By JAMES DOWD
For patients diagnosed with brain tumors, standard treatments include chemotherapy, radiation therapy and surgery. And while those options can yield positive results for many, some patients with more difficult tumors must pursue other treatment avenues.
For Mid-Southerners, one such option – GammaTile therapy – is now available in Memphis. Until recently, patients had to travel hundreds of miles to access this innovative treatment.
“This fills a niche. We’re using GammaTile when a lot of other options have been exhausted, so instead of patients having to travel to MD Anderson in Houston for a second opinion, we have the best option available here,” said Dr. Matthew Ballo, radiation oncologist at West Cancer Center. “We occasionally see brain tumors that can’t be treated any other way, but GammaTile offers a great alternative for this patient population.”
There are two common forms of radiation therapy, Ballo explained. One is radiation from the outside, which involves large doses of external beam radiation to destroy cancer cells and shrink tumors. Treatments may last from only a few visits up to several months. The other is brachytherapy, or interior radiation. During this procedure, a sealed radiation source is placed in or near the treatment area.
GammaTile, or Surgically Targeted Radiation Therapy (START), involves a surgeon placing radioactive seeds inside the brain tumor. These seeds, embedded in square pieces of gauze-like absorbable material, are trimmed to fit the size of the tumor and remain in place. As the radioactive metals decay, the radiation directly targets the cancer without affecting larger areas. After several weeks, the radiation is depleted.
“For patients with difficult to treat or recurring brain tumors, we stack these squares along the tumor bed just like you would place tiles on your bathroom wall,” Ballo said. “They fit perfectly along the tumor wall with enough space between the seeds and the tissue, but there’s that not much damage – patients receive the perfect dosage of radiation.”
Although external beam radiation therapy is still the gold standard, Ballo said. GammaTile offers hope to patients who may feel as if they’re at out of options. Patients typically receive this therapy after having had surgery or radiation and the brain tissue cannot withstand additional external radiation doses.
“This serves a need to deliver that treatment close to home,” Ballo said. “We are tertiary care for these patients who are at the end of the line in treatment options.”
Ballo and local medical professionals such as Dr. L. Madison Michael II, neurosurgeon at Semmes Murphey and professor of neurosurgery at the University of Tennessee Health Science Center, worked for years to bring this technology to Memphis. The therapy has been used in other medical facilities with great success and dramatically improves quality of life for patients suffering from rare brain tumors.
Dr. L. Madison Michael, II, (left), walks with Dr. Matthew Ballo.
“The results have far exceeded our expectations,” Michael said. “Traditionally 20 percent of patients at this stage would make it one year without recurrence of the tumor, but now it’s 4 out of 5 instead of 1 out of 5. We’re on the winning side the majority of time.”
GammaTile therapy doesn’t require significantly more time than traditional brain tumor surgery, Michael said. And the team approach promotes efficiency, which contributes to outstanding outcomes.
“We take the patient back and administer anesthesia, then I go in and perform surgery to remove any tissue that needs to be taken out,” Michael said. “Then Dr. Ballo and a physicist come into room to determine the number of implants to be placed and then we arrange the tiles and it’s over. All told, the time added to the procedure is only a few minutes.”
Michael and Ballo are working alongside other medical professionals to explore ways in which GammaTile therapy may be useful in treating other pathologies. And they continue to conduct research to determine the impacts of this surgery on the nature of neurological diseases.
“One of the biggest things for us is that every time you add a treatment, you add a risk, but it’s rare for something to come along like this.” Michael said. “While this is not risk-free, the side effects of GammaTile are practically non-existent. That’s a full-speed ahead for us.”
Local doctors collaborating with St. Francis Hospital to offer the surgery have performed five in the last year. A sixth case is under evaluation now. Surgeons expect to perform the procedure every other month or so.
“The difference between this operation and some other procedures is that we work together,” Michael said. “We’re able to do this because we have a multidisciplinary approach with medical, radiation, and other experts in each field. Our drive is not only to work on the side of coming up with new treatments, but also to have every tool in our toolbelt so that people have the best chance possible.”
“I can’t say enough about how wonderful it is that St. Francis agreed to collaborate because these are rare cases,” Ballo said. “We do it because it’s the right thing to do.”