Gliomas

Surgery may be used in both the diagnosis and treatment of gliomas. Surgical removal of the tumor helps reduce pressure on nearby parts of the brain. Surgery may be followed by chemotherapy or a combination of chemotherapy and radiation therapy.

Working closely with specialists from University Hospitals Neurological Institute’s Brain Tumor and Neuro-Oncology Center our fellowship-trained neurosurgeons utilize the latest advances in surgical intervention to treat gliomas, including:

• Minimally invasive brain tumor surgery: This approach includes endoscopic techniques through which our neurosurgeons view detailed images of the patient’s brain using a small camera.
• Fluorescence-guided surgery: UH Seidman Cancer Center neurosurgeons have pioneered the use of special fluorescent markers (such as 5-ALA) to assist in precisely identifying the borders of a tumor in order to help the surgeon remove more of the mass while minimizing risk to the brain. Following FDA approval, UH Seidman Cancer Center was the first hospital to use Protoporphyrin IX to make glioblastoma tumors glow hot pink when illuminated with a special blue light during surgery, allowing surgeons to visualize the edges of tumors more clearly and remove them more completely.
• NeuroBlate®: This revolutionary laser interstitial thermal therapy destroys brain tumor tissue with a magnetic resonance imaging (MRI)-guided laser. Our hospital is one of only a few hospitals in the world that offers this minimally invasive treatment, which can be used to treat brain tumors that were previously diagnosed as untreatable.
• Intraoperative MRI: With specialized intraoperative MRI suites, we use magnetic resonance imaging to track surgical progress in real-time.
• Laser interstitial Thermotherapy (LITT): LITT is a minimally invasive surgical technique that uses thermal energy delivered by a laser to destroy and remove brain tumors that may be too difficult to reach via conventional surgery. During the procedure, a neurosurgeon implants a laser catheter into the tumor, guiding the laser using real-time MRI and delivering heat only to the tumor while sparing surrounding tissue.

Radiation therapy involves the use of high-energy x-rays or other types of radiation to kill cancer cells or prevent them from growing. Using a machine outside the body, external radiation therapy sends radiation directly toward the area of the tumor. Radiation therapy is often recommended after surgery and may be administered in combination with chemotherapy. For patients who can’t undergo surgery, radiation therapy and chemotherapy may be used as a primary treatment.

Innovative radiation technologies we use in the treatment of gliomas include:

• Proton therapy: UH Seidman Cancer Center is the first hospital in Northeast Ohio to offer this innovative, powerful and technologically advanced therapy. Effective for both adults and children, proton therapy has less side effects than other forms of radiation therapy, resulting in better quality of life during treatment, while also reducing patient risk for the development of radiation-induced secondary cancers decades after treatment.

Radiation therapy involves the use of high-energy x-rays or other types of radiation to kill cancer cells or prevent them from growing. Using a machine outside the body, external radiation therapy sends radiation directly toward the area of the tumor. Stereotactic radiosurgery differs from traditional radiation therapy in that stereotactic radiosurgery involves the use of precisely focused radiation beams. Unlike traditional radiation therapy, stereotactic radiosurgery exposes very little if any normal tissue to radiation.

Stereotactic radiosurgery is often recommended after conventional surgery and may be administered in combination with chemotherapy. For patients who can’t undergo conventional surgery, stereotactic radiosurgery and chemotherapy may be used as a primary treatment.

Innovative stereotactic radiosurgery technologies we use in the treatment of gliomas include::

• Gamma Knife®: An accurate form of stereotactic radiosurgery for the brain, this technology pinpoints a single area with numerous gamma radiation beams without damaging surrounding healthy tissue.
• Varian Edge™: This advanced, high-focus radiation beam radiosurgery system targets the DNA in cancer cells, destroying the cells. Unlike other radiosurgery systems that require the use of a rigid frame to secure a brain cancer patient’s skull during treatment sessions that can last several hours, Varian Edge delivers equally precise treatment without requiring a frame in as little as just a few minutes.

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or preventing their division. When taken orally or injected into a vein or muscle, chemotherapy drugs enter the bloodstream to reach cancer cells throughout the body (systemic chemotherapy). Chemotherapy placed directly into the cerebrospinal fluid is called intrathecal chemotherapy. Regional chemotherapy is when chemotherapy drugs are inserted in an organ, such as the brain, to primarily affect cancer cells in that local area. When suitable, we may use an innovative technique in which thin, circular wafers containing chemotherapy medicine are placed in the brain during surgery. These wafers dissolve slowly to provide the timed release of a medicine that kills cancer cells.

Targeted therapy is an approach to treatment that utilizes drugs or other substances to identify and attack specific cancer cells. In general, targeted therapies inflict less harm to normal cells than chemotherapy or radiation therapy. Promising targeted therapies for certain types of gliomas include monoclonal antibody therapy, tyrosine kinase inhibitor therapy and vascular endothelial growth factor (VEGF) inhibitor therapy.

CED is a local drug delivery technique by which a therapeutic agent is infused directly into a brain tumor through a cannula using hydraulic pressure. The procedure bypasses the blood-brain barrier and minimizes exposure to nearby healthy tissues.