Brain Cancer – The Final Frontier

Overview

In the past century, medicine has made remarkable strides, leading to healthier lives and increased longevity. Diseases like smallpox have been eradicated through vaccinations, and tuberculosis is now treatable with antibiotics. Healthy lifestyles have reduced morbidity and mortality from conditions such as diabetes, heart attacks, and strokes. However, despite these advances, primary brain cancer remains a formidable challenge with a grim outlook. Brain tumors, which can affect both children and adults, vary in type and prognosis. While benign tumors of the meninges are now completely curable by surgery, malignant gliomas, particularly glioblastoma (Grade 4), have poor outcomes. Glioblastomas affect 5 in 100,000 people, with a median survival of only 9-14 months despite the best available treatments.

Recent Advances

Despite the bleak prognosis, recent years have seen significant progress in the fight against brain cancer. Understanding the genetic mutations that trigger uncontrolled cell proliferation has been key. Pathology remains the cornerstone of cancer diagnosis, involving the examination of biopsy specimens to identify malignant cells. However, traditional biopsies may not always represent the tumor accurately due to the heterogeneous nature of gliomas.

Liquid Biopsy: This emerging technology offers a solution by detecting exosomes, circulating tumor DNA, and tumor cells in the blood and cerebrospinal fluid. This method can identify high-grade lesions that may be missed by conventional biopsies. Liquid biopsy was recognized as a breakthrough technology by MIT in 2015, and its application in brain tumor diagnosis has been demonstrated by Apollo Research and Innovations, Hyderabad.

Genomic Profiling: The introduction of genetic markers into the diagnostic process has improved the accuracy and treatment of gliomas. Today, testing for specific genetic mutations is mandatory for glioma diagnosis, allowing for targeted therapies that can halt the progression of the disease. This shift from purely pathological grading to incorporating genomic data is a significant advancement in cancer care.

Radical Surgery: Advances in surgical techniques, such as ‘awake’ anesthesia and intra-operative MRI, have improved outcomes for patients undergoing radical tumor removal. Awake anesthesia allows patients to communicate with the surgeon during the procedure, helping to avoid damage to critical brain functions. Intra-operative MRI provides real-time imaging, ensuring complete tumor removal while minimizing the risk of complications.

Radiation Therapy: High-dose radiation therapy remains a cornerstone of brain tumor treatment. Newer techniques like stereotactic radiosurgery and proton therapy have minimized damage to surrounding healthy tissue while delivering precise doses of radiation to the tumor. South Asia’s first proton therapy center recently opened in Chennai, offering advanced treatment options for brain cancer patients.

Chemotherapy and Immunotherapy: The role of chemotherapy in brain tumor management is evolving. Targeted chemotherapy based on specific genetic mutations has shown promising results. Additionally, immunotherapy, which harnesses the body’s immune system to fight cancer, has introduced new possibilities. The FDA has approved the first immune checkpoint inhibitors, marking a significant step forward in brain tumor treatment.

Conclusion

As we observe World Brain Tumor Day, there is more reason for optimism than ever before. Advances in surgical and radiation techniques have significantly improved survival rates, from 3-4 months 30 years ago to nearly 14 months today. Gliomas, which constitute only 1%