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Brain Cancer
Delivering Chemotherapy Directly Into Tumor Sites

Each year more than 18,000 Americans - mostly young and otherwise healthy - are diagnosed with malignant tumors of the brain. More than 12,000 die each year from brain cancer. Even with intensive treatment, the median survival time is one year.

Why? Because its symptoms are so vague, brain cancer is often diagnosed after it's too late to do anything meaningful about it. And, even if the diagnosis comes at an early stage, brain cancer is notoriously difficult to treat. The blood-brain barrier prevents complex molecules in the blood from entering the brain, making it extremely challenging to treat a patient with chemotherapy.

The only way to ensure that enough chemotherapy reaches the brain with sufficient impact to reduce tumor size would be by using extraordinarily high doses to "flood" the system. Side effects would be devastating, causing significant damage to other organs.

Because of the drug delivery challenges, Dr. Jeffrey N. Bruce, the Edgar M. Housepian Professor of Neurological Surgery and co-director of the Brain Tumor Center at Columbia University Medical Center, decided to find a way to bypass the blood-brain barrier and deliver chemotherapy directly to the site of the tumor.

Through research with rats, Dr. Bruce and his research team have found that sufficient drug concentrations can be delivered directly to the tumor, with very little going elsewhere in the body, producing fewer side effects. The safety of this method has been proven, and scientists are now conducting early clinical trials in humans with brain tumors.

"We think this method has the potential to be used to slow the growth of the tumors, improve quality of life and lengthen survival," said Dr. Bruce. "But more research needs to be done."

Dr. Bruce is currently leading a multidisciplinary, NIH-funded trial for patients whose brain tumors have grown back after initial treatments. Of the first 10 patients treated in a phase I trial, most tolerated the procedure with little or no side effects, and several survived up to two years - much longer than expected with traditional treatment.

One such patient is a renowned astrophysicist at an Ivy League school. Diagnosed at age 63, the professor's brain tumor proved resistant to both chemotherapy and radiation, and caused him to lose control over his right side and prevented him from being able to walk. Nearly 20 months after his initial topotecan treatment, from which he experienced no side effects, his tumor continues to shrink, according to MRI scans. And his quality of life has improved significantly as well - he is able to walk again, with a cane, and is back in the classroom educating some of the world's brightest students about stars, planets, comets and other mysteries in the skies above.
© 2005 Columbia University