MembersMeet 12 September 2011

The Molly Lane Fox Brain Tumour Unit

Dr Jeremy Rees consultant neurologist, Mr George Samandouras consultant neurosurgeon and Dr NaomiFersht consultant oncologist gave the most fascinating and informative presentations to the members about brain tumours.

Dr Jeremy Rees gave an overview of what a brain tumour was, of which around10,000 occur each year in the UK. Generally a larger % of men are affected with brain tumours than women but it’s not understood why this is.

There are four lobes in the brain: frontal, temporal, occipital and parietal, as well as the brainstem. Adults tend to have tumours in one or more of these lobes (the cerebral hemispheres), whereas children often have tumours at the back of the brain in the brainstem or cerebellum.

A special scan called a functional MRI is essential in being able to see the size and location of a brain tumour. A specialised type of MRI scan can also show up which parts of the brain control movement at the time of the scan by getting the patient to for example tap their feet! These scans allow the doctors to see how close the tumour is to important areas of the brain which cannot be safely removed. Scans can also give some idea about the severity of tumours, ie low grade (I-II) or high grade (III -IV). It is often the case that a grade ii brain tumour over time is likely to progress to a high grade, but it’s most unusual for a grade i to develop to a stage ii. Patients with low-gradebrain tumours are more likely to experience a seizure while patients with high-grade tumours are more likely to have stroke-like symptoms or headaches. Although headaches are an early symptom, the vast majority of patients who have headaches do not have a brain tumour.

The new Molly Fox Brain Tumour Unit is the Trust’s largest fight against brain tumours which has been set up by the National Brain Appeal fund and Molly’s Fund who raised over 2.5million pounds to help address the problem of brain tumours.

Mr George Samandouras gave the background of the NHNN, which is now part of UCLH, and outlined the major changes that have taken place in brain surgery over the last 150 years. Queen Square, where the NHNN is based, is the most famous address in the world when it comes to neurology and neurosurgery.

Mr Samandouras told members about two recent advances. Surgeons performthe most intricate and delicateoperations during brain tumour surgery and often a scan is required during surgery to see if all the tumour has been removed. However, to wake the patient up, scan and re-operate was not practical and a scanner called the “intraoperative MRI” has now been placed inside the theatre at the NHNN and this now means the patient can be rescanned during surgery. The scan has a high magnetic interface which means no metal or instruments can be left on the patient or the trolley during the scan and a red line is on the floor to show when the magnetic area is being entered. More than 100 operations have been done at Queen Square in the last 2 years using this scanner.

The other initiative that has been developed is a fluorescent dye that is taken up by brain tumour cells and allows the surgeon to identify the brain tumour through the operating microscope without touching any of the normal brain tissue which means more of the brain is preserved. A patient takes a pill 5 hours before surgery which makes the dye effective. George Samandouras showed a video to the members of a patient undergoing brain tumour surgery removal which showed how the interoperative MRI scanner and fluorescent dye was used and how essential these two recent advances are in ensuring very accurate and precise removal of the brain tumour. Once the tumour has been removed chemotherapy wafers are placed around the area where the tumour was and these waters dissolve over 3 – 4 weeks and remain as active chemotherapy. The computer used in brain surgery shows a navigation map of the brain and the tumour.

Dr Naomi Fersht talked about the different types of radiotherapy and the principles of it. Commonly, patients having radiotherapy need to come in every day for 6 weeks to receive 2 minutes of radiotherapy as it needs to be given in very small doses. Naomi talked about the advances and techniques used now which help spare the normal tissue as a much smaller area is able to betargeted.

Some of the newtechniques used in radiotherapy are:

RapidArc – this allows us to treat tumours with greater conformality, sparing normal tissue, and allowing higher doses to be given than with standard radiotherapy techniques.

Cyberknife – this is a new radiotherapy machine that can be used to deliver extremely precise and focussed radiotherapy in a few big doses, when surgery is not possible Although UCLH does not have this machine the one at Harley Street is able to be accessed with PCT funding.

Truebeam – this machine is used for all forms of advanced external beam radiotherapy.

Advances in technology for radiotherapy and determining which technology to use for the treatment of tumours present huge challenges.

Click here to view the available presentations.

Ros Waring

Membership Development Manager

October 2011