Fighting Glioblastoma | Dr. Christopher Duma, M.D. | TEDxCollegeoftheCanyons

the topic is tracking glioblastoma through the brain I know about 90% of you in the audience have no idea what a glioblastoma is but if we polled the audience I'm sure about 10% of you would have someone that you know a loved one a family member someone who's had to deal with glioblastoma suffered from it and most likely died from it what glioblastoma is is the number one most malignant aggressive cancerous tumor that grows in the brain we see it in mostly 60 50 year olds but we see it in all age ranges and it uniformly today in 2016 takes everyone's life I'm a brain surgeon my day job is making punctures and I open up skulls and I operate in the brain and for the vast majority of tumors we can take them out patient goes home in a couple of days they do great I've been doing this for 23 years as my shrah mentioned but if you add my residency years that's another seven years so I've been doing this for 30 years and the treatment of this tumor and the success of our treatment of this tumor has not changed in 30 years eleven years ago a new drug came on the market helped us a little bit added two months of survival so that's not saying a lot especially in the year 2016 let's look at what I'm trying to talk about today this tumor eludes us it's invasive it grows in a much different way than any other tumor in the entire body so this talk today on glioblastoma is special because it's a special tumor it doesn't grow like a snowball it doesn't get larger and larger it grows insidiously through the brain I'll explain that picture on the left is a normal MRI picture on the right is glioblastoma that big white thing looks pretty nasty spreads its way through the brain slowly that's another form of glioblastoma it's called a butterfly glioma because the shape of it looks like wings of a butterfly all that's doing is is the tumor is literally invading both hemispheres that's how invasive it is this is a glioblastoma and this is the glioblastoma so it can be multifocal in many places in the brain at once the nasty tumor why has it eluded us all this time why have all the great minds in science and medicine not been able to figure out this tumor we have lots of great new cures for various things but not this it is a common tumor it only makes up 15% of all of the brain tumors that we see but that's a large number three out of a hundred thousand people considered incurable and if you're a person and you all of a sudden start getting headaches maybe you have a seizure of epilepsy maybe you have a neurologic problem like you can't speak or you have a paralysis kind of like a stroke it might be a glioblastoma our treatment is fairly stable over the last 30 years radiation and chemotherapy we have new treatments immunotherapy vaccines Tomo LTP TTFN a lot of a lot of different variations on the theme but frankly none of them have made a huge impact only 2% of people live more than three years with this disease if you didn't treat it you'd be dead in an average of three months so the reason is because when we look at a GBM on MRI this looks like a couple of tumor areas right if we do a special MRI sequence a special inversion recovery it's called we see this so it's not just those two areas it actually is that an entire quadrant of the brain the tumor cells have literally taken over and started mobilizing like little troops through the brain from where they started there's an epicenter where this tumor starts is one problem and that's where it probably began but then it spreads throughout the brain in this fashion and look at this picture this this is the brain so if you're a surgeon you cannot take that out that is inoperable that's actually in that patient speech area not only would you make them unable to speak but you also make them unable to move their right side of the body so as a quandary how do you treat this tumor and what can we do that's different about it so you see this has come into the news as well Beau Biden just to come to this that's Vice President Biden's son dear and beloved son just say you're a little bit a little bit ago Senator Ted Kennedy had this so there are it is in the press we've seen it recently we've heard about vaccines poliovirus that type of thing problem with the tumor is it can't be cut out so that led me to start thinking how this really works okay how does this tumor get through the brain well I told you earlier that most tumors that come to the brain or start in the brain they grow like a snowball they get bigger and bigger and bigger those are easy to take out they're usually benign you take out the whole tumor the patient's doing fine that's not how Cleo blastoma works it doesn't grow like a snowball this is a jello mold of the brain you can actually buy this if you want good at parties but when I talk to patients I tell patients that the brain is like a bowl of jell-o with a saran wrap around it the saran wrap is what makes the shape and then once you get through that little membrane called the pia arachnoid once you're through that the brain is exactly like jello well then I searched the internet for a picture that might depict a brain tumor in jello are defined but this is the closest I got and this is a jello mold with numerous strawberries in it pretend each strawberries a tumor everybody in this room could take a little knife cut through grab the strawberry ease it out slowly and the brain would the jello would come back together wouldn't it it's as if you haven't taken out any jello at all in fact that's what most brain tumors are they're like a strawberry in jello you take the strawberry out the brain comes back everything's hunky-dory in the case of glioblastoma the tumor is the jello so that's the point to get across here it's a completely different tumor as far back as 1928 one of our famous neurosurgeons of you're actually cut the hemisphere out of a patient trying to rid them of this tumor and what happened three months later the tooling came back on the other side it's a weird tumor we have to try and outsmart it this led to a nihilistic approach I mean if you talk to most neurosurgeons most neurologists they say oh you got a glioblastoma go home and write your last will and testament it's not acceptable today okay nor is that median survival of fourteen point six months very bad well and as I mentioned there has been no change in eleven years we've added one medicine in eleven years so it led me to start thinking how to outsmart this tumor how does it invade how does it get through the brain how does it motor through the brain and I did some research if you look at where the tumor starts let's call that the epicenter it only has a few ways to go in the brain because there are only certain white matter pathways that lead from that area and it's all about white matter tracts you guys have heard of grey matter white matter the white matter are the tracks think of them as the highways 405 the five freeway getting from one area of the brain to the other so this tumor takes those highways and you know what it doesn't take right angles it doesn't go off the highway it stays in the highway and the highways are well known there's plenty of anatomy all of us who've been doing this a long time we know the anatomy so I discovered how the tumor cells become they become moved like little amoebas the tumor starts as a single cell it actually transforms into like a little amoeba it polarizes and it becomes motile it develops fibrian's that actually contracted it can contract and move like a little inchworm each tumor cell another 100,000 tumor cells in a tumor there might be more it even develops an anchor so that when they inch or moves it can move farther so if we see a tumor like this we can do that special MRI sequence that shows us this and what you see here is that the tumor has already made it halfway back into this patient's brain if your eye focuses on this here that's only half the story so I dub the term leading-edge pathway leading edge is that area where the tumor grows away from its epicenter and I said to myself let's try and cut it off of the pass let's figure out a way to stop it put up a break well easiest way to do that would be to give radiation to the front of the tumor where it's going and that's what my invention is I use a machine called the gamma knife the gamma knife is a specialized machine which actually delivers radiation to a pinpoint area but I can shape the area the beams come through these little openings and there are 193 beams each beam is very weak where they focus is very strong and powerful so I can shape the radiation right along those white matter pathways sounds logical doesn't it this is the way we treat and that's the concept of how we treat with gamma knife gamma knife is used to treating single round tumors like this that's a breast metastasis which is a little sphere very easy to treat this is a tumor one month later in the middle and 15 months later tumors gone patient never had his head open just focused radiation with a gamma knife with GBM we have to treat the tract where it's going right all of you now here are educated you wouldn't want to just treat the ball where it started now would you this isn't rocket science brain surgery so here's a patient where we started with the epicenter and I treated the leading edge you see that just that little bit save this patient's life just this little piece that we treated that did look like normal brain this patient lived 12 years I told you median survival is two years lesson two years fourteen point six months so this is the concept remember when you look at these films we have to look at where it's going not where it started where it's going and that's the concept of my invention so we have to treat that area kind of like setting up a firebreak you know you give you mowed down some trees so that if you have a forest fire god forbid it stops where you've mowed down the trees that's what we're doing with glioblastoma and that's what the invention is that's a gamma knife treatment plan that's cutting it off at the pass look at the big tumor at the top it's still there that's not where I'm focusing I'm focusing on where it's going now here's a great case okay so magnificent surgery I took out this huge tumor here and I knew this is a glioblastoma I knew it's going somewhere from where it started right I just thought all you that and this is that flare sequence so you can see the difference here's without the flare there's a flare and my goodness the tumour is already on the other side of the brain so it's dramatic how this tumor and grow this is a scan of that same patient do that see the excellent surgical resection this is four years later and this is five years later well that is all you're seeing here is scar tissue all practical purposes that patient is cured so if we look at our statistics they're spectacular hmm I have a series of 161 patients where I've used this technique as an adjunct to radiation and chemotherapy the technique brings median overall survival from twenty from fourteen point six months to 24 months that's almost an 80% improvement in survival everybody looks at median survivals in medicine its median survival is half the people are dead by that number and the other half are still alive but dying and as I mentioned two-year survival 3-year survivals are very very rare so if we plot my two-year survival 40% versus 30% for standard pair three years survival 27% vs. 2% I have 16 percent of my patients throughout five years and the literature doesn't even report that because it's unheard of about the seven year follow-up patients nine percent I've got 16 patients we're out nine seven years with this disease I even have 10-year survival and all it is is because I've outsmarted that smart tumor it's a very simple concept and when you all leave here you'll say whoa whoa why didn't anybody think of this before well I thought about it 15 years ago this is 15 year data I've been collecting all this all this time so while my colleagues have been you know in their box you know the chemotherapy guys stay in the chemotherapy box the radiation guys stay in the radiation box the medicine guys stay in medicine box you've got to think outside the box that's what this is all about innovation thankfully I got a US patent on this so is my Christmas gift last year and it is a technique patent so it's just based on my technique of using a piece of equipment to do this it is very rare the patent company had it for seven years so I'm going to end this with something that people in the hockey field on understand Wayne Gretzky don't skate to where the puck is skate to where the puck is going don't radiate don't treat glioblastoma where it is treat it where it's going thank you

Channel: TEDx Talks

Views: 172,521

Rating: 4.8300781 out of 5

Keywords: TEDxTalks, English, United States, Health, Cancer

Id: hErXkeIadsY

Length: 16min 21sec (981 seconds)

Published: Tue May 03 2016