Brain & Spinal Tumor Patient Care
CNI coordinates care using several available treatments with known value to achieve a state of complete remission in which no tumor can be identified by MRI scan. This goal is also known as radiographic remission, which we consider to be an essential requirement for long-term survival. CNI uses the following techniques an approach that has provided highly encouraging results for more than three years.
Doctors who treat cancer patients diagnosed with malignant brain tumors can be divided into two camps, each with very different philosophies. One camp believes that these tumors are uniformly fatal and that the best approach for such patients is to avoid doing harm. This philosophy has some merit since, statistically, the outcome for most malignant brain tumors is death, and it is important to preserve dignity and quality of life. The problem with this approach is that it is a self-fulfilling prophecy. And while it may spare some patients the burden of ineffective treatments and their side effects, it also may deprive many patients of a chance for a better outcome. Furthermore, the “do no harm” approach can never lead to progress.
The other camp, which we support for most patients, embraces the philosophy that the worst enemy of the brain tumor patient is the tumor itself and that aggressive treatment can provide some patients with substantial improvement in the length as well as quality of life. Such aggressive therapy, if it becomes too burdensome or is not successful, can be discontinued. However, most patients, in our experience, want to take an aggressive approach to their tumors if it is appropriate to do so. It is important to note that not all patients are good candidates for this aggressive approach because of a number of factors, including:
- Neurologic status
- Location of tumors
- Quantity of tumors
We treat each patient individually according to their specific health needs. Treatment is determined accordingly after extensive discussion between family members and our team.
In the initial surgery, our neurosurgeons attempt to remove as much tumor as possible. Our highly experienced neurosurgeons employ the latest tools and techniques, including awake craniotomy, functional MRI with pre- or intra-operative functional mapping, frameless stereotaxy and laser.
Multi-Agent Chemotherapy and Concurrent Radiation
Consistent with our philosophy to treat with the intent to cure, we have developed an innovative approach that utilizes combination chemotherapy in conjunction with radiation, and then intensifies chemotherapy after radiation. This approach is now formalized into an institutional research protocol CNI/SMC BT2001. The use of combination chemotherapy and radiation therapy is an innovative technique that takes advantage of the potential of chemotherapy to increase the sensitivity of the tumor to radiation therapy. In addition, two effective treatments given simultaneously are apt to be more effective than when provided independently.
Follow-up Surgery or Radiosurgery
Following completion of the combined chemo/radiotherapy program, which usually lasts 3-5 months, patients are reevaluated by MRI scan, and the results are reviewed by our entire team of specialists. If any tumor remains, surgery is our preferred recommendation to remove it. Many times, the initial chemo/radiotherapy will significantly reduce the amount of residual disease to the point where complete surgical removal is feasible. When possible, this approach provides the best results. If surgery is not possible, residual disease may be treated with radiosurgery. This is a non-surgical technique that uses precisely targeted radiation to target the remaining portions of the tumor. Within a single treatment, this powerful yet non-invasiveprocedure can destroy the residual tumor.
Following completion of this aggressive phase of therapy, patients undergo a final biological therapy phase, which entails the use of the drug tamoxifen in high doses plus or minus the drug thalidomide. These medications are not chemotherapeutic agents, and as such, are not nearly as toxic. They are, however, agents which have been shown to have a beneficial effect on malignant brain tumors, either stopping growth or severely impairing their ability to progress. In addition to providing highly encouraging results, this phase of therapy is typically well tolerated by patients.