Q & A: Burning unreachable brain tumors in real-time

University Hospitals Case Medical Center Dr. Andrew Sloan discusses the beginnings of a clinical trial to attack hard-to-cure brain tumors.

CLEVELAND, Ohio — Neurosurgeons affiliated with the Case Comprehensive Cancer Center hope to soon be one-third of the way through a Phase 1 study examining a way to dissolve previously unreachable brain tumors.

The procedure is through a device called AutoLITT, created by the Canadian company Monteris Medical. Through lasers and minimally invasive surgery, the device allows doctors to watch and adjust as they heat glioblastoma multiforme tumors and induce coagulative necrosis – a pasty state at which point the tumor is removed.

Cleveland Clinic and University Hospitals Case Medical Center (UH) physicians started these procedures last year. They will complete 15 in the first phase of the study.

Dr. Andrew Sloan is director of the Brain Tumor & Neuro-Oncology Center at UH and is participating in the research. Sloan also is a paid consultant and medical advisory board member for Monteris. Below, he discusses the progress and potential for the procedure.

Q. How have the first procedures gone?
A. We’re starting with a dose that is very, very safe, so far. We’ve presented the initial treatments and gotten permission to go to a slightly higher dose. The plan is to maximize the efficacy.

The higher dose will have a slightly higher risk profile to the area that’s treated but also a higher profile for efficacy.

Q. What’s compelling about the procedure?
A. We can fine-tune a procedure in real time.

Right now, we can’t always predict what can happen. With this, if we think we need to treat the tumor for 25 seconds to see an effect, and we see we got the effect after 12 seconds, we can stop. Or if we think we need a couple more seconds, we can go on.

It tells the temperature in real-time gradients as we’re doing the surgery – hundreds of times per second.

Q. How does it compare to existing treatments?
A. Radiosurgery has been extremely successful for some kinds of brain tumors but not for glioblastoma multiforme tumors (GBM). The problem with radiosurgery is that it’s a guessing game. You have to plan precisely on the MRI. And then you’ve given the dose and there’s not too much you can do about it.

Here, you put the catheter in using real-time MRI imaging. Let’s say the MRI is off by millimeter or two. You can choose to adjust and reimage. Then the treatment is delivered.

Q. Who are you treating and whom could you treat?
A. There are probably about 8,000 recurrent GBM tumors per year. We don’t expect to treat all of them. There’s other criteria. But I think we could treat half of them.

But we’re only testing this in GBM. Are there other tumors this procedure might be useful in? The answer is yes. But you have to start somewhere.

Q. What happens next?
A. We’d like to complete this study, which would be up to 15 patients. We had another procedure scheduled last week and have two other waiting in the wings. We are already designing the next stages.

It would be great if we finished the study early. We might be able to start a second study within the next year.