Technique to Give Chemotherapy Across Blood-Brain Barrier is Reproducible
02/08/00 Portland, Ore.
Study shows training, communication and collaboration are keys to success
For the past two decades, Oregon Health Sciences University's Blood-Brain Barrier Program has been regarded as an international leader. The barrier is a naturally occurring central nervous system function that allows the brain to filter out dangerous chemicals. However, for patients with brain tumors, it also can reduce the effectiveness of chemotherapy. In the early 1980s, under the direction of OHSU neurosurgeon Edward A. Neuwelt, M.D., doctors broke down the blood-brain barrier, allowing for increased delivery of chemotherapy. Now, the successful technique developed by Neuwelt at OHSU is being mirrored at medical centers across the country. A study published in this month's edition of the journal Cancer shows that techniques developed and perfected at OHSU also are successful when performed by trained physicians at other hospitals in the United States and overseas. In the past, patients have traveled hundreds of miles to undergo this treatment at OHSU.
Overall, the results of this study are very encouraging. For patients with primary central nervous system lymphomas who were treated at participating centers other than OHSU, 93 percent witnessed a complete response. A complete response involves the disappearance of the tumor on a CT scan. In addition, participating centers were able to achieve slightly more high-quality blood-brain barrier disruptions than OHSU.
The primary author of the study is Nancy D. Doolittle, Ph.D., R.N., OHSU Blood-Brain Barrier consortium coordinator, along with co-authors from the University of Missouri, Ohio State University, the University of Minnesota and the Hadassah-Hebrew University Medical Center in Jerusalem. "We've found the key to success is communication," said Doolittle. "The sharing of techniques, information and outcomes is essential in the effort to bring this procedure to medical centers around the country and around the globe. Our goal is to offer this treatment to as many brain tumor patients as possible by sharing the knowledge gained at OHSU and at participating centers."
To obtain the results of this study, researchers at OHSU and the consortium of participating hospitals studied patients with certain types of malignant brain tumors during a three-year period. In that time, all five university medical centers treated 221 patients with intraarterial chemotherapy. A total of 121 patients received treatment at OHSU. The rest received chemotherapy at the other participating centers. Prior to the study, a neurosurgeon, neuroradiologist and nurse clinician from each participating hospital traveled to OHSU to study the technique for administering intraarterial chemotherapy in conjunction with disruption of the blood-brain barrier. Annual scientific meetings also were held so that new information and technology could be shared. For the next five years, the National Institutes of Health has agreed to partially fund these annual meetings, documenting the need for multi-institutional collaboration.
The Blood-Brain Barrier Program at OHSU has been in existence since 1981. The team is made up of physicians, nurses, pharmacists, neuropsychologists and preclinical researchers working to treat people with brain tumors by outwitting the brain's natural defense system. The goal is not only to prolong patient's lives, but to also improve their quality of survival. Each year, more than 200,000 brain tumors are diagnosed in the United States, claiming about 12,000 lives a year. Since its creation, the Blood-Brain Barrier Program has treated more than 400 patients and performed more than 4,750 blood-brain disruptions.