doctors credit about three years of that survival time to a combination of surgery plus radioactive seeds and chemotherapy wafers placed inside his head.

His treatment was part of a study of 34 patients by the Mayfield Clinic in Cincinnati, which recently reported this combined attack can extend survival time for people with brain tumors called recurring glioblastoma multiforme.

This is one of the most common and most fatal kinds of brain tumor, accounting for about a fourth of the 20,000 brain tumors diagnosed nationwide each year.

With the combined treatment, average survival times grew to about 18 months, with four patients living longer than two years, Mayfield physicians report. That compares to survival times ranging from seven months to a year after getting chemotherapy or radiation alone.

The Mayfield study was presented in May in Orlando at the annual meeting of the American Association of Neurological Surgeons. The study ran October 1998 to September 2002.

Since then, nearly all the participants have died, because even with this treatment, the cancer returns. Randy, a resident of Columbia City, Ind., west of Fort Wayne, is the longest survivor. Even his tumors returned a few months ago.

"We've known from the start that a cure wasn't going to come," Jean says. "But most people with this die in the first year."

Dr. Ronald Warnick, chairman of the Mayfield group and the surgeon who worked with Randy Williams, said the new approach offers hope for people who had few options before.

How it works

The treatments are more powerful than standard care, Warnick said, because they are placed directly against tissue containing tumor cells. That allows the medicines to get past the blood-brain barrier that often limits the effect of injecting drugs into the bloodstream while reducing the harmful side effects of chemotherapy.

Radioactive seeds have been used for several years for several kinds of cancer. The chemotherapy wafers are a more recent development.

Surgeons place as many as eight of the wafers - each about as big as a Necco candy wafer - in the void left after removing as much of the tumor as possible. The wafers emit a chemotherapy drug as they dissolve in two to three weeks, while the radioactive seeds emit effective doses for about six months.

Most patients can tolerate the procedure, but harmful side effects can include abnormal wound healing, seizures, infections and brain swelling.


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