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February 2008 Issue

Ronald Warnick, MD, and John Breneman, MD, see patients at the Precision Radiotherapy Center at University Pointe.
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'Combo' Therapy Might Help Treat Brain Tumors

By Cindy Starr
Published February 2008

In the battle against malignant brain tumors, dual implantation of radioactive seeds and chemotherapy wafers following surgery showed promising results, specialists at the Neuroscience Institute at UC and University Hospital report.

The study, published in the February 2008 issue of the Journal of Neurosurgery, revealed that patients treated with simultaneous implantation of radioactive seeds and chemotherapy wafers following removal of glioblastoma multiforme (GBM) experienced longer survival compared with patients who had implantation of seeds or wafers alone.

The study was the first ever to explore the combination treatment in patients suffering from recurrent GBM. The study’s purpose was to assess the safety and effectiveness of the highly localized, combination therapy.

“Treatment of recurrent GBM presents a major challenge to neurosurgeons and neuro-oncologists,” says investigator Ronald Warnick, MD, professor of neurosurgery at UC and chairman of the Mayfield Clinic board.

“Glioblastoma is an aggressive, highly malignant tumor with unclear boundaries. Because of its diffuse nature, surgeons are unable to remove it completely, and it regrows in the majority of patients. Our aim is to find a way to keep the infiltrating glioblastoma cells from growing into adjacent, healthy

Because most GBM tumors recur within two centimeters of the initial tumor margin, Warnick and his team have focused their efforts on highly localized treatment.

Previously they studied the implantation of permanent, low-activity iodine-125 seeds following the surgical removal of the tumor. The seeds, housed in a titanium casing filled with iodine-125 (a radioisotope of iodine) are the size of grains of rice. The seeds are left in the brain cavity permanently, and radiation is delivered for six months.

Other institutions have studied implantation of chemotherapy wafers, which are the size of a nickel. The wafers contain BCNU (carmustine), a standard form of chemotherapy. The wafers are placed along the surface of the brain following removal of the tumor.

Combining radiation seeds and chemotherapy wafers was a logical next step, Warnick says. The combination of seeds and wafers “appears to provide longer survival” compared with studies of seeds and wafers alone, he says, and “disease progression also seems to be further delayed.”

Warnick cautioned that the effectiveness of the combination therapy is not definitive, because the study did not include a control group.

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