On the Mayo Clinic Radio program, Dr. Jennifer Martinez-Thompson, a Mayo Clinic neurologist, discusses diagnosis and treatment options for Lou Gehrig's disease, also called amyotrophic lateral sclerosis (ALS). Also on the program, Dr. Molly Jeffery and Dr. W. Michael Hooten share new Mayo Clinic research on trends in opioid use. Dr. Jeffery is the scientific director of Emergency Medicine Research at Mayo Clinic, and Dr. Hooten is a Mayo Clinic anesthesiologist and pain medicine specialist. And Dr. Paul Brown, a Mayo Clinic radiation oncologist, explains a new radiotherapy approach aimed at preserving cognitive function for some brain tumor patients.

The post Mayo Clinic Radio: ALS / opioid research / new radiotherapy techniques appeared first on Mayo Clinic News Network.

Diagnosed with a brain tumor, Marrissa Janssen was scared. Her biggest fear was that doctors wouldn't be able to get rid of the entire mass. But after consulting with experts at Mayo Clinic, Marrissa's fear turned to hope. Now, after surgery and proton beam therapy, the tumor is gone.

Sept. 6, 2018, started off as a typical day for 33-year-old attorney Marrissa Janssen. She was on a conference call at work, trying to share some facts and figures. "I wanted to say a number, but couldn't get the words out," Marrissa says." It lasted about 10 or 15 seconds."

Shortly after, she experienced tingling and numbness in her arms and legs. Although her symptoms only lasted a short time, she was concerned. She texted her husband. Suspecting a stroke, she went to a local emergency department in Sioux Falls, South Dakota.

Scans showed that Marrissa had an unusual mass in her brain. The hospital recommended she go to Mayo Clinic's Rochester campus for further evaluation.

A team of experts

Five days later, Marrissa and her husband made the four-hour drive from Sioux Falls to Mayo Clinic to meet with neurosurgeon Giuseppe Lanzino, M.D. After reviewing the scans, Dr. Lanzino asked colleague Terence Burns, M.D., Ph.D. for his opinion.

"The tumor was surrounding a branch of the middle cerebral artery," Dr. Burns says. "It was located within the part of Marrissa's brain that allowed her to speak. Removing tumors from this area is most safely achieved via awake brain surgery — a procedure some of my colleagues and I do on a regular basis."

Awake brain surgery is the safest and most effective strategy for removing tumors from parts of the brain where various important functions are located. During the mapping portions of the surgery, sedation is suspended, so the patient can be fully awake and participate in neurological and cognitive testing.

By electrically stimulating and briefly inactivating sensitive brain areas affected by a tumor, the surgeon can determine whether a tumor can safely be removed without compromising function. Depending on the region of the brain that's involved, those functions can include coordination, sensation, language and higher-level cognitive processes, such as problem-solving.

"Dr. Burns was confidently soft in the way he delivered the news," Marrissa says.

"He said it was a small tumor with clear margins, or areas where it started and stopped. He said that after he removed it, he would take a slice of the mass and send it to pathology to determine if it was cancerous."

"Dr. Burns was extraordinary. And Mayo, it's this majestic unicorn. When you're there, it feels as though this whole team is in place just for you."

Marrissa Janssen

Marrissa's surgery took place the following day. During the procedure, Dr. Burns found that the tumor appeared quite different than the surrounding brain tissue, with no obvious evidence of infiltration. Based on its appearance during surgery, Dr. Burns hoped the tumor would be a pleomorphic xanthoastrocytoma, or PXA, because complete removal of these tumors typically bodes well for long-term survival. PXA is an extremely rare type of brain tumor that occurs in less than 1 in 1 million individuals — typically in children and young adults.

A complicating factor in the surgery was that the section of Marrissa's brain responsible for language came up to the edge of the tumor, making complete removal challenging.

"We had to accept that if there were any infiltrating cells even slightly beyond the visible edge of the tumor, we would not be able to safely chase after them," Dr. Burns says. "Marrissa and I had agreed prior to surgery that our top priority was to keep her safe — maintaining her language function and thereby preserving her quality of life. By the end of surgery, I felt all visibly suspicious areas for tumor had been removed, and her language function remained intact."

An unusual finding

When the pathology results returned, they did include certain genetic features of a PXA, as Dr. Burns had hoped. However, the genetics of Marrissa's tumor showed something more unusual and concerning. Her tumor harbored additional alterations not seen in PXA, but characteristic of glioblastoma — a far more aggressive type of tumor. What it meant to have mixed features intermediate between PXA and glioblastoma was uncertain.

Mayo Clinic has been actively pioneering the field of glioma genetics. According to Dr. Burns, the vast majority of people with gliomas have no family history. In most cases, the genetic changes arise spontaneously, allowing a tumor to develop.

"Identifying these genetic alterations can help establish a diagnosis and provide insights regarding response to therapy. However, there are occasional tumors, like Marrissa's, that simply defy known classifications," Dr. Burns says. "It can be quite a challenge to predict how these will behave, and it requires the wisdom of the multidisciplinary team to tailor optimal treatment recommendations."

An excellent result

After surgery, Marrissa met with neuro-oncologists Joon Uhm, M.D., Michael Ruff, M.D., and Ivan Carabenciov, M.D., to craft a treatment plan going forward.

"They were very calm and comforting. They gave me hope, in the sense that my age and overall health were on my side, and that the tumor was missing a lot of markers for an aggressive epithelioid glioblastoma," Marrissa says. "They indicated that radiation would be part of the care plan and referred me to Paul Brown, M.D., for proton beam therapy."

Marrissa began daily proton beam therapy treatments on Oct. 15, 2018, and completed her last treatment on Dec. 5. "It wasn't painful, but there was fatigue and some hair loss, which were anticipated side effects," she says.

Marrissa's follow-up scans in January and April brought good news, with no evidence of any recurrence of the tumor.

"Dr. Burns was extraordinary," Marrissa says. "And Mayo, it's this majestic unicorn. When you're there, it feels as though this whole team is in place just for you."

"We may not be able to fully appreciate everything our patients and families are going through at these most vulnerable moments in their lives. But it is a privilege to be there for them and with them as an extended family."

Terence Burns, M.D., Ph.D.

"In January, Marissa and her husband sent one of the most beautiful and eloquent letters I have ever read," Dr. Burns says. "It reflected on the fear and sadness in being so abruptly reminded that life is so fragile, yet also on gratitude for life's joy and richness, and the gift of time to share memories with family and friends. We may not be able to fully appreciate everything our patients and families are going through at these most vulnerable moments in their lives. But it is a privilege to be there for them and with them as an extended family."

Now Marrissa is savoring life as it comes. She's returned to work part time while she continues to fully regain her strength. She also recently traveled to the New Orleans Jazz & Heritage Festival for the first time with her husband.

"I'm grateful that no matter what may come, we were given more time to spend together," Marrissa says. "I'm thankful that the care team gave us hope and that my life was worth trying to save."

HELPFUL LINKS

• Read about Mayo Clinic's Brain Tumor Program.
• Learn more about the Proton Beam Therapy Program at Mayo Clinic.
• Connect with others talking about living with a brain tumor on Mayo Clinic Connect.
• Explore Mayo Clinic's Rochester campus.
• Request an appointment.

The post Tackling a Rare Brain Tumor With Expertise and Skill appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Jennifer Martinez-Thompson, a Mayo Clinic neurologist, will discuss diagnosis and treatment options for ALS. Also on the program, Dr. Molly Jeffery and Dr. W. Michael Hooten will share new Mayo Clinic research on trends in opioid use. Dr. Jeffery is the scientific director of Emergency Medicine Research at Mayo Clinic, and Dr. Hooten is a Mayo Clinic anesthesiologist and pain medicine specialist. And Dr. Paul Brown, a Mayo Clinic radiation oncologist, will explain a new radiotherapy approach aimed at preserving cognitive function for some brain tumor patients.

Here's your Mayo Clinic Radio podcast.

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The post New radiotherapy treatment for brain cancer offers superior preservation of cognitive function, Mayo researchers say appeared first on Mayo Clinic News Network.

Radiosurgery, not whole-brain radiotherapy should be the standard of care following surgical resection of metastatic brain tumors

Embargoed until Sunday, Sept. 25, at 3:15 p.m. EDT

Radiosurgery to the surgical cavity following surgery to remove metastatic brain tumors is effective in killing residual cancer and results in fewer cognitive problems and better quality of life than whole-brain radiotherapy, according to the results of a phase III, multi-institutional, cooperative group study presented today at the 2016 ASTRO annual meeting.

“This trial confirms radiosurgery to the surgical cavity is a viable treatment and should be one of the standards of care after resection of brain metastases,” says lead author Paul Brown, M.D. a radiation oncologist at Mayo Clinic. “We found no difference in survival whether a patient receives postoperative radiosurgery or whole-brain radiotherapy; however, radiosurgery avoids the cognitive damage caused by whole-brain radiotherapy and other unpleasant side effects, such as hair loss, fatigue and skin redness.” Dr. Brown adds that recovery after radiosurgery is typically shorter than with whole-brain radiotherapy, so patients can restart systemic therapies such as chemotherapy sooner.

Effective treatments for mouth sores caused by radiation therapy

Embargoed until Sunday, Sept. 25, at 3:15 p.m. EDT

Pain from oral mucositis, or mouth sores, in patients receiving radiation therapy for cancers of the head and neck was significantly reduced by an oral rinse of doxepin and an oral rinse containing diphenhydramine, lidocaine and antacids, known as Magic Mouthwash, compared to a placebo. These were the findings of a three-arm, multi-institution, randomized, double blind, placebo-controlled, phase III trial, led by Robert Miller, M.D., a radiation oncologist at Mayo Clinic. Dr. Miller presented his findings at today at the 2016 ASTRO annual meeting.

“We published a study in 2012 showing that an oral rinse of doxepin reduced oral mucositis-related pain, compared to placebo,” says Dr. Miller. “However, there were no large randomized controlled trials studying the potential benefits of Magic Mouthwash.”

Dr. Miller and his colleagues studied 275 patients between November 2014 and May 2016 and found that pain related to oral mucositis was significantly less following both doxepin and Magic Mouthwash rinses versus placebo. They also found that both doxepin and magic mouthwash rinses were well tolerated by patients.

Researchers identify specific sites of prostate cancer recurrence following radiation therapy using C-11 choline positron emission tomography scanning

Embargoed until Tuesday, Sept. 27, at 4:45 p.m. EDT

A team of Mayo Clinic researchers have used C-11 choline positron emission tomography scanning (CholPET) to identify anatomic patterns of prostate cancer recurrence in patients who have a rising prostate-specific antigen level (PSA) after having received radiation therapy to treat their cancer. Researchers found that most recurrences were localized to the pelvis (prostate and or surrounding tissue). Using these data, they were able to generate a tool that estimates the risk of recurrence outside of the pelvis. This information may be an aid in clinical decision -making.

“Management of recurrent prostate cancer after radiation therapy depends on accurately identifying the site of the recurrent disease,” says William Parker, M.D., a urologic oncology resident at Mayo Clinic. “We found that CholPET identified the site of recurrence in 87 percent of patients who had a rising PSA after radiation therapy, most of whom had disease that could potentially benefit from further salvage therapy. Our findings underscore the importance of advanced imaging in tailoring a treatment plan for patients who have a rising PSA following primary radiation therapy.”

C-11 choline positron emission tomography (PET) scanning useful in locating prostate cancer recurrence following surgery and radiation therapy.

Embargoed until Tuesday, Sept. 27 4:45 pm ET

Using C-11 choline positron emission tomography, Mayo Clinic investigators observed very few sites of prostate cancer recurrence within prostate bed of patients who had previously undergone prostatectomy followed by either salvage or adjuvant radiotherapy. This is the finding of a study presented today at the 2016 ASTRO annual meeting by Jaden Evans, M.D., a radiation oncology resident at Mayo Clinic.

“C-11 Choline PET scanning is a useful means of evaluating sites of prostate cancer recurrence following radiation therapy,” says Dr. Evans. "It provides an opportunity to improve our ability to locate disease recurrence and hopefully an earlier stage in disease progression when the burden of disease is lower."

MEDIA CONTACT: Joe Dangor, Mayo Clinic Public Affairs, 507-284 5005, newsbureau@mayo.edu

Researchers studied more than 2800 patients with prostate cancer who were scanned using CholPET between 2008 and 2015. 391 patients had previously received either definitive, adjuvant, salvage or palliative radiotherapy. Of these patients, researchers identified 41 patients who had undergone prostatectomy followed by prostate bed only radiotherapy and who subsequently experienced a biochemical relapse with at least one site of recurrence identified by CholPET.

Researchers examined sites of recurrence with respect to radiation fields and patient anatomy. Researchers noted that the majority of recurrence sites occurred in lymph nodes outside of the previously irradiated field.

“Perhaps our most compelling observation in this cohort was very few in-field sites of recurrence,” says Dr. Evans. “We interpret these findings as evidence that post-prostatectomy radiotherapy is effective.”

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About Mayo Clinic Cancer Center
As a leading institution funded by the National Cancer Institute, the Mayo Clinic Cancer Center conducts basic, clinical and population science research, translating discoveries into improved methods for prevention, diagnosis, prognosis and therapy. For information on cancer clinical trials, call the clinical trial referral office at 1-855-776-0015 (toll-free).

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or https://newsnetwork.mayoclinic.org/.

The post Mayo Clinic physicians present research findings at 2016 ASTRO Annual Meeting appeared first on Mayo Clinic News Network.

“Metastatic brain tumors are unfortunately common in patients with cancer,” says Paul Brown, M.D., a radiation oncologist at Mayo Clinic and the lead author of the study. Dr. Brown says that, while SRS gives physicians the opportunity to treat tumors and spare healthy brain tissue, a combination of SRS plus WBRT has been shown to help control growth of metastatic brain tumors. “The concern is that WBRT also damages cognitive function,” says Dr. Brown. “That is why we have been studying the use of SRS alone.”

Researchers enrolled 213 patients between February 2002 and December 2013, and randomly assigned them to treatment with SRS alone (111) or SRS followed by WBRT (102). Researchers found less cognitive deterioration at three months in patients treated with SRS alone. Quality of life (QOL) was also higher at three months among patients treated with SRS alone. There was no significant difference in functional independence at three months between treatment groups. Median overall survival was 10.4 months for patients treated with SRS alone and 7.4 months for patients treated with SRS and WBRT.

MEDIA CONTACT: Joe Dangor, Mayo Clinic Public Affairs, 507-284 5005, newsbureau@mayo.edu

“This is the first large-scale clinical trial to evaluate this patient population with a comprehensive battery of cognitive and QOL instruments,” Dr. Brown says. “WBRT has often been offered early in the disease course for patients with metastatic brain tumors, but, because of this trial, we know the negative impact of WBRT on both quality of life and cognitive function is significant. With these trial findings, we expect practice will shift, reserving WBRT for patients with more extensive disease in the brain.”

Mayo Clinic co-authors are:

• Kurt Jaeckle, M.D.
• Jane Cerhan, Ph.D.
• Bruce Pollock, M.D.
• Evanthia Galanis, M.D.
• Jan Buckner, M.D.
• Karla Ballman, Ph.D.

Other co-authors are:

• Anthony Asher, M.D., Carolinas Healthcare System
• Elana Farace, Ph.D., Penn State Hershey Medical Center
• Xiomara Carrero, B.S., Alliance Statistics and Data Center
• Keith Anderson, M.S., Alliance Statistics and Data Center
• Fred Barker II, M.D., Massachusetts General Hospital
• Richard Deming, M.D., Mercy Medical Center
• Stuart Burri, M.D., Levine Cancer Institute
• Cynthia Ménard, M.D., Princess Margaret Cancer Center
• Caroline Chung, M.D., Princess Margaret Cancer Center
• Volker Stieber, M.D. Novant Health Forsyth Medical Center

The trial was conducted by the NCCTG (Alliance for Clinical Trials in Oncology) in collaboration with other cooperative groups, including the Radiation Therapy Oncology Group, and was supported by grants U10CA180821, U10CA180882, CA076001, CA025224, RTOG U10CA21661, and NRG U10CA180868 from the National Cancer Institute.

About Mayo Clinic Cancer Center
As a leading institution funded by the National Cancer Institute, the Mayo Clinic Cancer Center conducts basic, clinical and population science research, translating discoveries into improved methods for prevention, diagnosis, prognosis and therapy. For information on cancer clinical trials, call the clinical trial referral office at 1-855-776-0015 (toll-free).

###

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or https://newsnetwork.mayoclinic.org/.

The post Stereotactic Radiosurgery may be Best for Patients with Metastatic Brain Tumors appeared first on Mayo Clinic News Network.