Kathleen[a]
UVa doctors work to improve deadly tumor treatment
By Sarah Barry / Daily Progress staff writer
January 15, 2006
The idea of removing or killing brain tissue is in many ways too frightening to bear. It is almost as if, in an act of self-preservation, our brains will not even allow the thought.
But where there is a brain tumor, the primary treatment options if a patient hopes to survive are surgery, radiation and chemotherapy.
Dr. David Schiff, an associate professor of neurology at the University of Virginia, is teaming up with doctors in five other departments at UVa to develop improved treatment options for patients with the deadliest of tumors.
"I think it´s clear that brain tumors are not the most common type of cancer but they are among the most horrible," Schiff said. He explained that the worst tumors can rob a person of their memories, their ability to see or walk, their identity.
Schiff co-directs the Neuro-Oncology Center, which focuses both on new and promising clinical trials, as well as emotional support and attentive care for patients. Each patient´s treatment is not only overseen by neurosurgeons and neuro-oncologists, but also psychologists who can help patients and their families cope with the disease and treatment.
"Many of these tumors, we´re still not curing," Schiff said. "That makes it all the more incumbent on us to be thoughtful, informed and prompt."
Much of Schiff´s work focuses on gliomas, which, according to statistics from the National Cancer Institute, are the most common primary brain tumor in adults in the United States. They are also among the most deadly.
Glioblastomas, the most common type of glioma, have a particularly low survival rate. According to the Central Brain Tumor Registry of the United States, only 29 out of 100 people usually survive a year after diagnosis, and only three out of 100 survive five years after diagnosis.
The difficulty of treating these cancers is part of what drew Dr. Roger Abounader to the neuro-oncology program at UVa.
"In part, the terrible prognosis of brain tumors, especially glioblastomas which are almost always deadly, and the speed with which they kill, and the almost complete lack of cures made it challenging for me," Abounader said.
Abounader was recruited from Johns Hopkins University to do basic and translational research in the laboratory that can later be tested in the clinic.
"Basic research deals with understanding the mechanisms of brain tumor development," Abounader explained, "and translational research is using this understanding to develop experimental therapies."
Once he develops the therapies, he tests them on cultured cells and animals before recommending that they be tested on people. The process of moving from animal to human models is a slow and cautious one, as what works in the laboratory many times does not work on a patient, Schiff said.
"Our brain is much bigger than the brain in a mouse, so it´s a much bigger problem," Schiff said. Both Schiff and Abounader, however, believe a strong emphasis needs to be put on treating brain tumors medicinally rather than surgically. Abounader is interested in looking beyond current chemotherapy and radiation models, and is studying the role different genes and proteins play in the formation and growth of tumors.
Of surgery, chemotherapy and radiation, Abounader said, "They are useful but they are pretty rough methods." He hopes that by targeting the genes within the diseased cells, damage from both the tumor itself and current treatment methods can be prevented. Within the last three years, the Neuro-Oncology Center at UVa has completed five clinical trials on patients with glioblastomas, and four more are open. Five trials are waiting in the pipeline.
Schiff believes it is imperative that UVa offer its patients unique and novel treatment options, especially if it expects people to travel for hours from surrounding regions. So far, new patients continue to come. In 2002, the Neuro-Oncology Center treated 406 patients. In 2005, the number of patients had grown to 549.
Both Schiff and Abounader know that much work and study has to be done before brain tumors can be fully cured. Schiff takes comfort in the success he has seen in the past and the gratitude of the patients. "The patients and families in general are so appreciative to have someone who understands their illness," he said. "We understand what they are going through even if we can´t treat it as well as we would like."
Abounader looks to the possibility of future progress. "It´s not going to be one single discovery and one single person that cures cancer," he said. "It´s the accumulation of the discoveries of all scientists everywhere that hopefully will someday lead to a breakthrough."