{"id":542691,"date":"2023-01-23T22:45:46","date_gmt":"2023-01-23T19:45:46","guid":{"rendered":"https:\/\/en.buradabiliyorum.com\/qa-with-the-surgeons-who-developed-a-world-first-brain-tumour-treatment\/"},"modified":"2023-01-23T22:45:46","modified_gmt":"2023-01-23T19:45:46","slug":"qa-with-the-surgeons-who-developed-a-world-first-brain-tumour-treatment","status":"publish","type":"post","link":"https:\/\/buradabiliyorum.com\/en\/qa-with-the-surgeons-who-developed-a-world-first-brain-tumour-treatment\/","title":{"rendered":"#Q&#038;A with the surgeons who developed a world-first brain tumour treatment"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_85 counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of Contents<\/p>\n<label for=\"ez-toc-cssicon-toggle-item-6a3f8f5cb121e\" class=\"ez-toc-cssicon-toggle-label\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #dd3333;color:#dd3333\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #dd3333;color:#dd3333\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/label><input type=\"checkbox\"  id=\"ez-toc-cssicon-toggle-item-6a3f8f5cb121e\" checked aria-label=\"Toggle\" \/><nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/buradabiliyorum.com\/en\/qa-with-the-surgeons-who-developed-a-world-first-brain-tumour-treatment\/#%E2%80%9CQ_A_with_the_surgeons_who_developed_a_world-first_brain_tumour_treatment%E2%80%9D\" >&#8220;Q&#038;A with the surgeons who developed a world-first brain tumour treatment&#8221;<\/a><\/li><\/ul><\/nav><\/div>\n<h1><span class=\"ez-toc-section\" id=\"%E2%80%9CQ_A_with_the_surgeons_who_developed_a_world-first_brain_tumour_treatment%E2%80%9D\"><\/span>&#8220;Q&#038;A with the surgeons who developed a world-first brain tumour treatment&#8221;<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<div>\n                                                                        <i><span style=\"font-weight: 400;\">In early January, a team of researchers and physicians from Toronto\u2019s Sunnybrook and SickKids hospitals completed the first step in a world-first clinical trial of a new treatment for pediatric brain cancer. They used MRI-guided ultrasound to temporarily open the blood-brain barrier<\/span><\/i><i><span style=\"font-weight: 400;\">\u00a0<\/span><\/i><i><span style=\"font-weight: 400;\">and deliver chemotherapy to a malignant, inoperable brain-stem tumour called diffuse intrinsic pontine glioma<\/span><\/i><i><span style=\"font-weight: 400;\">, or DIPG, most commonly found in children. Patients currently have\u00a0<\/span><\/i><i><span style=\"font-weight: 400;\">an average life expectancy of less than a year after diagnosis.\u00a0<\/span><\/i><\/p>\n<p><i><span style=\"font-weight: 400;\">The study\u2019s co-principal investigators are <\/span><\/i><i><span style=\"font-weight: 400;\">J<\/span><\/i><i><span style=\"font-weight: 400;\">ames Rutka, a<\/span><\/i><i><span style=\"font-weight: 400;\"> pediatric<\/span><\/i><i><span style=\"font-weight: 400;\"> neurosurgeon at SickKids Hospital who sub-specializes in brain tumour and epilepsy surgery, and Nir Lipsman, a neurosurgeon and director of Sunnybrook\u2019s Harquail Centre for Neuromodulation. Here, they share what h<a href=\"https:\/\/buradabiliyorum.com\/en\/category\/download-scripts-themes-apps\/\" data-internallinksmanager029f6b8e52c=\"9\" title=\"Download Scripts &amp; Themes &amp; Apps\" target=\"_blank\" rel=\"noopener\">app<\/a>ened during the groundbreaking trial:\u00a0<\/span><\/i><\/p>\n<p><b>Congratulations on this achievement. To start off: what <\/b><b><i>is<\/i><\/b><b> a diffuse intrinsic pontine glioma?<\/b><\/p>\n<p><span style=\"font-weight: 400;\"><em>Rutka:<\/em> DIPG is the second-most-common malignant brain tumour in children, and primarily affects kids aged five to seven. Typically, patients present with symptoms that can include facial weakness, double vision and ataxia (or incoordination).<\/span><\/p>\n<p><b>What\u2019s the typical outlook for children with this diagnosis?<\/b><\/p>\n<p><em><span style=\"font-weight: 400;\">Rutka:<\/span><\/em> <span style=\"font-weight: 400;\">This tumour steadily and rapidly grows within the brain stem. Without treatment, children <\/span><span style=\"font-weight: 400;\">survive<\/span><span style=\"font-weight: 400;\"> around six months; with treatment, which includes radiation therapy, they might <\/span><span style=\"font-weight: 400;\">last<\/span><span style=\"font-weight: 400;\"> as long as 18 months. As surgeons, we feel helpless with diagnosis, because there\u2019s nothing we can do surgically to extend life for those who have it.\u00a0<\/span><\/p>\n<p><b>That\u2019s shockingly grim. Why is it so difficult to treat?<\/b><\/p>\n<p><em>Lipsman:<\/em> <span style=\"font-weight: 400;\">DIPG is located in the brain stem\u2014the lower part of the brain connected to the spinal cord\u2014which controls autonomic bodily functions like heart rate, breathing, consciousness, swallowing and many others. <\/span><span style=\"font-weight: 400;\">One cannot intervene in the brain stem surgically in any capacity, let alone resect a tumour, without risking any or all of these functions.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In short, the challenges in treating this tumour are many, but one of them is the blood brain barrier, <\/span><span style=\"font-weight: 400;\">or BBB,<\/span><span style=\"font-weight: 400;\"> the border of cells that prevents certain solvents circulating in the bloodstream from entering the brain. We have chemotherapy drugs<\/span><span style=\"font-weight: 400;\"> that <\/span><span style=\"font-weight: 400;\">may treat the tumour, but because these drugs don\u2019t cross the BBB, we just can\u2019t get them there.<\/span><\/p>\n<p><b>And here we are, for the very first time in history, using imaging and sound waves to open the blood brain barrier and deliver medication to the brain stem. How did you come to pull it off?<\/b><\/p>\n<p><span style=\"font-weight: 400;\"><em>Lipsman:<\/em> It was a combination of the <\/span><span style=\"font-weight: 400;\">right expertise at the right time. Dr. Rutka led the pre-clinical work that showed for the first time, using animal models, that it was safe and feasible to use focused ultrasound to deliver chemotherapy for DIPG. Essentially, the <a href=\"https:\/\/buradabiliyorum.com\/en\/category\/technology\/\" data-internallinksmanager029f6b8e52c=\"4\" title=\"Technology\" target=\"_blank\" rel=\"noopener\">technology<\/a> uses soundwaves to non-invasively make a temporary opening in the BBB, which lets the medication in. His work gave us compelling pre-clinical rationale to translate this to a human population.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">At the same time, the work I led at Sunnybrook amassed an experience of BBB-opening in adult patients across multiple indications, including primary and secondary brain tumours, Alzheimer\u2019s and Parkinson\u2019s disease. This gave us compelling data that opening the BBB in human patients can be done safely.\u00a0<\/span><\/p>\n<div id=\"attachment_1243049\" style=\"width: 3010px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" data-sizes=\"auto\" class=\"size-full wp-image-1243049 lazyload\" src=\"https:\/\/www.macleans.ca\/wp-content\/uploads\/2023\/01\/FUS_1797_20221028_.jpg\" alt=\"\" width=\"3000\" height=\"2000\"\/><\/p>\n<p class=\"wp-caption-text\">A five-year old patient is in the MRI during treatment<\/p>\n<\/div>\n<p><b>Walk me through January 4, the day you treated your first patient.<\/b><\/p>\n<p><span style=\"font-weight: 400;\"><em>Lipsman:<\/em> The patient is a five-year-old girl: the youngest allowed for our trial. We all had sensitivities, obviously, to treating such a young patient. There was certainly an emotional element. The patient\u2019s family was hopeful but realistic, and really invested their trust in the research team.\u00a0<\/span><\/p>\n<p><b>How many people were in the room?<\/b><\/p>\n<p><span style=\"font-weight: 400;\"><em>Rutka:<\/em> Around 20 people, including nurses, physicists, imaging scientists, anaesthetists, and Dr. Lipsman and myself. The family arrived around seven in the morning at the front doors of Sunnybrook. It was a long time coming\u2014we had initially planned to do the procedure in December, but the patient unfortunately came down with a viral infection, so we had to wait. There was all this anticipation leading up to it, because the family really wanted to start the therapy as soon as possible.\u00a0<\/span><\/p>\n<p><b>What happened first?<\/b><\/p>\n<p><span style=\"font-weight: 400;\"><em>Lipsman:<\/em> She was anaesthetized, and then we applied a head-immobilization device, which is essentially a crown or ring that keeps the head steady. That frame was then attached to a helmet-like device that delivers the ultrasound. The patient went into the MRI machine, which is where the entire procedure took place. First, we took about an hour and a half to do detailed imaging of the brain to make sure the tumour hadn\u2019t changed since we last checked. Then we infused the chemotherapy, which we believe has to be actively circulating in the bloodstream when the BBB opens.\u00a0<\/span><\/p>\n<p><b>How did you feel approaching this critical juncture in the procedure?<\/b><\/p>\n<p><span style=\"font-weight: 400;\"><em>Rutka:<\/em> We were a little anxious about what would happen, since it had never been done in this region of the brain before. A complication could be devastating in this region of the brain, since it could affect vital bodily functions, and may have led to a termination of the study. As we opened the BBB in a <a href=\"https:\/\/buradabiliyorum.com\/en\/category\/watch-movies-tv-seriess\/\" data-internallinksmanager029f6b8e52c=\"8\" title=\"Watch Movies &amp; TV Series\" target=\"_blank\" rel=\"noopener\">series<\/a> of layers, we did special MRI sequences to look for things like bleeding and swelling in the brain. The treatment was extremely well tolerated, and there were no adverse events.\u00a0<\/span><\/p>\n<div id=\"attachment_1243050\" style=\"width: 3010px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" data-sizes=\"auto\" class=\"size-full wp-image-1243050 lazyload\" src=\"https:\/\/www.macleans.ca\/wp-content\/uploads\/2023\/01\/FUS_1172_20221028_.jpg\" alt=\"\" width=\"3000\" height=\"2000\"\/><\/p>\n<p class=\"wp-caption-text\">Brain scan showing world-first MRI-guided focused ultrasound opening of blood-brain barrier for delivery of chemotherapy to a common brain tumour in children<\/p>\n<\/div>\n<p><b>That must have been an incredible relief.\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400;\"><em>Lipsman:<\/em> We didn\u2019t see any abnormalities at all, which was the best-case scenario. In fact, the treatment went so well that we wondered if we had successfully opened the BBB in the first place, which we needed to confirm with another MRI with contrast. That\u2019s because contrast will only go to the parts of the brain where the BBB is open. <\/span><span style=\"font-weight: 400;\"><br \/><\/span><\/p>\n<p><span style=\"font-weight: 400;\">We confirmed that it was actually open, which means the chemotherapy did get into the brain. That image was very exciting: the culmination of many years of research! After that was done, the patient came out of the scanner and was observed for two hours at Sunnybrook before moving back to SickKids. She was back in the recovery room making jokes two hours after the procedure.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The next morning, she had another scan\u2014this time, we confirmed that the barrier had closed. The closure is just as important as the opening, since we want to make sure it\u2019s a reversible procedure.\u00a0<\/span><\/p>\n<p><b>What happens next for this patient, and for the others in this study?<\/b><\/p>\n<p><span style=\"font-weight: 400;\"><em>Lipsman:<\/em> Every patient will undergo three treatments about four to six weeks apart. If all goes well, we\u2019re looking to treat 10 patients in six to 12 months.\u00a0<\/span><\/p>\n<p><b>What has the reaction from the medical community been like?<\/b><\/p>\n<p><span style=\"font-weight: 400;\"><em>Rutka:<\/em> Since we\u2019ve launched the trial, I\u2019ve had no shortage of people from around the world asking what the entry criteria are, since there are so many children worldwide afflicted with this condition. I hope this will be the start of several trials. For this trial, we chose the chemotherapy drug doxorubicin, a potent drug that\u2019s never been used for brain tumours because it doesn\u2019t cross the BBB. But there are a host of other drugs, either singly or in combination, that we can use to treat this disease. In the future, we can hopefully focus on the tumour\u2019s molecular genetics to target the most effective drugs.\u00a0<\/span><\/p>\n<p><b>What\u2019s the potential impact of this research beyond DIPG?<\/b><\/p>\n<p><span style=\"font-weight: 400;\"><em>Lipsman:<\/em> <\/span><span style=\"font-weight: 400;\">This method\u2014getting medication into the brain stem (or another part of the brain) via focused ultrasound\u2014can be used for more than just chemotherapy. <\/span><span style=\"font-weight: 400;\">In theory, we could open the blood-brain barrier to deliver any promising medication to the brain. Parkinson\u2019s is one we\u2019re actively working on: we recently published a phase-one trial where we showed that in patients with genetic-form Parkinson\u2019s, we can safely deliver promising enzyme replacement therapy. We\u2019re also interested in metastasis: using BBB opening to deliver immunotherapy and antibody treatments for breast cancer that\u2019s metastasized to the brain.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In short, it\u2019s a broad tool that could be used across many different indications. It\u2019s all part of a larger trend in neurosurgery towards non- or minimally invasive methods of intervening in the brain.<\/span><\/p><\/div>\n<p><script async defer crossorigin=\"anonymous\" src=\"https:\/\/connect.facebook.net\/en_US\/sdk.js\"><\/script><\/p>\n<blockquote><p><strong><span style=\"color: #ff6600;\">If you liked the article, do not forget to share it with your friends. Follow us on\u00a0<span style=\"color: #ff0000;\"><a style=\"color: #ff0000;\" href=\"https:\/\/news.google.com\/publications\/CAAqBwgKMLG0nwswvr63Aw\" target=\"_blank\" rel=\"nofollow noopener noreferrer\">Google News<\/a><\/span>\u00a0too, click on the star and choose us from your favorites.<\/span><\/strong><\/p><\/blockquote>\n<blockquote>\n<p style=\"text-align: center;\">For forums sites go to <span style=\"color: #ff9900;\"><a style=\"color: #ff9900;\" href=\"https:\/\/forum.buradabiliyorum.com\/\" target=\"_blank\" rel=\"noopener\">Forum.BuradaBiliyorum.Com<\/a><\/span><\/strong><\/p>\n<\/blockquote>\n<blockquote>\n<p style=\"text-align: center;\"><strong>If you want to read more <a href=\"https:\/\/buradabiliyorum.com\/en\/category\/news\/\" data-internallinksmanager029f6b8e52c=\"2\" title=\"News\" target=\"_blank\" rel=\"noopener\">News<\/a> articles, you can visit our <span style=\"color: #ff9900;\"><a style=\"color: #ff9900;\" href=\"https:\/\/en.buradabiliyorum.com\/general\/\" target=\"_blank\" rel=\"noopener\">General category.<\/a><\/span><\/strong><\/p>\n<\/blockquote>\n<p><span style=\"color: black;\"><a style=\"color: #ff9900;\" href=\"https:\/\/www.macleans.ca\/society\/health\/qa-with-the-surgeons-who-developed-a-world-first-brain-tumour-treatment\/\" target=\"_blank\" rel=\"noopener\">Source<\/a><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>&#8220;Q&#038;A with the surgeons who developed a world-first brain tumour treatment&#8221; In early January, a team of researchers and physicians from Toronto\u2019s Sunnybrook and SickKids hospitals completed the first step in a world-first clinical trial of a new treatment for pediatric brain cancer. They used MRI-guided ultrasound to temporarily open the blood-brain barrier\u00a0and deliver chemotherapy&#8230;<\/p>\n","protected":false},"author":1,"featured_media":542692,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"fifu_image_url":"https:\/\/www.macleans.ca\/wp-content\/uploads\/2023\/01\/FUS_0864_20221028_-766x431.jpg","fifu_image_alt":"","footnotes":""},"categories":[1],"tags":[138819,73014,138820],"class_list":["post-542691","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general","tag-chemotherapy","tag-health-care","tag-medical-discovery"],"_links":{"self":[{"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/posts\/542691","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/comments?post=542691"}],"version-history":[{"count":0,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/posts\/542691\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/media\/542692"}],"wp:attachment":[{"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/media?parent=542691"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/categories?post=542691"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/tags?post=542691"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}