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Focused Ultrasound

With help from an innovative clinical trial, researchers and care team members at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC) are achieving outstanding outcomes for brain cancer patients.

In 2019, Rick Miller, 65, was diagnosed with a glioblastoma, a deadly brain cancer. Told the average survival time was a little more than a year, Miller began receiving care at University of Maryland Shore Regional Health. He was able to enroll in UMGCCC's phase one focused ultrasound clinical trial, which changed the trajectory of his life and disease.

Historically, glioblastoma has been a nightmare diagnosis. It is a fast-growing brain cancer with a high rate of recurrence and a five-year survival rate of just five percent. Whereas previous therapeutics were of limited success, focused ultrasound (FUS) is a promising new therapy – among the first in recent years.

A noninvasive procedure, FUS can circumvent the blood-brain barrier (BBB), which has limited the effectiveness of chemotherapy for brain cancers. The blood-brain barrier protects the brain by preventing germs, toxins and other harmful substances from entering. This protective capability, however, also keeps chemotherapeutic agents from reaching tumors in the brain.

How FUS Works

FUS uses high-intensity ultrasound waves guided by high-definition MRI. During the procedure, the patient lies on a table in an MRI machine. There are two stages to the procedure: planning (mapping) and treatment.

First, the treatment team uses the MRI to create a map of the brain to pinpoint the tumor's location and treatment targets. Once the mapping process is complete, the treatment phase begins. Using MRI guidance, the team injects material into the patient's arm vein that forms tiny bubbles. The treatment team uses more than 1,000 high-intensity ultrasound waves, each individually tuned to travel through the skull to the tumor's precise location. The ultrasound waves activate the bubbles within the brain blood vessels, causing a temporary opening of the BBB at the site of the tumor. This temporary opening allows the chemotherapy agents to reach the brain tumor cells. FUS does not use radiation and does not require incisions (surgical cuts).

Currently, the blood brain barrier therapy for brain tumors is not commercially available. The UMGCCC team, however, is working to open more clinical trials.

Better Patient Outcomes

Today, Miller's scans show no trace of cancer, as is the case for many of the 14 other people who also participated in the initial clinical trial. Miller's case stands out because he is not only alive but also enjoying a great quality of life. He works on a limited basis and has resumed the leisure and travel activities he loves.

Miller "stands out because he's done so well. He's not had any recurrence, but more importantly, he's maintained his quality of life and is getting back out and doing things he used to do before his cancer diagnosis," said Mark Mishra, MD, associate professor of radiation oncology at University of Maryland School of Medicine (UMSOM).

New Hope for Brain Tumor Treatment

University of Maryland Medical Center (UMMC) is a national leader in FUS. It is among the few institutions nationwide with deep expertise in the procedure, which it uses for movement disorders as well as brain tumors like glioblastoma. 

"All we can say now is that we can do this safely," said Graeme F. Woodworth, MD, FACS, professor and chair of neurosurgery at UMSOM and who performed the FUS procedure on Miller. "Today, this is all quite promising. But we need more proof, there is more work to do." 

UMMC is continuing its groundbreaking FUS research for different therapeutic agents and different brain tumor types. In the future, FUS could enable clinicians to detect brain tumor biomarkers, which is currently impossible because the blood-brain barrier prevents tumor cells from entering the bloodstream. The team hopes that, eventually, many more people can benefit from the life-changing outcomes similar to Miller.

To learn more about this innovative treatment, call 410-328-3514.

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