Treating brain tumors and central nervous system (CNS) tumors has been an integral part of the UF Health Proton Therapy Institute since day one. Two-thirds of the children we treat have brain tumors, most commonly craniopharyngiomas and ependymomas. Hundreds of adults and children have benefited from targeted proton therapy that effectively treats the tumor and reduces the risk of side effects. Ronny Rotondo, MD, CM, FRCPC, leads the brain tumor and CNS program, with expertise in pediatric and adult malignancies and base-of-skull tumors. Following is a Q&A with Dr. Rotondo about brain tumors and proton therapy.
Q: May is brain tumor awareness month. What should people know about this type of cancer?
A: There are many kinds of brain tumors. Tumors that arise in the brain can be malignant or benign. Sometimes tumors in the brain are caused by a cancer that has spread from another part of the body. The type of cancer determines the type of treatment which can include surgery, radiation and chemotherapy, often in combination.
Q: What are the symptoms of a brain tumor? How do you know when you should see a doctor?
A: The signs and symptoms of a brain tumor vary greatly and depend on the brain tumor’s size, location and rate of growth. General signs and symptoms caused by brain tumors may include:
- New onset or change in pattern of headaches, or headaches that gradually become more frequent and more severe
- Unexplained nausea or vomiting, vision problems, hearing loss
- Numbness, weakness, difficulty with balance, speech
- Confusion/personality changes
- Seizures, especially in someone who doesn’t have a history of seizures
Make an appointment with your doctor if you have persistent signs and symptoms that concern you.
Q: What role does proton therapy have in treating brain tumors?
A: The benefit of proton therapy is it can deliver high dose radiation to the tumor site while minimizing or even avoiding depositing radiation in other parts of the brain. The higher the dose of radiation, the better chance we have of controlling the tumor. By minimizing radiation to healthy brain tissue, we can reduce the loss of memory function and cognitive function. By minimizing or avoiding damage to critical structures near the brain, we can preserve vision, hearing and hormone function.
Q: And for children who have brain tumors, preserving healthy brain tissue can mean a lifetime of benefit.
A: That’s right. Proton therapy’s benefit is seen in both adults and children. We safely treat children who are as young as 18 months old. We can give children an excellent chance of survival and a good quality of life. Studies show that even small amounts of radiation exposure can have a negative impact on a developing child’s IQ. Because proton therapy deposits less radiation in healthy brain tissue than conventional X-ray radiation, we can have a better chance of preserving the child’s IQ.
Q: What would a patient experience while having proton therapy for a brain tumor?
A: Brain tumor patients are usually treated over a 5 ½ - 6 ½ week period. Prior to treatment starting, we take CT scans to accurately identify the treatment area. Custom devices are made for each patient, including immobilization masks and body molds. These enable us to position the patient in the exact same spot each day of treatment. Once the patient is in position, the proton beam is delivered for about one minute, during which the patient remains completely still. Overall treatment time is about 35-45 minutes (one hour door-to-door).
Q: Are there side effects?
A: Most patients tolerate treatment very well with minimal side effects. Some side effects may occur including fatigue, nausea/vomiting, headache, hair loss, skin irritation.
Q: What is the success rate of proton therapy in treating brain tumors?
A: Success rates vary significantly depending on the type of brain tumor, spanning from benign or low-grade tumors with excellent long-term survival and more aggressive, high-grade tumors such as a glioblastoma multiforme (GBM) for which outcomes remain poor.
Q: Is there more that can be done with protons for brain tumors?
A: We have ongoing research to explore opportunities to intensify treatment in some cases which may lead to improved outcomes. We are currently participating in a multi-institutional clinical trial funded by the National Cancer Institute for GBM tumors, the most common primary brain tumors. This study compares a higher radiation dose using proton radiation to the standard radiation dose using IMRT. Both groups will receive the standard chemotherapy, Temodar. The study will allow the researchers to better understand whether this higher dose technique is better, the same or worse than the standard approach. This study is geared towards newly diagnosed GBM. Recurrent tumors and patients who have received prior chemotherapy or radiation therapy for GBM are not eligible. Given patients on this trial must begin treatment within five weeks of surgery, prompt referral after surgery is essential, ideally within two weeks. For further information about this study, please call toll-free 877-686-6009.