A protective barrier lines your brain's blood vessels to keep substances from going easily from your bloodstream into brain tissue. This is called the blood-brain barrier. Because this barrier exists, medical therapy (chemotherapy) drugs must be given a certain way to treat brain tumors effectively.
Blood-brain barrier disruption therapy (BBBD) is an intensive, effective way of sending medication to brain tumors. The BBBD treatment allows medication to pass through the protective barrier. The largest possible amount of the drug is sent to the tumor and nearby tissue. Most OHSU Brain Institute patients who receive BBBD have few side effects.
Doctors at the OHSU Brain Institute are experts on the blood-brain barrier and this type of treatment. Research by OHSU Brain Institute expert Edward Neuwelt, M.D., shows that compared to standard chemotherapy, the BBBD procedure delivers 10 to 100 times more medication to the tumor and its surrounding area (Neuwelt 1998).
How blood-brain barrier disruption (BBBD) therapy works
The brain's protective barrier is made of tightly knit cells that line the blood vessels in the brain. These cells create a barrier that blocks out certain substances, including many medications.
By temporarily shrinking these cells with a concentrated sugar solution, we can open this barrier. This lets medication (chemotherapy drugs) pass into the brain and reach the tumor.
Compared to standard chemotherapy, the BBBD procedure delivers 10 to 100 times more medication to the tumor and its surrounding area (Neuwelt 1998)
If you think blood-brain barrier disruption therapy might be an option for you, talk to a nurse about whether you can participate.
If you might meet the basic requirements for treatment, you visit the OHSU Neuro-Oncology clinic to meet Dr. Neuwelt and other team members. A member of the team takes your medical history, does a physical examination and reviews your brain scans. You talk with the team about BBBD, including benefits and risks.
Having BBBD therapy
If you have BBBD therapy, you usually stay at OHSU Hospital for four days.
On the first day, you go to the OHSU Pre-Admission Testing Clinic. The Blood-Brain Barrier (BBB) Program's nurse practitioner takes your medical history and does a physical examination. He or she orders any laboratory tests you need, schedules an anesthesia evaluation and requests a CT or MRI scan of your head.
After your pre-admission testing appointment, you go to the oncology (cancer) floor of OHSU Hospital. That evening, you have intravenous (IV) fluids (fluids sent directly into your body through a vein). You also take medication to prevent seizures.
On your second and third days at OHSU Hospital, you have BBBD therapy with chemotherapy (anti-cancer medication).
For the BBBD procedure, you go to an operating room or radiology (imaging) treatment room. During the procedure, you have general anesthesia (you're asleep and don't remember the procedure when you wake up).
The doctor places a catheter (thin, hollow tube) in your femoral artery, a large blood vessel just below your hip. Next, the doctor moves the catheter slowly and carefully up to one of the arteries (large blood vessels) in your neck.
When the catheter is in your neck artery, the doctor sends mannitol (a concentrated sugar solution) through the catheter. This temporarily opens the tightly knit cells of the blood-brain barrier. While the barrier is open, the doctor sends chemotherapy (anti-cancer medication) through the same catheter. You also have chemotherapy intravenously (through a vein) during treatment. This sends a concentrated dose of chemotherapy (anti-cancer medication) to the brain tumor.
Your doctor and an anesthesiologist (doctor specializing in anesthesia) watch you closely during the BBBD procedure. After treatment, you go to the recovery room to wake up, and then back to your hospital room. Nurses watch you carefully to make sure you wake up normally and do not have side effects.
After two days of treatment, you can usually go home.
If you are in the BBB Program, you usually have treatment every four weeks (one month) for one year. After a year of monthly treatments, you go back to Dr. Neuwelt's clinic and have regular brain MRI scans or CT scans of your head. This allows Dr. Neuwelt and your other healthcare team members to see if the tumor has changed or come back.
After you finish BBBD therapy, a BBB nurse practitioner will call you often. Our nurses also keep in touch with your primary care doctor.
Blood-Brain Barrier Program clinical trials
The OHSU Blood-Brain Barrier Program has clinical trials (research studies that test new treatments in humans) through OHSU. Please visit the OHSU clinical trials database for more information on Blood-Brain Barrier Program studies that are currently enrolling subjects.
Blood-brain barrier disruption treatment may be effective in reducing the size of a brain tumor. However, we cannot guarantee that it will be effective in treating every patient. Through research and the opportunity to work with many patients, we are striving to significantly alter the outcome of this disease. We learn from each patient, and the information we acquire in treating each one is used on behalf of other patients.