By Lauren Johnson
In March, Grandview Medical Center became the first hospital in Alabama to treat patients with brain tumors using Surgically Targeted Radiation Therapy (STaRT). This targeted therapy is for patients with newly diagnosed malignant brain tumors and recurrent brain tumors, including gliomas, glioblastomas, meningiomas, and brain metastases.
Through this radiation therapy, a GammaTile is implanted into the operative cavity within the last five minutes of brain tumor removal surgery, providing direct radiation that will delay brain tumor regrowth while protecting healthy brain tissue.
The GammaTile is a small white tablet, about the size of a postage stamp, that has titanium bars that will be radioactive for about 60 days. Over time, the white portion of the tile will resorb naturally, leaving the tiny pieces of titanium behind. Surgeons will typically implant one to four of these tiles in the operative cavity.
Usually, patients would need to wait two to four weeks before receiving traditional radiation after surgery, and they could be required to have up to 30 treatments over a span of several weeks. The GammaTile gives patients another option.
“It’s more convenient for the patient,” said Henry Ennis, MD, a radiation oncologist at Grandview. “We generally have to hold off on radiation until the patient heals after surgery, which could allow some of the tumor to start growing back. If you’re able to put a radioactive source directly into the operative cavity at the time of surgery, then you don’t have that four-week delay.”
Ennis performed treatment for the first patient in Birmingham alongside neurosurgeon Elizabeth Kuhn, MD who was the first in the state to perform this surgery. Ennis also treated the second patient alongside neurosurgeon Phillip Cezayirli.
“One of the exciting aspects of this is that Glioblastoma Multiforme (GBM), which is a very aggressive tumor, is typically treated with surgery, then radiation, followed by chemotherapy,” Ennis said. “These tumors try to grow back in the area where the tumor resection was. Using GammaTile may be more effective because you’re getting a good radiation dose right where it needs to go, and you’re able to get that radiation started quicker. We’re also able to increase access for patients in rural parts of the state that don’t have a radiation machine in their backyard.”
A release from Grandview Medical Center stated, “Over 200,000 patients are diagnosed with an aggressive brain tumor in the U.S. each year. Aggressive brain tumors tend to be resistant to current treatments and have a high likelihood of recurrence.”
This therapy is shown to improve local tumor control, providing hope for patients battling aggressive tumors and extending their life. Patients are able to go to rehab sooner and can get on with their lives without worrying about more treatment. Most patients also avoid losing their hair during treatment.
“This type of targeted therapy is not new to medicine, but it is relatively new to neurosurgery,” Cezayirli said. For brain metastatic disease, we don’t have to do any radiation after the GammaTile, necessarily, because we’re delivering all of the radiation there. For glioblastomas, we’re able to reduce the amount of radiation and the number of sessions required.”
Trials for upfront GBM haven’t been completed, but Cezayirli believes the outcome will be positive just like the first clinical trial was for recurrent brain metastases.
“The hypothesis is that delivering radiation immediately is better than waiting because the tumors aren’t waiting for your skin to heal,” he said. “Although the trial isn’t completed for GBM, I think that’s the most promising. It’s the most aggressive tumor that we have in neurosurgery where the average survival rate is two years or less.”
Studies have shown that the side effects from the GammaTiles are about the same as the traditional radiation treatment. “There was no statistically significant change in overall complications or side effects from the surgeries with GammaTiles or without,” Cezayirli said.
GammaTiles are a type of brachytherapy, meaning it’s delivering radiation through an implanted device, which is common for prostate cancer treatment. While GammaTiles were designed for neurosurgery, there are discussions going on about using them for spine and spinal cord tumors.
“Conceptually, it could certainly be used in other places. There’s no reason it has to be used for only neurosurgery,” Cezayirli said. “The limitation to how we use the GammaTiles is making sure we understand the physics of it in that location.”
