This type of tumor is fast growing and now accounts for the majority of brain-tumor-related deaths in children. DIPG is particularly difficult to treat because of its location deep among the most vital structures of the brain. Further, the dosage of chemotherapy necessary to kill these cancer cells is too toxic for the body.

The best doctors have been able to offer these patients is a lower dose of chemotherapy along with radiation. Both of which, for the most part, just ease their symptoms.  Newer, more effective therapeutic modalities are desperately needed for children with DIPG.

For the first time, at the Morgan Stanley Children’s Hospital/Columbia University Medical Center, Drs. Anderson and Bruce used convection enhanced delivery (CED) to deliver the chemotherapy agent topotecan directly into the tumors of two pediatric patients.

CED uses stereotactic brain imaging to correctly place ultra thin catheters deep into the brain with minimal disturbance to the surrounding tissue. In this way, doctors are able to deliver a higher dose of the drug exactly where its needed and avoid the system wide toxicity of conventionally delivered chemotherapy.

The children are the first two pediatric patients with DIPG enrolled in a phase I clinical trial.  Anderson and Bruce are optimistic that their work will establish CED as a safe and effective new treatment for children with these deadly tumors.

Dr. Marc Otten

Neurosurgery Resident Dr. Marc Otten gave a talk on Task-Free Functional MRI to Study Connectivity in Patients with Brain Tumors at Grand Rounds last week .

Specifically, he explained how resting state functional MRI can track connectivity within the motor network in these patients and that the strength of connectivity correlated with the patient’s neurological function.

Dr. Jeffrey Bruce

Columbia’s College of Physician’s and Surgeon’s Newsroom has an article about Dr. Jeffrey Bruce‘s latest research on the treatment of brain tumors.

The article, Breaking a Barrier in Brain Cancer, has been receiving wide attention and has become one of the main stories they are circulating.

In the article, Dr. Bruce talks about his a recent clinical trial involving “convection enhanced delivery” of chemotherapy drugs in the treatment of brain tumors.

Traditionally difficult to treat, Dr. Bruce says, “It’s not that the drugs don’t work. It’s that you can’t get enough of the drug into the tumor where you need it.”

In his trial, Dr. Bruce’s was able to treat malignant gliomas in particular with the drug Topotecan using a new method of delivery.  His results have been very promising and it is no wonder the news is spreading.

You can learn more about Dr. Bruce’s research: in the article, Breaking a Barrier in Brain Cancer; in the following blogs, Bruce Presents Exciting New Brain Tumor Research At AANS and Dr. Bruce Invited To Speak At Cornell; as well as at the Bartoli Brain Tumor Laboratory‘s page.

'The New Walkway' by Kate McGloughlin

Along a brightly lit hallway on the 4th floor of the Neurological Institute hangs a series of four oil paintings. Their muted colors and industrial lines capture the hospital’s surrounding neighborhood of Fort Washington.

They were painted by Kate McGloughlin from a handful of sketches she made while waiting for her twin brother, Michael, to recover from brain surgery.

“Michael was a strapping young Irishman,” says Kate.  ”He was just swinging along in his life, doing everything right, when he started getting these headaches.”

This was in 1989 and Michael was just 27 years old. Kate remembers, “He had been having a hell of a time all spring long. We finally got him down to the local emergency room.”

Four days later, at Columbia Presbyterian Hospital, Michael went in for his first craniotomy.

Michael’s surgeon, Dr. Michael Sisti from the Brain Tumor Center and  the Gamma Knife Center says, “Michael had a tumor in the front of his brain. The surgery was very successful; the tumor just popped right out. There was no invasion into the brain.”

Kate says, “Michael, through the entire time, had the most optimistic outlook. It was so infectious. We just never thought the guy would die.  He’d be fine for 20-24 months and then he’d start with getting a seizure, or his one eye would look funny. It was a bear of a tumor. It just kept growing back.”

During one of Michael’s last operations, Kate says, “I took my sketch book and did eight or ten little sketches.” Kate is a print maker and a painter and from those six sketches came about 35 pieces.

“The gallery I was working for in Woodstock loved them,” says Kate. “We had this big show called ‘Waiting for Michael,’ because that is what I was doing when I was doing those sketches.”  The critics loved them.   Michael himself was at the opening.  Kate says, “He was the big celeb. He loved that something good could come from something so difficult.”

But, after nine years of repeated surgery, chemotherapy, and radiation, “Michael had really had it,” Says Kate. “He was done.”  Michael died a few months after the exhibit.

Things got dark for Kate for a while, and so did her art work. She says, “I really had to make room on the bus for grief. The irony is that after that, my career took off.

About a year later I got a call, kind of randomly, from a guy named John Collins at the Department of Neurosurgery inquiring about the artwork. I said the only ones I have left are the large oils and he said ‘we’ll take them.’

It was a stroke of great fortune for me because, my studio was down in this tractor garage and got completely flooded that year, and I lost a lot of work.”

Kate opened a new account with the money she got from the Department of Neurosurgery, and determined to put any art proceedes towards building a new studio.  “And, don’t you know, once I opened that account and started putting money in it, I started selling work hand over fist. It was unbelievable.”

By the summer of 2000 Kate had drawn up the plans, had the building permits, and was building her studio.

It sits on her family’s old Dairy farm in Olivebridge, New York. Fashioned after a chicken coop, the 14×24 foot building has high ceilings, lots of light, and a tin roof for the sound of the rain.

“The other beautiful part,” says Kate, “is that, Michael’s friends helped me build it.  Actually build it–with hammer and nails.  I have this beautiful wall of Northern light because of one friend who got us all these recycled windows.

Every time I walk in there it is like another gift.  It is very inspiring.  There is something—I don’t want to get too corny—it’s like walking into a church in a way.  The studio that Michael built.”

We are privileged to have Kate’s paintings, and all they represent, hanging in our hallway. “I walk by Kate’s paintings everyday on the way to my office before going to surgery,” says Dr.Sisti. ”The beauty of the paintings and their connection to Michael, Kate, his family, and our hospital has been a source of daily inspiration to me since the first day they were hung up.  They demonstrate art’s power to speak to our struggles, memories, and hopes.”

Thank you Kate.

You can learn more about Kate and see more of her artwork at www.katemcgloughlin.com.

In Michael’s honor, donations are welcome at the Olivebridge United Methodist Church Food Pantry, PO Box 1397, Olivebridge, NY 12461.

“I was involved in several symposia which allowed us to present some of the latest work we are doing at Columbia to advance the field,” Says Dr. Bruce.

He was active in five different sessions as: Speaker at a symposium about Maximizing Extent of Resection in Primary Brain Tumors; Moderator at a Scientific Session on Tumors; Moderator at the Joint Section Session on Tumors; Discussant on a Panel about the Prevalence and Natural History of Pineal Cysts in Adults; And Panelist for a discussion on the Spectrum of Adjuvant Therapy for Brain Tumors.

“The conference provided a good update on all of the newest developments in neurosurgery.” Says Dr. Bruce, “ I am completing my term as Chairman of the Tumor Section where we have been productive. The brain tumor field has been very active in trying to develop new treatments for patients.”

He spoke about his lab‘s recently completed convection enhanced delivery trial of topotecan. The trial, led by Dr. Bruce at the Bartoli Brain Tumor Laboratory is described as follows:

-a multidisciplinary NIH-funded Phase I trial for brain tumor patients using a novel strategy that delivers chemotherapy directly into the tumor. A chemotherapy drug, Topotecan, is slowly pumped into the tumor and surrounding brain tissue through catheters that have been stereotactically implanted. This strategy, known as convection enhanced delivery, significantly increases the amount of drug that enters the tumor and avoids systemic side effects since the drug remains only in the brain. Bartoli Brain Tumor Laboratory

The results of the trial showed, “Significant anti-tumor activity as described by radiographic changes and prolonged overall survival with minimal drug associated toxicity,” Says Dr. Bruce. They also extablished a maxiumum tolerated dose for future phase II studies.

Congratulations to Dr. Bruce and everyone at the Bartoli Brain Tumor Lab on the completion of this important trial!

Perfexion Gamma Knife with its cover off before it left the factory in Sweden

Our multi-million dollar Gamma Knife up-grade is complete.  The new state-of-the-art  Gamma Knife Perfexion System is in place and our radio surgery program is back in full swing.

Dr. Michael Sisti from the Gamma Knife Center says, “We have had a great start for the week, with a total of eleven patients and the following conditions treated: three acoustic neuromas, four meningiomas, one Glomus Jugulare tumor, one brain metastasis, one lymphoma, and one case of trigeminal neuralgia.”

Our Centurion Perfexion Gamma Knife on Site

The Gamma Knife (not a literal knife) generates a highly concentrated beam of radiation that is used to specifically target these kinds of lesions in the brain as well as brain tumors, cerebral arteriovenous malformations (AVMs), and epilepsy.

The upgrade to the Perfexion system has expanded this capability to include more treatment areas within the brain, and an advanced planning system that enables even greater accuracy.

Reception

According to Elekta,the maker of the Perfexion System, there is also, “faster set-up and treatment delivery to one or more tumors in a single session[.]”

As the 100th unit produced by the company, Elekta gave the machine a unique gold finish and gold colored patient mattress.  Accordingly, Dr. Sisti and his group have coined it the Centurion Perfexion Gamma Knife!

Our Centurion Perfexion Gamma Knife on Site

Dr. Sisti says, “The unit is beautiful installed with its covering on too. We are happy to offer our patients the increased capability and accuracy of this new machine. Our treatments have been seamless.  We just treated our 2900th patient and we hope to treat our 3000th patient this year.”

Watch this video to learn more about the new Perfexion Gamma Knife.

Learn more from our page on Gamma Knife Radiosurgery and our previous blogs:Gamma Knife Upgrade Coming This Summer, One Picture Speaks a Thousand Words-These Neurosurgeons use Two and Radiosurgery Trials Looking Good for Epileptics.

Dr. Jeffrey Bruce from the Brain Tumor Center is quoted extensively in the latest issue of Advances, New York Presbyterian’s e-Newsletter.

In the article, Skull Base Techniques Offer Brain Tumor Patients Less Invasive Options, Dr. Bruce says,”When tumors arise along the base of the skull, they may grow around nerves and blood vessels, which are fragile and soft.”Minimally invasive techniques enable us to see the tumor more clearly and remove as much of it as we can without damaging these delicate nearby structures.”

Jeffrey Bruce, MD

Read the article to learn more about these amazing innovations.

Jeffrey Bruce, MD

Dr. Jeffrey Bruce from the Brain Tumor Center just returned from Scotland where he was an honored guest lecturer at the 2011 Annual Scientific Meeting of the British Neurosurgical Research Group (BNRG 2011). The title of his talk was, Convection enhanced delivery for brain tumors.

He also co-authored the preface and two articles in this issue:  With Dr. Steven Isaacson from the Gamma Knife Center he wrote, Radiosurgical Management of Brain Metastases; and with resident Dr. Christopher Kellner he wrote, Surgical Management of Brain Metastases.

Also of note, Dr. Paul McCormick from the Spine Center is a consulting editor for this journal.

To learn more see Neurosurgery Clinics of North America,Volume 22, Issue 1, Pages 1-110 (January 2011). You can also read the preface of that issue written by Dr. D’Ambrosio and Dr. Ganesh Rao.

On the second day of the conference, he was one of the faculty for a Practical Course called, Brain Tumor Update (Part II): Non-Glial Tumors.

He then co-moderated the AANS/CNS Section on Tumors‘s Neurosurgical Forum and was a faculty member at a Luncheon Seminar on Malignant Gliomas: Future Treatment Strategies.

On the last day of the conference, he was one of the featured discussants on the subject of Tumors in a program called Cases and Coffee with the Masters.

Related news item: Docs Present at 2010 Congress of Neurological Surgeons Meeting