Brain Tumor Program

Program Overview

As Orange County’s leading brain tumor program (by volume), Hoag offers a unique multi-modality diagnostic and treatment program for patients suffering from benign and malignant primary brain tumors, and those with metastases to the brain.

Experience and expertise are what set Hoag’s Brain Tumor Program apart. Treating approximately 300 patients with brain tumors each year (the most in Orange County), Hoag’s neurosurgeons offer a superior level of experience. And while many hospitals offer craniotomy or stereotactic radiosurgery, Hoag clinicians specialize in both routine and minimally invasive surgical brain tumor management as well as Gamma Knife and Cyberknife stereotactic techniques. They meet in a weekly tumor conference reviewing treatment options, and are therefore uniquely equipped to approach each case with a consensus opinion regarding the right treatment modality.

Hoag Hospital was the first hospital in Orange County to have the Gamma Knife and the only hospital in Orange County to have all three radiosurgery options: Gamma Knife Radiosurgery, Cyberknife, and Tomotherapy. Hoag’s Brain Tumor Program also has the shortest hospital stays for craniotomies.

Dr. Duma, Hoag’s brain tumor program director, utilizes a leading-edge technique for radiosurgical treatment of patients that have GBM (Glioblastoma Multiforme)—the deadliest of all brain tumors. This technique targets the borders of the lesion spreading away from the tumor’s epicenter. With this technique, Dr. Duma’s cumulative results in the treatment of 109 patients since 1998 show significant increases over expected survival rates.

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 sub-millimeter accuracy. In 2015, 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, 117 were neurosurgical cases. 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.

Outcomes

Hoag’s multidisciplinary team of brain tumor specialists is committed to providing the latest and most effective diagnostic imaging studies, surgical techniques, clinical research and management strategies for each patient.

Support & Education

Hoag Brain Tumor Program’s weekly academic conference is designed for all practitioners to present patient cases. This conference determines the appropriateness of a given patient’s condition for conventional surgery, Gamma Knife radiosurgery, and/ or other type of oncologic and medical management.This conference serves as an “oversight council” forthe proper objective selection of patients, including acceptability for clinical research protocols.

Hoag’s Brain Tumor Support Group offers education and support for anyone diagnosed with a primary brain tumor or metastatic disease. The group meets on the third Wednesday of every month at 3 p.m. This group is beneficial for patients, family, and friends.

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.

Team

The Brain Tumor Program is led by Medical Director Christopher Duma, M.D. The nurse navigatoris Lori Berberet, R.N., M.S. Dr. Duma and Lori are supported by a team of neurosurgeons,neuroradiologists, neurologists, radiation oncologists, radiation physicists, RNs, operating room staff, and researchers.

Clinical Research

Christopher Duma: Northwest Biotherapeutics, Inc. Protocol 020221: A PHASE II CLINICAL TRIAL EVALUATING DCVax®- Brain, AUTOLOGOUS DENDRITIC CELLS PULSED WITH TUMOR LYSATE ANTIGEN FOR THE TREATMENT OF GLIOBLASTOMA MULTIFORME (GBM)

Publications, Lectures, Book Chapters

Duma, C., Kim, B., Chen, P., et al. Up-Front Boost Gamma Knife “Leading Edge” Radiosurgery (LERS) to MR FLAIR- Defined Tumor Migration Pathways in 174 Patients with Glioblastoma Multiforme: A 15-Year Assessment of aNovel Therapy.” Accepted for Publication in the Journal of Neurosurgery.

Duma, C, Kano, H., Sheehan, J., Sneed, PK., et al. “Skull base chondrosarcoma radiosurgery: report of the North American Gamma Knife Consortium”. Journal of Neurosurgery. 2015 Nov; 123 (5): 1268-75. doi: 10.3171/2014.12 JNS132580 Epub 2015 Jun 26. PMID: 26115468

Duma, C., Ou SH., Klemper, SJ., et al. “Radiation necrosis presenting as pseudoprogression (PsP) during alectinib treatment of previously radiated brain metastases in ALK- positive NSCLC: Implications for disease assessment and management. Lung Cancer. 2015 June; 88(3): 355-9. doi:10.1016/j.lungcan.2015.03.022. Epub 2015 Mar 30. PMID:25882777

Duma, C., Kano, H., Shuto, T., et al. “Stereotactic radiosurgery for intracranial hemangioblastomas: a retrospective international outcome study.” Journal of Neurosurgery. 2015 Jun; 122(6): 1469-78. doi: 10.3171/2014.10.JNS131602. Epub 2015 Mar27. PMID: 25816088

Presentations

Duma, C., Kim, B., Chen, P., et al. Up-Front Boost Gamma Knife “Leading Edge” Radiosurgery (LERS) to MR FLAIR- Defined Tumor Migration Pathways in 174 Patients with Glioblastoma Multiforme: A 15-Year Assessment of a Novel Therapy.” 18th Annual Lesksell Gamma Knife Society Meeting. Amsterdam – May 15-19, 2016.

Duma, C., Van den Bent, M., Stupp, R., “Pathophysiology of Gliomas Leading Edge Radiosurgery Emerging Approaches” Panel Debate. 18th Annual Lesksell Gamma Knife Society Meeting. Amsterdam – May 15-19, 2016.