Joe’s Story: Oligodendroglioma

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Joe calls it a miracle and a gift from “a higher power.” Others might call it a fortuitous turn of fate. Either way, Joe’s experience embodies a reversal of fortune that is both wonderful and startling. Once a man with a brain tumor and little hope, Joe is today cancer-free and buoyed by a favorable prognosis.

Joe had seen brain tumor specialists in two different cities when he finally found the person who could help him: Ronald Warnick, MD, of the Mayfield Clinic and the Brain Tumor Center at the University of Cincinnati Neuroscience Institute.

A resident of a central Ohio city, Joe was diagnosed with a brain tumor and surgically treated by a local physician in December 2005. Joe described that surgery as “unsuccessful.” Indeed, the surgeon sought only to remove a fragment of the tumor for a biopsy, not to remove the tumor in its entirety. But merely removing the specimen left Joe with a severe speech problem.

The central Ohio doctor recommended radiation treatments, which might have contained the tumor for a while but was unlikely to eradicate it.

“They did not think it could be removed,” Dr. Warnick says, reflecting. “When they did a biopsy and were confronted with the language problem, it confirmed their sincere opinion that removing the tumor was too dangerous.”

Joe remained hopeful, however, and he sought a second opinion at a leading brain tumor center in the Midwest. Those doctors, similarly concerned, agreed that surgery was not possible and that Joe should have radiation and chemotherapy.

Help finally came after Joe’s sister, Susan (pictured above with Joe), mentioned his situation to her doctor in Greater Cincinnati. The doctor, well aware of the Mayfield Clinic and its commitment to excellence in neurological care, advised Susan to investigate Mayfield. A quick search on the Internet led Susan and Joe to Mayfield’s Web site and Dr. Warnick, a neurosurgeon who specializes in the treatment of tumors of the nervous system. Joe and his family were impressed with what they saw, and they scheduled an appointment with Dr. Warnick at Mayfield’s West Chester, Ohio, office.

The first person Joe met, a registered nurse named Dale Greene, put him at ease. Joe then met Dr. Warnick and liked him immediately. “I used to work in human services,” Joe says. “I worked with alcoholic teenagers and other people with health issues. I also worked in the prison. I was a corrections specialist. Because of my experience in human services, I can tell a good person when I see one. And that’s what sold me on Dr. Warnick. He cares.”

Dr. Warnick and the Mayfield Clinic also provided something the two other surgical centers could not: a confident approach to brain tumor treatment supported by state-of-the-art technology.

Dr. Warnick ordered an MRI to assess the tumor’s size and location: a mass 5 by 4 centimeters in the left temporal lobe of Joe’s brain. Dr. Warnick also obtained functional MRI (fMRI) imaging to identify the location of Joe’s language area in relation to the tumor. Functional MRI creates a series of images that capture blood oxygen levels in parts of the brain that are responsible for movement, perception, and cognition. By filming the brain in action in this manner, doctors can pinpoint critical language and motor areas that must be avoided during surgery.

The MRI and fMRI images were promising. “We identified the tumor and discovered that the language area in Joe’s brain was above his tumor,” Dr. Warnick said. “A group of specialists who gathered at our weekly Tumor Board meeting predicted that, based on the fMRI images, the tumor could be safely removed without causing a permanent language problem for Joe.”

Dr. Warnick explained the situation to Joe and said he was confident that the tumor could be surgically removed. He also cautioned Joe that the surgery could result in post-operative speech deficits and the loss of peripheral eyesight in the right eye.

“I knew in my gut that this was the guy I wanted to do my surgery,” Joe recalls. “I said, ‘Let’s go for it.’ ”

In April 2006 Dr. Warnick and neurosurgery resident Dr. Michael Petr removed the entire tumor during a six-hour operation at University Hospital. The complete removal, or resection, was confirmed while Joe was still under anesthesia through intraoperative MRI (ioMRI) technology within the operating room.

In a surprising discovery, the surgeons also learned that the initial diagnosis of  Joe’s tumor was incorrect. The biopsy of a small piece of the tumor had suggested a low-grade astrocytoma; but the complete tumor pathology revealed a low-grade oligodendroglioma, a less aggressive cancer that originates from oligodendrocyte cells in the brain. “This underscores the difficulty with representative sampling of a tumor,” Dr. Warnick said. “When you examined 1 percent of the tumor, you got a different answer than when you examined 100 percent of the tumor.”

Joe spent three days recovering in University Hospital’s state-of-the-art Neuroscience Intensive Care Unit. He lost very little of his sight and suffered no permanent speech impairment.

Dr. Warnick advised against radiation or chemotherapy. “Given his young age, the complete degree of removal, and the pathology of oligodendroglioma, which carries a more favorable prognosis, we felt he didn’t need radiation. The power of Joe’s story is that, instead of having an unresected tumor and the prospect of facing radiation and chemotherapy treatments, he was looking toward a future with a completely resected tumor and no radiation or chemotherapy. All in all, it was a stunning turnaround.”

Three years and three months later, however, a small amount of tumor reappeared and was spotted during a routine MRI test. Joe, who was then living in Albuquerque, New Mexico, had his films sent to Dr. Warnick in Cincinnati. Dr. Warnick and John Breneman, M.D., a radiation oncologist, recommended a 28-day course of fractionated radiotherapy to eliminate the recurrence. Joe returned to Cincinnati for the treatment at the Precision Radiotherapy Center.

Fractionated radiotherapy is a non-invasive therapy that enables patients like Joe to keep their cancer at bay, with minimal risks or side effects. During fractionated radiotherapy, a small burst of radiation is delivered to the lesion every day over a period of weeks. Delivering radiation in this way, rather than in a single, concentrated session, allows healthy tissue to recover in between treatment sessions.

During his treatment Joe settled into a comfortable routine, walking his sister’s dogs or playing his guitar in the morning, and undergoing high-precision radiotherapy in the afternoon. Joe has had very few side effects from his treatment. His main complaint remains the arthritis that prompted him to move from Ohio to New Mexico, and then Arizona.

Joe thanks the “higher power” that brought him to Cincinnati. He also credits his family and a group of friends who helped him through his difficult times. Ever the counselor, Joe likes to share his story and is available to talk with other patients by way of the National Brain Tumor Foundation. He advocates daily exercise, and he walks every day. One piece of advice he frequently shares: trust your instincts and seek out a second opinion, or even a third, if you are uncomfortable with the advice you are getting.

He views healing as a kind of trilogy. First comes prayer, then the medical practitioners’ skill. The final piece, he says, “is up to you.”

* * *

Hope Story Disclaimer – This story describes an individual patient’s experience. Because every person is unique, individual patients may respond to treatment in different ways. Outcomes are influenced by many factors and may vary from patient to patient.

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