Brain tumors present a particular challenge for cancer specialists and their patients. While significant progress has been made against many cancers, successful prevention and treatment strategies for brain cancer have been elusive. At Norris Cotton Cancer Center, doctors, scientists and bioengineers are working together to change that.

"Brain tumors are a challenge because of their unique biologic characteristics," says Camilo Fadul, M.D., leader of the Neuro-Oncology Program at the Cancer Center. "Even small tumors may result in severe functional impairment and personality changes. Furthermore, brain tumors in general are not very sensitive to standard oncology treatments."

The Neuro-Oncology Program is a team of specialists who focus on nervous system cancers, including "primary" brain tumors, which develop in the brain, and brain "metastases," which move to the brain from other tumors in the body. These experts use the latest research and technologies to determine the best possible treatment for each patient, and to develop new therapies to improve outcomes for brain cancer patients everywhere.

Dr. Mark Israel, Director of the Cancer Center, is a leader in the study of Id (inhibitor of differentiation) genes, which play a key role in abnormal growth of human brain tumors. Dr. Israel studies glioma, a form of brain cancer that is becoming more frequent among adults, and medulloblastoma, the most common malignant brain tumor in children. His lab is working to better understand how genetic changes in brain tumor cells control tumor growth. He hopes this research will yield important clues leading to better treatments for patients.

Dr. Fadul collaborates with immunologist Michael Fanger, Ph.D., to develop ways to use the body's immune system to fight glioblastoma multiforme (GBM), the most common form of glioma in adults. GBM is an aggressive, fast-growing tumor, and more than half of patients die within a year of diagnosis. Fadul and Fanger are trying to understand why the immune system doesn't effectively reject these tumor cells, and how to strengthen the immune system using anti-cancer vaccines.

In a clinical trial developed at the Cancer Center, Dr. Fadul is also testing new, more targeted chemotherapy agents, combining drugs that kill tumor cells with drugs designed to cut off the tumor's blood supply and shut down the process that allows cancer cells to grow uncontrolled.

Current treatment for brain tumors often begins in surgery, where skill and precision are critical. Neurosurgeon David Roberts uses the latest in image-guided surgery to precisely map a brain tumor during surgery. The system uses GPS (global positioning system) technology to pinpoint the location of the tumor, and computer-generated images to model its size and shape in the brain.

Dr. Roberts hopes to make image-guided surgery even more accurate through his work with Keith Paulsen of Dartmouth's Thayer School of Engineering. They're using models to predict the changes that occur in the brain during surgery as brain tissue is compressed or removed. The goal is to provide continually updated images to neurosurgeons as they operate, enabling more precise surgical procedures.

Dr. Eugen Hug, chief of Radiation Oncology at DHMC, has worked to bring the latest technology in radiation therapy to the Cancer Center to improve options for brain tumor patients. Radiosurgery, which delivers high-dose radiation in a single treatment, can be an effective alternative to surgery for some brain tumors. Intensity Modulated Radiation Therapy (IMRT) - one of the most sophisticated approaches to 3-D radiation therapy available-precisely focuses beams to target tumors without harming surrounding healthy brain tissue. Both radiosurgery and IMRT allow physicians to deliver higher doses of radiation more precisely, and to treat areas that would have been considered too risky just a few years ago.

For patients with brain tumors, the time following diagnosis is stressful, and filled with many difficult decisions. To support brain cancer patients and their families through this difficult period, the Neuro-Oncology group has teamed up with DHMC's Center for Shared Decision Making to develop a program to help brain tumor patients consider their preferences and values in making treatment-related decisions. Through this program, they hope to decrease patient stress and increase patient satisfaction with their care. "Our efforts are not simply directed toward prolonging survival but also toward improving the quality of life of brain tumor patients," Dr. Fadul says.