For this personal trainer, brain cancer treatment demanded strength and perseverance
In June 2020, Renée Ware of Gray, Louisiana, noticed drooping on the left side of her face. Thinking it was Bell’s palsy, she made a doctor’s appointment. Renée Ware of Gray, Louisiana, underwent brain cancer treatment in June 2020 after noticing drooping on the left side of her face. A CT scan revealed a brain tumor the size of a golf ball, which doctors suspected was malignant. After surgery, they sent her to West Jefferson General Hospital to see neurosurgeon Dr. Frank Culicchia Neurological, whose specialty is brain tumors. The biopsy determined it was a glioblastoma, a Stage 4 type of glioma with a 4-5% survival rate at five years. Only 90% of Ware’s tumor was excised during the surgery, but the other 10% was in an area where vital centers control functions like speech, vision, and motor skills. Despite the dire statistics, there is no evidence of disease.
Veröffentlicht : vor 2 Jahren durch LESLIE CARDÉ | Contributing writer in Health
In June 2020, Renée Ware of Gray, Louisiana, noticed drooping on the left side of her face. Thinking it was Bell’s palsy, she made a doctor’s appointment. But on the morning of her appointment, she had a seizure. Then her left side went numb, while her 11-year-old son witnessed the entire event. An EMT in the neighborhood stayed with her until the paramedics came and medevac’ed her to the Thibodaux Regional Multi-Specialty Clinic. She had seizures for an hour and a half. A CT scan revealed a brain tumor the size of a golf ball, which they suspected was malignant. Knowing this would need specialized care, they sent her to West Jefferson General Hospital to see neurosurgeon Dr. Frank Culicchia of Culicchia Neurological, whose specialty is brain tumors. Renée was 36 years old.
The next morning, an MRI was done, which confirmed the brain tumor, and two days later she would have surgery. Prior to the operation, she swallowed a substance called Gleolan, which gives neurosurgeons the ability to visualize the outer reaches of the malignant tumor. “I proceed with the surgery as I normally would, removing all the tumor until I get a clear white bed, and then I shine the blue light on the area that fluoresces because of the swallowed chemical substance,” Culicchia said. “Suddenly, I can see additional cancer cells. This substance pushes the envelope to remove more of the cancer cells that were previously undetectable even under a microscope.” After the surgery, the biopsy determined it was a glioblastoma, a Stage 4 type of glioma, which has a 4-5% survival rate at five years.
Ninety per cent of Renée’s tumor was excised during the surgery, but the other 10% was in an area called the eloquent part of the brain, containing such vital centers that control functions like speech, vision, and motor skills. To rid her of the remaining fragments of the tumor, she would receive radiation treatment at the Mary Bird Perkins Cancer Center in Houma, closer to her home, along with oral chemotherapy. This would last for 45 days. Every month after that, for the next year, she would receive five days of chemotherapy. “It was quite an experience,” remembered Ware. “While undergoing radiation, I had to wear face molds to protect other areas of my head. I looked like something out of a horror movie. ... I was getting scans every month to check on my progress, and now it’s every three months.”
Thirteen thousand glioblastomas are diagnosed every year in America. It is an aggressive brain tumor with no cure. Ware’s neuro-oncologist, wanting to give her the best possible chance with chemo, sent her excised tumor to a lab in Arizona for genetic testing. The results showed that she should respond well to treatment. Considering the dire statistics, she is still alive, and has gone back to her job as a personal trainer. At this point, there is no evidence of disease. Whether there are hidden cells lurking unseen isn’t something anyone can know. In a metastatic tumor, (which comes from somewhere else) doctors can remove it completely, Culicchia said. “In a glioblastoma, with its tentacles, you can fluoresce the area during surgery, but individual cells don’t light up, tissue lights up. So, there are no guarantees.
"The rare people with glioblastomas where you can resect the tumor and get clear margins, and scans show nothing else growing, are still alive 12-15 years later... but that’s rare.” Ware is doing well, in spite of the chemotherapy pushing her into early menopause at the age of 40. But, she’s exercising regularly, is off sugar, and maintains a low-carb diet as it’s best for her treatment. The 10% of her tumor that couldn’t be surgically removed has been eradicated with chemo and hasn’t returned, based on her most recent scan. Culicchia notes that when he first started practicing 30 years ago, to see a patient live a year was amazing. Now, it’s not unusual to see people survive for two years. To see them die at three to six months, he says, is not unusual either.
But, overall, he believes with better chemo, more research, and the advent of neuro-oncologists, we have a better focus on this area. The combined efforts bode well for a patient’s survival. Although no one is sure what causes brain tumors, known factors are exposure to pesticides and other chemicals, some genetic conditions that lead to tumors, and previous radiation therapy to the head. However, there are still many unknown factors. New research is going on at institutions everywhere, giving those with brain tumors increasing hope. Scientists are concentrating on being able to predict recurrences before they ever show up on an MRI with serum biomarkers that could show up in the blood.
CAR-T therapy, which involves reprogramming a patient’s own T-cells and which has been effective in treating other cancers is being looked at for brain cancer and is currently undergoing clinical trials. A cancer-killing virus for glioblastomas is being developed at MD Anderson at the University of Texas. Researchers at UCLA have developed the first personalized vaccine for brain tumors, claiming to increase survival in patients by a year. And, there are other promising vaccines being studied at multiple centers. One is in Phase II trials in Buffalo. The immunotherapeutic treatment (vaccine) is still in Phase 2 Trials of 63 patients. It attacks Survivin, a cancer molecule, which is present in all glioblastomas, and keeps the tumor alive. A larger trial has now been ordered.