What’s New in Adult Brain and Spinal Cord Tumor Research?

Research is always being done in the area of brain and spinal cord tumors. Scientists and doctors are looking for causes and ways to prevent these tumors, better tests to help characterize these tumors, and better ways to treat them.

Lab tests of brain tumors

In recent years, researchers have found some changes in genes, chromosomes, and proteins inside brain tumor cells that can be used to help predict a person's outlook (prognosis) or help guide treatment. Some examples of changes that can now be tested for include: 

• IDH1 or IDH2 gene mutations
• Chromosomal 1p19q co-deletions
• MGMT promoter methylation

For more on how these tests are used, see Tests for Brain and Spinal Cord Tumors in Adults.

Testing  might also be done in certain situations to look for changes in other genes, such as ATRX, TERT, H3F3A, BRAF, and HELA.

Researchers are also looking for other changes in tumor cells that might help guide treatment.

Imaging and surgery techniques

Recent advances have made surgery for brain tumors much safer and more successful. Some of these newer techniques include:

Magnetic resonance spectroscopic imaging (MRSI)

In this approach, specially processed information from magnetic resonance spectroscopy (MRS, described in Tests for Brain and Spinal Cord Tumors in Adults) is used to make a map of important chemicals involved in tumor metabolism. MRSI can help surgeons direct their biopsies to the most abnormal areas in the tumor. It can also help doctors direct radiation to the right areas and evaluate the effects of chemotherapy or targeted therapy.

Diffusion tensor imaging (DTI) or tractography

This is a type of MRI test that can show where the major pathways (tracts) of white matter are in the brain. Surgeons can look at this information before operating to help avoid these important parts of the brain when removing tumors.

Fluorescence-guided surgery

For this approach, the patient is given a special fluorescent dye a few hours before surgery. The dye is taken up by some tumors, which then glow when the surgeon looks at them under special lighting from the operating microscope. This lets the surgeon better separate the tumor from normal brain tissue. Researchers are now looking to improve on the dyes currently in use.

Newer surgical approaches for some types of tumors

To treat some tumors near the pituitary gland, a 3-D endoscope, a thin tube with a tiny video camera lens at the tip, is used to allow the surgeon to see the small area around the tumor in 3 dimensions. The surgeon passes the endoscope through a small hole made in the back of the nose to operate through the nasal passages, limiting the potential damage to the brain. A similar technique can be used for some tumors in the ventricles, where an endoscope is inserted through a small opening in the skull near the hairline. The tumor’s size, shape, and position determine if this technique can be used.

Laser interstitial thermal therapy (LITT)

For some tumors that are hard to treat surgically, another option might be to insert a thin probe with a tiny laser on the end through a small hole in the skull and into the tumor. The laser is then used to heat and destroy (ablate) the tumor. This technique is still fairly new, so doctors are still learning about the best ways to use it.

Radiation therapy

Some newer types of external radiation therapy planning can help doctors deliver radiation more precisely to the tumor, which helps spare normal brain tissue.

Modern radiation techniques such as intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), proton beam therapy, and image-guided radiation therapy (IGRT) are described in Radiation Therapy for Adult Brain and Spinal Cord Tumors.

Other new methods of planning and delivering radiation therapy are also being studied.

Chemotherapy

Along with developing and testing new chemotherapy drugs, many researchers are testing new ways to get chemotherapy to the brain tumor.

Many chemotherapy drugs are limited in their effectiveness because the tightly controlled openings in the brain capillaries, sometimes referred to as the blood-brain barrier, prevents the drugs from getting from the bloodstream to the brain. Researchers are now trying to modify some of these drugs by putting them in tiny droplets of fat (liposomes) or attaching them to molecules that normally cross the blood-brain barrier, to help them work better. This is an area of active research and clinical trials.

Other new treatment strategies

Researchers are also testing some newer approaches to treatment that may help doctors target tumors more precisely. This could lead to treatments that work better and cause fewer side effects. Several of these treatments are still being studied.

Tumor vaccines and other types of immunotherapy

Several vaccines are being tested against brain tumors. Unlike vaccines against infections, these vaccines are meant to help treat the disease instead of prevent it. The goal of the vaccines is to stimulate the body’s immune system to attack the brain tumor. Early study results of vaccines to help treat glioblastoma have shown promise, but more research is needed to determine how well they work.

Researchers are also looking at other types of treatments that could boost the immune response against brain tumors.

At this time, brain tumor vaccines and other types of immunotherapy are available only through clinical trials.

Targeted drugs (such as growth factor inhibitors)

Tumor cells are often very sensitive to proteins called growth factors, which help them grow and divide. Newer drugs target some of these growth factors, which may slow the growth of tumor cells or even cause them to die. Many targeted drugs are already used for other types of cancer, and some are being studied to see if they will work for brain tumors as well.