Brain Tumor Program
Incidence and Prevalence
According to the National Cancer Institute, approximately 23,880 adults
will be diagnosed with a primary malignant brain tumor in 2018.1 Metastatic
brain cancer will affect a larger number of individuals, though estimates
widely vary.2 While approximately 13,000 individuals in the U.S. are diagnosed
with pituitary tumors annually, fewer than 1% of these are malignant.3
Program Overview
Pickup Family Neurosciences Institute, in collaboration with Hoag Family
Cancer Institute, offers unique multi-modality diagnostics and treatment
services for patients suffering with primary brain tumors, metastases
of the brain, pituitary tumors and other neoplasms and invasive tumors
of the complex skull base region. This program aligns neurosurgeons, ENT
surgeons, neurologists, neuro-ophthalmologists, neuro-oncologists, radiation
oncologists and physicists, neuro-radiologists, pathologists and endocrinologists
who are committed to providing the latest and most effective diagnostic
imaging studies, surgical techniques, clinical research and coordinated
management strategies for each patient. The program is comprehensive,
offering both craniotomy and stereotactic radiosurgery, minimally invasive
surgical approaches, access to advanced therapeutics, as well as Gamma
Knife and Cyberknife stereotactic techniques.
The Brain Tumor Program is led by Medical Director Christopher Duma, M.D.,
F.A.C.S., a board-certified neurosurgeon and a fellow of the American
College of Surgeons. Robert Louis, M.D., who is boar d-certified in neurosurgery
and fellowship-trained in complex cranial surgery and minimally invasive
skull base and pituitary surgery, leads Hoag’s Skull Base and Pituitary Program.
Diagnostics
Hoag Pathology provides full support for intraoperative evaluation and
diagnosis of brain, pituitary and skull base tumors as well as brain metastases.
A dedicated pathologist provides specialized expertise to the program.
Tumor molecular genomic profiling is available for patients with gliomas
to help clinicians select the most effective treatment.
Patients’ brain cancer samples are sent for genomic profiling and
bioinformatic analysis to Caris Life Sciences, and the results of the
genomic testing are presented and discussed for clinical relevance at
the Neuro-Oncology Tumor Board.
The full range of advanced imaging options is available to patients with
brain, pituitary and skull base tumors through Hoag Radiology. Hoag is
the first hospital on the West Coast to routinely offer PET/MR to patients.
The revolutionary hybrid imaging technique is being utilized for patients
with brain tumors who have had surgery or radiation to evaluate and differentiate
between necrosis of tumor versus recurrent disease. PET/MR offers significant
advantages over MRI alone in the differentiation of tumor recurrence and
post therapy changes.
Treatment
Surgery
Hoag’s neurosurgeons employ image-guided preoperative surgical planning
as well as intraoperative navigational equipment to minimize impact on
parts of the brain critical for motor, sensory, speech, visual and memory
functions. The team also specializes in awake craniotomy.
Whenever possible, Hoag’s neurosurgeons use minimally invasive surgical
techniques employing some of the most advanced technology available including
biomedical electronics, sophisticated neuronavigation systems, neuroendoscopic
equipment and microsurgical tools. The majority of pituitary and skull
base surgeries at Hoag are done through tiny incisions or utilizing naturally
occurring orifices such as the nostrils.
Since 2015, minimally invasive neurosurgery has been guided utilizing the
Surgical Navigation Advanced Platform (SNAP), by Surgical Theater, a system
for planning and performing brain surgery that was developed and based
on flight simulator technology for F-16 fighter jets. It allows for V
irtual Reality 360-degree reconstruction, planning, rehearsal and navigation
for complex neurosurgical procedures. Virtual Reality “fly-throughs”
performed on each case allow Hoag’s neurosurgeons to practice an
operation in 3-D before ever picking up the scalpel. The tool optimizes
minimally invasive approaches, with smaller incisions, fewer complications,
and better overall outcomes. In the two years since Surgical Theater was
introduced at Hoag, more than 700 surgical cases have been performed utilizing
this innovative technology.
Upper left: MR of benign brain tumor (arrow), and surroundings, the dark
zone on the MRPET color image indicating edema only, as compared to lower
images of another patient showing recurrent malignant tumor with combination
of edema and tumor infiltration on the MRPET
Building upon the same platform, in 2017, EndoSNAP was introduced at Hoag.
This provides the additional capabilities of Augmented Reality for endoscopic
cases. The split screen view provided by the EndoSNAP gives the surgeon
a “heads-up display” and allows for pinpoint accuracy and
improved visualization of critical structures.Hoag remains the only center in California and ranks as the second highest
volume center in the nation to use Augmented Reality in Neurosurgery.
Neuro-Oncology Clinic
The Hoag Neuro-Oncology Clinic provides state-of-the-art treatment for
patients with cancers of the brain and nervous system. Physicians Santosh
Kesari, M.D., and Jose Carrillo, M.D., provide expert care for patients
that are diagnosed with malignant brain tumors and endure neurologic complications
from cancer or cancer therapies.
Our team of skilled and experienced physicians participate in a multidisciplinary
treatment approach working with neurosurgeons, radiation oncologists,
neuropathologists and neuroradiologists to plan a course of treatment
that is unique and comprehensive for each patient.
The implementation of reflex tumor molecular genomic profiling for brain
tumor patients has resulted in the identification of molecular targets
to help oncologists direct therapy.
Tumor Board
Hoag Neuro-Oncology Tumor Board is designed for all practitioners to present
and discuss patient cases. It is attended by neurosurgeons, ENT surgeons,
neurologists, neuro-ophthalmologists, neuro-oncologists, radiation oncologists,
neuroradiologists, pathologists, endocrinologists, and the specialized
nurse navigator.
Surgery planning using Surgical Theater 3D Virtual Reality
The Neuro-Oncology Tumor Board is held every Friday at 11:30 a.m. at the
Patty & George Hoag Cancer Center in Newport Beach and via videoconferencing
at Hoag Cancer Center Irvine. It is moderated by Christopher Duma, M.D., F.A.C.S.
To submit a case for the Neuro-Oncology Tumor Board, contact Brain, Skull
Base & Pituitary Tumors Nurse Navigator, Lori Berberet, R.N., M.S.,
at 949-764-6656 or [email protected] or Rosana Figueroa at 949-764-7044
or [email protected]
Hoag Survival Rates Compared to National Average SEER 2007-2013
Radiation Oncology
Hoag offers all three radiosurgery options for the treatment of brain tumors
– Gamma Knife Radiosurgery, Cyberknife®, and TomoTherapy®
– ensuring patients receive the most appropriate and effective treatment
for their unique case.
Hoag offers Gamma Knife® Perfexion, which is the most advanced radiosurgical
device available and targets brain tumors with half a millimeter accuracy. An expanded and specialized treatment area in Hoag’s Marilyn Herbert
Hausman Advanced Technology Pavilion optimizes the patient experience.
Hoag’s Gamma Knife team includes neurosurgeons, radiation oncologists,
physicists, and specially trained nurses.
Stereotactic radiation therapy can also be delivered in fractionated form
using Hoag’s advanced technologies in cases where single treatment
radiosurgery is not indicated. Hoag radiation oncologists meet weekly
to discuss the most appropriate treatment modalities and have expertise
in utilizing both radiosurgery and stereotactic radiation therapy techniques.
Cyberknife is a non-invasive robotic radiosurgery system that can be used
to treat both neurological sites (i.e the brain and spine) as well as
tumors throughout the body. Because of its unique engineering and freely
moving robotic arm, it can target tumors from hundreds of angles with
submillimeter accuracy. In 2018, the Cyberknife at the Newport Beach Radiosurgery
Center/Hoag Hospital (NBRC) continued to be quite busy, treating hundreds
of cancer patients from referral centers across Southern California. Of
these, 114 were neurosurgical cases; 101 intracranial and 13 spine. Because
of the Cyberknife’s ability to treat extracranial lesions, both
brain and spine tumors (malignant and benign alike) are included in these
figures. Dr. Amanda Schwer, a Hoag-affiliated radiation oncologist, is
the medical director for the Cyberknife at NBRC.
Clinic Research
Through Hoag Family Cancer Institute’s Developmental Therapeutics
Program, in alliance with USC Norris Comprehensive Cancer Center, patients
have access to clinical trials not typically offered at community hospitals.
For an up to date list of open trials, please contact Leila Andres, M.S.,
at 888-862-5318.
Screening and High Risk Services
It is estimated that up to 10% of all brain tumors (malignant and benign),
occur because of a hereditary syndrome. In contrast to other hereditary
cancer conditions, those involving brain tumors/brain cancer almost always
involve more than a single tumor diagnosis. Conditions involving hereditary
brain tumors include: Li Fraumeni syndrome, Lynch syndrome, familial adenomatous
polyposis, neurofibromatosis types 1 and 2, Cowden syndrome, von Hippel-Lindau
and tuberous sclerosis. Hoag Family Cancer Institute’s Hereditary
Cancer Program offers genetic counseling and genetic testing.
Support and Education
Hoag’s Brain Tumor Support Group offers education and support for
anyone diagnosed with a primary brain tumor or metastatic disease. The
group meets monthly and is beneficial for patients, family, and friends.
The program’s specialized nurse navigator, Lori Berberet, R.N., M.S.,
is a vital member of the team, providing guidance and navigation to patients
with brain, pituitary, and skull base tumors throughout their treatment.
Hoag Family Cancer Institute’s range of Integrated Cancer Support
Services help patients address the emotional, physical, spiritual, social,
and financial challenges that accompany a cancer diagnosis.
Hoag is also designated as a teaching center for Stereotactic Radiosurgery
for the UCI Neurosurgical Residency Program annually. It is a three-month
rotation, approved by the Board of Neurologic Surgeons. The program director
is Christopher Duma, M.D.
1 Surveillance, Epidemiology, and End Results Program of the National
Cancer Institute, https://seer.cancer.gov/statfacts/html/brain.html
2 National Brain Tumor Society, Braintumor.org
3 Cancer.net, The American Society of Clinical Oncology (ASCO)
To learn more, visit the
Brain Tumor section or call 949-764-6066.