At OHSU, we treat many different kinds of brain tumors. Unfortunately, many types of malignant brain tumors are not yet curable regardless of the type of treatment. Yet, by combining Blood-Brain Barrier Disruption with chemotherapy, in some tumor types the OHSU team has achieved excellent results in increasing the long-term survival of patients.
When patients with brain tumors are treated with any therapy, they can suffer cognitive damage, which may be manifested by memory problems, a decreased ability to use mathematics or good judgment, or to problem solve.
An exciting, positive result of BBBD therapy is that our neuropsychological data shows the absence or low incidence of cognitive damage after a patient's treatment is over.
At OHSU we have treated the largest group of primary CNS lymphoma patients in the U.S. who have had long-term survival and have not experienced intellectual loss.
Dr. Neuwelt has been treating primary central nervous system (CNS) lymphoma patients at OHSU since 1982. Our data shows that when CNS lymphoma patients are treated with BBBD, there is a 42 percent chance that a patient will survive for five years. This is based on our study of 74 consecutive patients with primary CNS lymphoma treated with BBBD with chemotherapy who had not undergone prior radiation. The median length of survival for these patients is 40.7 months.
Of this data, Dr. Richard S. Kaplan of the National Institutes of Health in Bethesda, Md., writes, "This information provides additional confirmation that [primary CNS lymphomas] can be treated without radiotherapy. This [BBBD] regimen is clearly as effective as any known today, if not more effective." (from editorial accompanying the report: LD McAllister et al, Cognitive outcomes and long-term follow-up results after enhanced chemotherapy delivery for primary central nervous system lymphoma, Neurosurgery 46:51-61, 2000.)
Comparison of OHSU vs. Massachusetts General survival data on primary central nervous system (CNS) lymphoma. (DC Miller et al, Pathology with Clinical Correlations of Primary Central Nervous System Non-Hodgkin's Lymphoma, Cancer 74:1383-1397, 1994)
Case study: CNS lymphoma
In 1993, a 25-year-old male with a brief history of headaches and focal seizures was diagnosed with CNS lymphoma. In March of that year, he began BBBD treatment with chemotherapy and successfully completed the treatment program in one year. He did not receive any radiation.
Three years after diagnosis, the patient married, graduated from law school, and passed the bar exam. Ten years after his diagnosis, he is practicing law and doing very well with no evidence of disease.
Case study: CNS lymphoma and ocular lymphoma
In 1995 a woman in her mid-60s began seeing floaters and then experienced progressive visual loss over the next two years. In 1998 her eye fluid was tested, and she was diagnosed with lymphoma in her eyes. Her cerebral spinal fluid also was examined and found to contain lymphoma cells.
She soon began BBBD treatment with chemotherapy and also received chemotherapy treatments to her eyes. She completed the treatment program and did not receive radiation to her brain or eyes.
Before her vision problem began, this patient had been a proficient artist. But her increasing visual loss kept her from painting for several years. During the treatment program, however, her vision improved, and she began painting again.
She is now over 5 years from her initial diagnosis and is once again very active with her painting and within the art community.
Excerpt: A patient’s perspective
During his time as a patient in the BBB Program, a 23-year-old man diagnosed with CNS lymphoma described in writing his reasons for selecting this treatment:
"Based on its positive outcomes, I became convinced that BBBD is a reasonable alternative form of treatment. It has been actively practiced and directed by a very dedicated man, Dr. Neuwelt … and only involved chemotherapy in the hope that radiation won’t have to be an option in the long haul."
"That was enough to convince me that OHSU is the place to be. Knowing that I could kill the cancer cells in my brain without radiation, and preserve and prolong my cognitive mind, is exciting indeed. I willingly and confidently accepted this alternative."
"Based on its positive outcomes, I became convinced that BBBD is a reasonable alternative form of treatment. It has been actively practiced and directed by a very dedicated man, Dr. Neuwelt … and only involved chemotherapy in the hope that radiation won’t have to be an option in the long haul." and "That was enough to convince me that OHSU is the place to be. Knowing that I could kill the cancer cells in my brain without radiation, and preserve and prolong my cognitive mind, is exciting indeed. I willingly and confidently accepted this alternative."
Other tumor types
Along with our excellent long-term survival results with CNS lymphoma, we have seen rewarding results in our BBBD patients with primitive neuro-ectodermal tumors (PNETs) and germ cell tumors.
Tumor responses and survival data indicate that 82 percent of children and young adults diagnosed with CNS lymphoma, PNET (medulloblastoma and pineoblastoma), and germ cell tumors have an objective response to chemotherapy with BBBD therapy.
At OHSU, we have also treated patients with glioblastoma multiforme (GBM) Previous, nonrandomized studies suggest a potential survival advantage of intraarterial chemotherapy (Madajewicz et al, Cancer 88:2350-2356, 2000) or BBBD (Neuwelt et al, Neurosurgery 19(4):573-582, 1986; Gumerlock et al, Journal of Neuro-Oncology 12:33-46, 1992; Kraemer, 2002).