Brain tumor next to the brain stem treated with Radio Surgery

New Delhi : In an exemplary case of medical excellence in the treatment of brain tumors, doctors at Venkateshwar Hospital, New Delhi recently helped a 55-year-old woman combat a serious brain tumor, which was leading to progressively worsening neurological complications over a sustained period of time.

The team of doctors treating this case was led by Dr. P K Sachdeva, Director and HOD Neurosurgery, Venkateshwar Hospital, Dwarka and Dr. Kuldeep Sharma, Senior Consultant, Radiation Oncology, Venkateshwar Hospital, Dwarka.

This is the first time that a procedure like this was being followed at a hospital in this region.

The machine used for the treatment is known as Versa HD, a sophisticated beam-shaping linear accelerator that aids precision and speed in the treatment of brain tumors.

-Radio surgery is a method where the skull does not have to be opened

-The patient had undergone two failed surgeries prior to this

Sangita Kapoor (name changed), a housewife from Delhi, was suffering from persistent headaches for the last one year now; so much so that she had to give up on her daily household chores. She was weak, anxious, and depressed at the same time.

After a few weeks, she started experiencing physical balance disorders and cognitive problems too. Her mouth started deviating to one side of the face, and she had difficulties in hearing and was unable to close her left eye.

Dr. P. K. Sachdeva, Director & HOD Neurosurgery, Neurosurgeon, Venkateshwar Hospital, Dwarka revealed, "Sangita's condition was very critical when she came to our hospital for consultation; she was experiencing facial nerve palsy (a nervous disorder in which a damaged nerve affects the movement of the muscles of the face) and vertigo (loss of physical balance along with dizziness) symptoms frequently. The patient had been treated surgically at two other hospitals previously, but the surgeries did not work out for her. The tumor, which was 3X3 cm. in size was rare form of tumor in the brain; it came with challenges to our team of doctors particularly because of its location, as the tumor lay very close to the brain stem."

From the medical perspective, classification and treatment of brain tumors is generally done depending on the size, type, and location of the tumors. When tumors are small in size, radiation is an option, but if located in vital areas, even benign tumors can also be life-threatening, and surgical removal is being seen as a gold standard for cure.

Although rarely fatal, most brain tumors can cause serious physical and mental disabilities and or progressive weakness or paralysis over the long term. Again, some types of gliomas often have the potential to change itself into high-grade malignant tumors, owing to mutation over a significant period.

For Sangita's treatment, keeping the age factor and advanced complications in mind, the team of doctors at Venkateshwar Hospital decided to go for a Radio Surgery, new-age surgical procedure where the skull does not have to be opened to treat the tumor. This treatment involves applying a high dose of radiation by linear acceleration.

"Radio surgery is a type of treatment that helps in destruction of precisely selected areas of the afflicted tissue by using ionizing radiation. As opposed to the conventional radiation, this method focuses only on the site of the tumor. Patient generally needs one to five sittings on daily basis either as an outpatient or as a day care procedure," noted Dr. Kuldeep Sharma, Senior, Radiation Oncologist, Venkateshwar Hospital.

"Fortunately in Sangita's case, she was neither diabetic nor hypertensive, and did not possess any other significant co-morbidity which could have resulted in additional side effects during the treatment. During conventional whole-brain radiation, the beams cover the entire brain, due to which it may be associated with decline in cognitive functions in few cases. However, in stereotactic radio surgery, radiation is delivered to more precise and accurate areas inside the brain. The targeted therapy causes notably less collateral damage to healthy brain tissue," shared Dr Kuldeep Sharma.

"In Sangita's case too, the site-focused radio surgery helped her overcome the tumor entirely, without damaging other brain tissues in the surroundings. After having completed the sessions of the therapy, she has shown significant improvement in her cognitive functional abilities, and her quality of daily living has also improved parallel," added Dr. P. K. Sachdeva.

The global incidence rates of primary malignant brain and other types of CNS tumors was 3.4 per 100,000 in 2012, and brain cancer accounts for 1.8% of all cancer cases (excluding non-melanoma skin cancer). In addition to primary brain tumors, there are secondary brain tumors or brain metastases, which are widely prevalent among older adults worldwide.

Survival rates and life expectancy for brain tumors vary widely, depending on the type and stage of detection. The incidence of central nervous system (CNS) tumors in India ranges from 5-10 per 1,00,000 population, accounting for 2% of all malignancies. Brain tumors are quite complex, and over 130 types of 'high grade' or 'low grade' brain tumors are known clinically.

The risk factors reported are genetic pre-disposition, age, and environmental hazards such as ionizing nuclear radiation and close contact with radio-frequency waves from mobile devices.