New Protocol Targets Aggressive Brain Cancer

After 20 years in the U.S. Marine Corps, 50-year-old Joseph Wollschlager Jr. felt invincible. Until one day at work when what looked like a seizure led to the diagnosis of a life-threatening brain tumor. The outlook was grim: Survival rates for this type of cancer are usually less than a year.

But in typical Marine Corps style, Wollschlager is fighting all the way. Thanks to a new treatment regimen being tested at the University of Michigan Comprehensive Cancer Center, Wollschlager is back to work and optimistic about his prognosis.

“There’s nothing in this life that I can’t beat. Nothing will beat me in this life. I believe that wholeheartedly,” Wollschlager says.

Wollschlager’s tumor is called a glioblastoma multiforme. It is the most common and most aggressive form of brain tumors in adults. Typically, only 10 percent of patients live two years past their diagnosis.

The treatment Wollschlager is receiving was developed at U-M. It uses a type of radiation treatment called intensity-modulated radiation therapy, or IMRT. This allows doctors to target the radiation to the most aggressive parts of the tumor and spare adjacent normal critical structures. The radiation is combined with a type of chemotherapy called temozolomide, which has been shown in previous studies to improve survival in this type of brain tumor.

The specialized radiation treatment is possible through novel imaging techniques, including MRI and PET scans, that give doctors a clear picture of the most aggressive and resistant parts of the tumor. The IMRT allows individual beams of radiation to target only those cancerous areas, effectively carving out the tumor from the surrounding normal brain tissue. This allows doctors to deliver higher doses of radiation to kill the cancer because normal tissue will not also be damaged.

Results to date are preliminary but encouraging. Of 30 patients treated on this protocol, 20 have been followed for at least 12 months and 16 have lived longer than 12 months. It’s significant progress for a disease that usually kills in less than a year. The other 10 patients, including Wollschlager, are still less than a year out from their diagnosis.

“Novel imaging is a very important new tool for the treatment of high grade gliomas. It will allow us to better define the target and to define aggressive areas of the tumor where higher radiation doses can be safely delivered, in combination with effective chemotherapies. Imaging will also allow us to assess response to treatment so that we can adjust therapies early,” says Christina Tsien, M.D., assistant professor of radiation oncology at the U-M Medical School and lead investigator for this protocol.

Traditional imaging techniques require a patient complete seven weeks of treatment, followed by an MRI scan six weeks after completing therapy to determine if the tumor shrank. If the cancer did not respond to the treatment, a new approach may be tried. With newer imaging techniques, doctors can determine as early as one week after treatment begins whether it is effective.