Brain Tumor Surgery: Could a New Laser Dramatically Improve Accuracy?

English: TAC_Brain_tumor_glioblastoma-Coronal_...
TAC_Brain_tumor_glioblastoma-Coronal_plane Italiano: Immagine TAC della zona cerebrale, identificando un tumore di tipo glioblastoma (Photo credit: Wikipedia)

Background: Everyone loves a laser (I can almost hear my mom addressing the childhood me: “It’s all fun and games, until someone loses an eye…”). Now comes news that a new laser-based technology may improve the accuracy of brain tumor surgery, allowing the surgeon to better discern cancer tissue from normal tissue while they are operating. This can help avoid leaving cancer cells behind. Unfortunately, with current techniques, less than 1 in 4 patients with the aggressive brain tumor glioblastoma can have a complete gross resection.

Investigators from Harvard and University of Michigan describe a technique to distinguish health tissue from tumor in the brains of living mice. They showed that the technique worked with glioblastoma multiforme (GBM), one of the most aggressive forms of brain tumors. The technique is known as SRS microscopy, and the team is looking to test it in a clinical trial at Michigan.

Basics: SRS stands for stimulated Rama scattering. C.V. Raman was one of the Indian scientists who co-discovered the effect and shared a 1930 Nobel Prize (physics) for it. More recently, Sunney Xie, PhD (Harvard) amplified the Raman signal by more than 10,000 times. This makes it possible to create multicolor SRS images of living tissue or other materials. The team can create 30 new images every second, allowing for the creation of videos of tissue in real time!

The key is to identify the margin of a tumor, or the boundary area where tumor cells infiltrate normal cells.This can be a zone quite difficult in which to operate. The new technique allows for the detection of the difference between the signal given off by the dense cellular structure of tumor tissue, and the normal healthy gray and white matter.

So how good is this technique? In their hands, the investigators found it to be as effective as the current technology (looking at the tissue under the microscope with something called H&E staining). But here’s the great thing: The SRS microscopy can be done in real time, without the use of dyes (and without the removal and processing of the tissue, as is currently necessary).

Next steps: A smaller laser (one that is small and stable enough for use in the operating theater). Then clinical trials, perhaps as soon as next year! I’m Dr. Michael Hunter, and I thank you for joining me in sharing this exciting news.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Science Translational Medicine, September 2013 DOI:10.1126/scitranslmed.3005954.

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Harvard AB Yale MD UPenn Radiation Oncology Radiation Oncologist, Seattle area

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