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MRI And Proton Beam Study Brings Glioblastoma Boost

Gioblastomas are among the most aggressive and difficult-to-treat forms of cancer, posing significant challenges for both surgical and radiotherapy approaches.

Their hair-like filaments that weave in and out of brain tissue make them impossible to excise with invasive surgery, while radiotherapy, though effective against the tumour, brings a high risk of damage to the brain.

Such harm to otherwise healthy tissue can add to the side effects of radiotherapy by causing the brain to swell, making speech impairment and memory loss additional problems on top of skin issues, nausea and hair loss.

These symptoms can be gruelling enough for anyone to handle over a treatment period of several weeks, but the impact is harder for older patients to handle.

New Hope For Older Patients

For all these reasons, a new study by the Mayo Clinic in the US, published in Lancet Oncology, has provided new hope for older patients.

The study found that using very precise proton beam therapy, guided with the latest MRI scanning technology such as 18F-DOPA PET, plus contrast-enhanced MRI, can extend the survival time of over-65s with aggressive stage 4 glioblastomas.

The use of the new method meant there was far less damage to surrounding brain tissue, and the whole process could be completed in 1-2 weeks rather than the usual duration of between three and six, making treatment less gruelling.

Describing this, Mayo Clinic radiation oncologist Dr Sujay Vora said: "The advanced imaging along with the proton beam therapy allowed us to be more focused with radiation and protect surrounding healthy brain tissue from the effects of radiation.”

He noted that a particular advantage of the MRI technology was the improved targeting it offered. "Combining advanced imaging allowed us to determine the most metabolically active, or aggressive, regions of the glioblastoma,” he explained.

However, the most important finding was the substantial improvement in survival rates among the 39 patients who undertook the single-arm Phase 2 trial. 56 per cent of them survived for more than a year, with a median survival of 13.1 months.

Putting this in perspective, Dr Vora said: “As compared to prior phase 3 studies in an older population having a median survival of only six to nine months, these results are promising.”

Better still was the fact that patients with particularly favourable genetic make-ups had an average survival of 22 months. Dr Vora exclaimed: “We are very excited about these results”.

Swapping Hospital For Hawaii

The Mayo Clinic report on the study went on to quote the thoughts and experiences of patients who underwent the trial and benefitted both from less gruelling treatment and longer life.

One of the patients, Nadia El-Afandi from Minnesota, said after she was able to enjoy a trip to Hawaii that included snorkelling and hiking: “There's no cure for glioblastoma yet, but I've been able to take advantage of this medical opportunity, and it has given me a quality of life that is just outstanding."

The development is a clear sign of the progress that is being made in making radiotherapy ever more precise, especially when it comes to brain cancer and the imperative to deliver intense and precise doses of radiation to minimise damage to healthy brain tissue.

Proton beam therapy is joined by other tools such as gamma knives in helping achieve this, while MRI technology is now proving its value.

Another Promising Development

The Mayo study has pointed the way towards one advance in treatment that can have clear beneficial outcomes. But there is other research taking place that may offer further hope for fighting the scourge of brain tumours like glioblastomas.

A study at Washington University published in the journal Cancer Cell has revealed that there is a link between the body’s hormone cycles and tumour growth. It found that glucocorticoid signalling aids the growth of glioblastomas by synchronising circadian rhythms with the host.

This implies that therapies that disrupt this circadian rhythm-driven tumour development could help slow or halt the growth of glioblastomas. It is not an entirely new discovery, however, as it has been established before now that chemotherapy can be more effective at certain times of the day.

Therapies could include corticosteroids and well-established medications such as Dexamethasone, a drug with a range of uses (including antiviral properties that led to it becoming the first existing medication to be identified as effective in reducing COVID-19 mortality).

What all this shows is that the available treatments for glioblastoma are advancing rapidly. That may not mean every patient can get another chance to go on snorkelling or hiking holidays, but it does demonstrate that for many, even patients of advancing years, the options are better and more numerous than they were a few years ago.

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