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Cincinnati – Fueled by the hope of finding better treatments, patients like Kenneth Jacques are helping medical science map the entire genetic sequence of a few types of brain tumors.

Those tumors include Grade 3 gliomas, an uncommon type of brain malignancy that struck Mr. Jacques in September 2011. At that time, the West Chester, Ohio, engineer and father of two made two decisions. One was to get well. The other was to give back by enrolling in the genetic sequencing study, also known as The Cancer Genome Atlas Trial, at the Brain Tumor Center at the University of Cincinnati (UC) Neuroscience Institute.

As a participant in the study, Mr. Jacques donated tissue from his tumor to be used for genetic sequencing.

“Our goal is to map out a tumor’s entire genome to identify potential areas at the molecular level that are abnormal and that could be targets for therapies of the future,” says Christopher McPherson, MD, pictured above, a neurosurgeon with the UC Brain Tumor Center and Mayfield Clinic and Director of the Division of Surgical Neuro-Oncology at the UC College of Medicine. “We are extremely interested in developing sophisticated drugs that target specific differences within cancer cells. As of now, we don’t have a lot of good treatments for patients with these particular tumors.”

The Cancer Genome Atlas Study, a project of the National Cancer Institute and the National Human Genome Research Institute, involves a network of institutions throughout the United States, including clinical sites, a specimen processing facility and genomic characterization centers.

Dr. McPherson, principal investigator of Cincinnati’s portion of the study, stresses that the search for targets in genetic or protein abnormalities is a very important step but only the earliest phase of discovery. “We have to identify the targets before we can identify the drugs to use,” he says.

“We send tissue specimens to NIH and don’t get the answers back right away. They have to study and process the tissue. But this study holds promise for the future. As abnormal areas are identified, treatments will be developed, and then we will be able to provide clinical trials.”

The Cancer Genome Atlas was launched in 2006 with a pilot study of three types of tumors: glioblastoma multiforme (a Grade 4 glioma), serious cystadenocarcinoma of the ovary, and squamous cell carcinoma of the lung. Researchers hoped to learn whether such a comprehensive analysis would be feasible as well as beneficial. The pilot study was so successful that additional cancer types, including Grade 3 glioma, were added in 2010. The UC Brain Tumor Center began enrolling patients in 2011.  

“Glioma is a broad term that encompasses all of the tumors that come from the glial cell, a supporting cell in the brain,” Dr. McPherson says. “Any of the glial cells can become tumors. Astrocytoma, ependymoma, oligodendroglioma: all are different types of gliomas. Gliomas are graded on a scale of one to four.”

A Grade 4 glioma, the most malignant, is a glioblastoma multiforme, so named because each individual cancer can include many different genetic forms and aberrations.

“Research has enabled us to see the step-wise progression of mistakes that occur as a tumor evolves from a low-grade glioma to a Grade 3 to a glioblastoma,” Dr. McPherson says. “We have already identified some of those errors; but these discoveries have not been as fruitful as we would wish. We hope that by mapping entire genome we will find more answers for potential treatment.”

Mr. Jacques’s symptoms began as mini seizures, “brief spells where I started to feel like I was going to pass out, but I never did.” Shortly after an incident in which he was supposed to talk to his son about breakfast but instead began talking about work, he called the doctor. An MRI revealed the tumor, an anaplastic astrocytoma, in an “eloquent” area in the left side of his brain, near the areas responsible for speech.

After discussing Mr. Jacques’s situation at the weekly Multidisciplinary Tumor Board Conference, the Brain Tumor Center team settled on a strategy that including careful three-dimensional mapping of the tumor as well as the critical functional centers and electrical pathways in Mr. Jacques’s brain. Dr. McPherson then operated, removing as much of the tumor as possible, while Mr. Jacques was awake. Surgery was followed by 33 radiotherapy treatments at the Precision Radiotherapy Center in West Chester, Ohio, and chemotherapy.

Mr. Jacques says he was informed about ongoing clinical trials around the time of his surgery. “I accepted the opportunities as a way to help others,” he says. “That is a part of who I am.”

“Basically, the importance of research is what we can develop for the future,” Dr. McPherson says. “Mr. Jacques is allowing his tissue to be studied and looked at for treatment that will hopefully benefit him -- but if not him, then future generations. Every person with brain cancer should be involved in research because we still don’t have good treatment options.”

The UC Brain Tumor Center (in collaboration with the Mayfield Clinic) is joined by three other Ohio centers in The Cancer Genome Atlas study: Case Western Reserve University and University Hospitals Case Medical Center; the Brain Tumor Center at the Cleveland Clinic Foundation; and the Department of Neurosurgery at the Ohio State University Medical Center. These four Ohio centers are simultaneously taking part in the Ohio Brain Tumor Study, which seeks to determine risk factors for brain tumors.

For more information about research and clinical trials at the UC Brain Tumor Center, please contact Alison Kastl at kastla@ucmail.uc.edu or (513) 584-0436.

West Chester, Ohio – Acquisition of a new-generation linear accelerator is included in a significant expansion under way at the Precision Radiotherapy Center, a state-of-the-art radiotherapy/radiosurgery treatment center for people with cancer, benign tumors and other abnormalities.

The expansion will double Precision Radiotherapy’s size to 16,000 square feet and will more than double the center’s operating capacity, increasing the number of patients treated from 35 per day to 75.

Precision Radiotherapy Center’s growth mirrors the growing oncology presence at University Pointe, the northern clinical practice site for UC Physicians. Together, Precision Radiotherapy and University Pointe are supported by eight radiation oncologists and eight medical oncologists.

Precision Radiotherapy Center, which opened in 2003, is operated by the Mayfield Clinic and UC Health’s Department of Radiation Oncology, two nationally recognized programs affiliated with the University of Cincinnati (UC) College of Medicine. The center works closely with the UC Cancer Institute, the Barrett Cancer Center and the UC Brain Tumor Center.

Loraine Henderson, Executive Director of Business and Administration for UC’s Department of Radiation Oncology, said the expansion will be especially helpful to referring physicians whose patients live in the West Chester area and the high-growth Cincinnati-Dayton corridor. “Our patients often are treated over a course of weeks,” Mrs. Henderson said. “If they live in the northern suburbs, they may not be able to drive downtown for daily treatment.”

In addition to providing state-of-the-art clinical care, Precision Radiotherapy Center is committed to cancer research and education. The center contributes $300,000 annually to the UC Brain Tumor Center for research and an additional $350,000 annually to UC’s departments of neurosurgery and radiation oncology for research and resident education. “It’s a commitment by Precision Radiotherapy Center to the advancement of cancer research and the training of future cancer specialists for the community,” said Ronald Warnick, MD, Co-Medical Director of Precision Radiotherapy Center, Chairman and President of the Mayfield Clinic, and Professor of Neurosurgery and Radiation Oncology at UC.

Precision Radiotherapy Center’s new treatment machine is the TrueBeam™ system, the newest linear accelerator manufactured by Varian Medical Systems. It will enable image-guided brain and body radiosurgery (one to five high-dose treatments) and radiotherapy (five to 40 lower-dose treatments) of almost any tumor or abnormality. The radiation is shaped precisely to the tumor, sparing critical structures, and can be delivered, with high precision, in increments of less than a millimeter.

High-energy radiation kills cancer cells by damaging their DNA.

The TrueBeam™ system, in addition to supporting radiosurgery and general radiotherapy capabilities, also provides Precision Radiotherapy Center with electron beam radiotherapy for the first time. Electron-beam radiotherapy is used primarily for tumors close to the surface of the body, including skin cancers.

“Acquisition of Varian’s TrueBeam™ system reinforces our mission to provide the most current cancer treatments available to the Greater Cincinnati region,” said John Breneman, MD, Co-Medical Director of the center and Professor of Radiation Oncology at UC. “As we map out the optimal treatment strategy for each individual patient, we now have the full range of superb radiotherapy options from which to choose.”

“The expanded Precision Radiotherapy allows the sub-specialized clinical expertise of the University physicians to be available to the community with the very latest, state-of-the-art technology,” added William Barrett, MD, Chairman of the Department of Radiation Oncology at UC and an expert in the treatment of prostate cancer and head and neck Cancer.

The center will also acquire its first wide-bore CT simulator. The CT simulator, manufactured by Philips, will allow pre-treatment imaging for simulation and planning to be performed at Precision Radiotherapy. The large bore size accommodates patients who are in immobilization devices or attached to bulky monitoring devices. The system, which has advanced 4D capability, also will gather important data related to tumors that move when a person breathes in and out. This “respiration motion” data can then be factored into the patient’s treatment plan.

The TrueBeam™ system joins two other valuable treatment options at Precision Radiotherapy:

• The Novalis shaped-beam system, which is used primarily to treat tumors and other abnormalities of the brain and spine. This image-guided system allows for precise localization of the tumor and a treatment beam that mirrors the lesion’s shape and size. The shaped, high-resolution beams strike the tumor from many different directions to minimize exposure to healthy tissue.


• The TomoTherapy Hi-Art System, which is used primarily to treat tumors and other abnormalities outside the brain and spine. This image-guided system can capture CT images of a patient’s tumor immediately prior to treatment sessions, thereby allowing for precise tumor targeting and sparing of normal tissue. The TomoTherapy system is based on intensity-modulated radiotherapy, or IMRT, which allows physicians to adjust the intensity of the radiation during treatment sessions to maximize accuracy and spare healthy tissue. 

CINCINNATI—Isaiah Fidler, DVM, PhD, one of the world’s leading experts in brain metastasis, has been recruited to head the University of Cincinnati Brain Tumor Molecular Therapeutics Program’s new Scientific Advisory Board.

Dr. Fidler is the Distinguished Chair in Cell Biology and Head of the Metastasis Research Laboratory in the Department of Cancer Biology at the University of Texas MD Anderson Cancer Center. He will serve as an external advisor to the Molecular Therapeutics Program, which was established in March 2011 with a $2 million gift from the Harold C. Schott Foundation and an additional $4.5 million in funding from UC. The Molecular Therapeutics Program is a collaboration between the UC Cancer Institute and the UC Neuroscience Institute.

Dr. Fidler will be on the UC Academic Health Center campus Nov. 2-3 to lecture about brain metastasis, to evaluate grant presentations by UC researchers, and to offer insight into future research strategies and recruitments.

“Dr. Fidler is likely the world’s No. 1 expert on metastasis,” said Olivier Rixe, MD, PhD, Director of the Experimental Therapeutics Program and Professor of Medicine in UC’s Division of Hematology-Oncology. “In the 1980s he discovered all the key mechanisms to explain how a primary tumor can metastasize to another organ. More recently, he has focused on brain metastasis and has put forth explanations for why brain metastases are more difficult to treat and how they develop drug resistance.”

“We are fortunate to have Dr. Fidler visit to help us set our new Molecular Therapeutics Program on the right path,” said George Atweh, MD, Director of the UC Cancer Institute and Head of the Division of Hematology-Oncology. “We look forward to interacting with him and using his expertise to bring our program to the next level.

“In addition to establishing the Scientific Advisory Board,” Dr. Atweh continued, “we are in the process of recruiting three new scientists who will focus their research on brain metastasis to complement the existing strengths in our institution in this field of research.”

Each year more than 170,000 Americans experience brain metastasis, the spread of cancer from its point of origin to the brain, according to the National Cancer Institute. The UC-based Molecular Therapeutics Program, which is dedicated exclusively to tackling the growing problem of brain metastasis, is believed to be the first comprehensive brain metastasis-specific translational research program in the United States. Translational research is the process of converting laboratory research into therapies that can benefit human beings.

Specifically, the Molecular Therapeutics Program seeks to translate laboratory findings about brain metastasis into original clinical trials for patients whose tumors have metastasized to the brain from tumors of the breast, lung, colon or skin (melanoma).

“By asking prominent researchers like Dr. Fidler to become external advisors who evaluate and sometimes guide our research, we hope to accelerate our efforts and improve our ability to help patients who suffer brain metastasis,” said Ronald E. Warnick, MD, Medical Director of the UC Brain Tumor Center and Chairman of the Mayfield Clinic.

Other members of the Scientific Advisory Board are:

• Drs. Atweh, Rixe and Warnick


• John Breneman, MD, Associate Director of the UC Brain Tumor Center and the Charles M. Barrett Professor of Radiation Oncology


• Jean-Yves Blay, MD, PhD, President, European Organisation for Research & Treatment of Cancer (EORTC)


• L. Thomas Hiltz, Trustee, the Harold C. Schott Foundation


• Roger Stupp, MD, Vice President, European Organisation for Research & Treatment of Cancer (EORTC)


• Bin Tean Teh, MD, PhD, Professor of the Center for Cancer Genomics and Computational Biology at the Van Andel Institute, Grand Rapids, Mich.


• John M. Tew, MD, Clinical Director, UC Neuroscience Institute and Mayfield Clinic neurosurgeon


• George Thomas, PhD, Scientific Director of UC’s Metabolic Disease Institute and the John and Gladys Strauss Professor in Cancer Research

Dr. Fidler, a native of Jerusalem, chaired the Department of Cancer Biology at MD Anderson from 1983 to 2008. Prior to joining MD Anderson he served as head of the Biology of Metastasis Section at the National Cancer Institute’s Frederick Cancer Research Facility in Maryland. He earned his doctorate in human pathology at the University of Pennsylvania.

He has authored or co-authored more than 795 scientific publications and has won numerous national and international awards, including the World Health Organization Medal for Biological Science, the American Cancer Society Distinguished Service Award, and the Nature Publishing Lifetime Achievement Award.

Dr. Fidler is the creator of the “seed and soil hypothesis.”

“You need a perfect seed in a perfect soil to develop metastasis,” Dr. Rixe explained. “The cancer cells are important, but the micro-environment of the surrounding tissues is also important to the development of metastasis, and especially brain metastasis. It turns out that the micro-environment in the brain is different from that of other organs.”

The difference, Dr. Fidler has hypothesized, can be attributed to cells – astrocytes -- that exist only in the brain and that play a critical role in brain metastasis. Like double-agents in a spy novel, these astrocytes communicate with the enemy cancer cells and then turn against their homeland (the brain) by making the enemy cells resistant to chemotherapy.

“When these astrocytes in the brain’s micro-environment interact with the metastatic cells, they can cause the metastatic cells to become drug resistant,” Dr. Rixe said. “They induce something bad for the patient. This is a new hypothesis. The tumor blood brain barrier, quite possibly, does not exist.”

During his visit to UC, Dr. Fidler will present the inaugural scientific lecture for the UC Brain Tumor Molecular Therapeutics Program. The presentation, titled, "The Biology and Therapy of Brain Metastasis: Targeting the Astrocytes," will take place at 12 p.m. Wednesday, Nov. 2, in the Medical Sciences Building, Room 4051, on the UC Academic Health Center campus.

Reporters, photographers and videographers are invited to meet with Dr. Fidler during the following times:

• 3:30-5 p.m. Tuesday, Nov. 2


• 10-11:30 a.m. Wednesday, Nov. 3


• Another mutually agreeable time on Nov. 2 or 3

CINCINNATI—The 2011 Midwest Regional Brain Tumor Conference, a free educational event for patients, caregivers and family members, will be held from 8 a.m. to 2:45 p.m. Saturday, Oct. 1, at Westin Cincinnati downtown. The conference, entitled "Hope, Innovation, Progress, Support,"is presented by the Brain Tumor Center at the University of Cincinnati Neuroscience Institute, in partnership with the National Brain Tumor Society.

A team of nationally recognized faculty members will provide patients, survivors and caregivers with the latest information about treatment and maximizing quality of life. Topics will include the origins of brain tumors, surgery and radiation therapy, the future of brain tumor treatment, nutrition and exercise and financial and emotional resources.

Breakout sessions will focus on brain tumor types, including pituitary adenoma, acoustic neuroma, meningioma, glioma and metastatic.

Fifteen-minute physician consults also will be available. Patients wishing a consult should contact Nancy McMahon at (513) 475-8646. All scans must be received before Wednesday, Sept. 21, to allow time for preparation.

Featured speakers and breakout session leaders include the following members of the UC faculty and UC Brain Tumor Center:

* Ronald Warnick, MD, Director of the UC Brain Tumor Center. 
* John M. Tew, MD, Clinical Director of the UC Neuroscience Institute.
* John Breneman, MD, Professor of Radiation Oncology and Neurosurgery.
* Tania Carreón-Valencia, MS, PhD, Assistant Professor of Environmental Health.
* Mary Gaskill-Shipley, MD, Associate Professor of Radiology.
* Jessica Guarnaschelli, MD, Assistant Professor of Radiation Oncology.
* Christopher McPherson, MD, Director of the Division of Surgical Neuro-Oncology.
* Myles Pensak, MD, H. B. Broidy Professor and Chair of the UC Department of Otolaryngology-Head and Neck Surgery.
* Olivier Rixe, MD, PhD, Professor of Hematology/Oncology. 
* Ravi Samy, MD, Assistant Professor of Otolaryngology-Head and Neck Surgery.
* Philip Theodosopoulos, MD, Director, Division of Skull Base Surgery.
* Lee Zimmer, MD, PhD, Director, Endoscopic Cranial Base Center, Division of Sinus Surgery.

The program director is Dr. McPherson.

The conference, which is free, includes a continental breakfast and lunch. Participants are asked to register in advance by calling (513) 558-8642 or by registering online at www.ucbraintumorcenter.com. An event brochure is available online and can be downloaded as a PDF.