Neurological Oncology – A Multidisciplinary Approach to Treatment

Intro: This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Well hello and welcome to the show. You are listening to Weekly Dose of Wellness. It's brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Asif Harsolia. Dr. Harsolia is a board-certified cancer specialist in radiation oncology. He completed his residency at William Beaumont Hospital in Royal Oak, Michigan, where he trained with some of the world's top specialists in the field of radiation oncology and established highly specialized skills in advanced radiation techniques such as brachytherapy, image guidance, radiosurgery, and intensity modulated radiation therapy. Today we'll discuss neurological oncology with emphasis on the multi-disciplinary approach to treatment. Welcome, Dr. Harsolia.

Asif Harsolia, MD: Thank you for having me.

Deborah Howell (Host): Let's get right into it. What are some of the latest advancements in treating brain and spine tumors?

Asif Harsolia, MD: Well, I think, you know, one of the most exciting developments in recent years has been the advancements in a technique known as radiosurgery, utilizing systems such as the CyberKnife. And, you know, while the word "knife" and "surgery" sort of brings up images of cutting in an operating room, radiosurgery is actually a virtual type of surgery where there's no real cutting involved. It's sort of a painless, non-invasive way of treating brain and spine tumors without anesthesia or hospital admissions.

Deborah Howell (Host): Incredible. It's like a Johnny Quest world, isn't it?

Asif Harsolia, MD: Ah, yes.

Deborah Howell (Host): Did you ever think we’d make these advances?

Asif Harsolia, MD: You know, I think 10, 15 years ago, some of these things were sort of the topics of science fiction. But these advancements in robotics and computer technology has really opened up brand new avenues that we never had before.

Deborah Howell (Host): Right. Now, it's a great age to be a patient, of course, because of these advancements. How does CyberKnife help in the treatment of these type of cancers?

Asif Harsolia, MD: That's a great question. You know, I think in the past, to give you an example, if a patient presented with a brain tumor in a critical location, let's say near the optic nerves, which are the nerves that control vision in the brain, it was a very sensitive area to operate in and it could be a very risky operation. Could potentially result in blindness for the patient. And, you know, normally when you're doing that type of an operation, a neurosurgeon would have to, you know, shave the patient's head and saw the skull open and, you know, remove the tumor. The patient would be admitted to the intensive care unit and have, you know, many days of recovery in the hospital. And now there's an alternative option for patients, you know, who present in these types of situations. They can have this outpatient CyberKnife procedure done, which is, you know, they can wear their street clothes, they lay on a table for about an hour and a half. There's no anesthesia, no cutting. And we're able to, in most cases, ablate the tumor safely with a relatively small risk of toxicity. And the patients usually are able to go home the same day.

Deborah Howell (Host): Absolutely incredible. I mean, it just blows my mind. Let's get more specific now. What is CyberKnife and why is it such an important piece of technology?

Asif Harsolia, MD: Yeah, so CyberKnife is sort of an advancement over some of the prior radiosurgery systems in that it basically is a... essentially, it's a robotic system. It was actually pioneered by a neurosurgeon from Stanford. And it's based off of actually automotive robots. And what it is, is a miniaturized linear accelerator that's mounted on this robot. And it allows essentially the ability to deliver hundreds of beams of radiation from multiple different directions.

Deborah Howell (Host): I see.

Asif Harsolia, MD: And it, you know, it allows almost basically the precision to treat... you can almost treat something on the head of a pin. It's that precise.

Deborah Howell (Host): Wow.

Asif Harsolia, MD: And so you're able to sort of, you know, carve radiation around critical structures and pinpoint, you know, the tumors with a high degree of precision and accuracy.

Deborah Howell (Host): So it is robotic surgery. It's just a very specific type.

Asif Harsolia, MD: Right, exactly. Except, you know, there's no cutting or there's no actual incisions. It's actually X-ray beams that are focused at a single point with high energy. And within a few millimeters away, you're able to sort of, you know, spare the regular healthy tissue.

Deborah Howell (Host): In Men in Black, they have, I forget what it's called, but it's the thing they point at people and it just kind of zaps... the neuralyzer, I think it was called... I'm just trying to put it in layman's terms... so you basically neuralyze the tumor...

Asif Harsolia, MD: Right, right, right. It's sort of like that. It actually, you know, it's able to... it's beams that go through the body. And because each beam is divided by 1/100th, where they intersect, it's a lot more powerful, but each individual beam doesn't hurt the body. So yeah, I guess you could sort of think of it that way.

Deborah Howell (Host): Okay. Alright, well, now, is it also... can you also use a CyberKnife for repair in terms of... say the optic nerve, we're back to the optic nerve. You couldn't reconnect and put in a new optic nerve using a CyberKnife. It's really used for more or less demolishing something that's foreign to the body.

Asif Harsolia, MD: That's exactly correct, yeah. So we can't do... so you can destroy or ablate tumors that are in critical locations, whether it's in the spine or in the brain. But you can't actually repair, you know, or reconnect nerves or things like that.

Deborah Howell (Host): Do you think there will be a time in the future when we'll be able to do things like that?

Asif Harsolia, MD: Possibly. Probably not using this type of technology, but I think this type of technology is very useful in treating, you know, cancerous tumors or foreign tumors, you know, things that should not be in the body.

Deborah Howell (Host): Okay.

Asif Harsolia, MD: It's also, people have used it even for... there are other uses besides cancer. People have used it for treating, for example, there's a disease called trigeminal neuralgia, which is a painful condition of the nerves, and you can ablate nerves with it. Or, you know, even benign tumors such as meningioma, which is a small tumor that is not malignant, but nonetheless can be very uncomfortable for patients.

Deborah Howell (Host): What about fibroids?

Asif Harsolia, MD: You know, it hasn't been used for fibroids yet, but that's an interesting thought.

Deborah Howell (Host): Yeah. A lot of women would be glad to hear that.

Asif Harsolia, MD: Right, I'm sure.

Deborah Howell (Host): Alright, what can a patient expect from their physician team when being treated for these and other types of cancers?

Asif Harsolia, MD: You know, I think the most important thing is, while we have, you know, this very advanced, you know, futuristic technology and cutting-edge type of equipment, we always try to keep in mind the actual patient's condition and the overall clinical picture. Additionally, we, you know, we try to select our teams such that they're able to balance this technology with compassion and with good bedside manner, as well as, you know, again, taking in... customizing each of the patients' treatment plans to their individual condition.

Deborah Howell (Host): Fantastic. How is MemorialCare leading the way in the treatment of neurological cancers?

Asif Harsolia, MD: Well, MemorialCare has been very, very supportive. I think their investments in advanced technologies and putting together a multi-disciplinary team of specialists, because this is never a one-man type of a thing. We work very closely with neurosurgeons, with neuroradiologists, with pathologists, medical oncologists, and many other members of the team. And MemorialCare has actually put together a multi-disciplinary neuro-oncology tumor board to help coordinate some of the more complex cases. And I think this really sets MemorialCare apart in terms of pioneering, you know, the treatment path in terms of neurologic cancers.

Deborah Howell (Host): It's really one of those things. It's about the team, and if egos get in the way, it can really harm the patient's prognosis. So it's wonderful when you see a team really working together.

Asif Harsolia, MD: Absolutely. I completely agree with you on that.

Deborah Howell (Host): Certainly, if you're a patient, that's what you would want.

Asif Harsolia, MD: Absolutely. It's very important.

Deborah Howell (Host): What other developments are we looking at in terms of cyber surgery?

Asif Harsolia, MD: You know, we, besides even though it was initially pioneered for the brain, there's been tremendous advancements in the treatment of lung cancers with CyberKnife, pancreatic tumors, liver cancers, and prostate cancers. And the preliminary data for all of these techniques have been very, very promising, so we're very excited about the future of this technology and this procedure.

Deborah Howell (Host): What about wound control? I've heard that there are some places looking into putting these machines around a wound that is non-healing and actually healing the wound from the perimeter of it.

Asif Harsolia, MD: Yeah, I think that is something that is being looked into with another type of technology, but the CyberKnife itself wouldn't be used for something like that. Mainly it affects the DNA and prevents any type of cell in the body that's replicating very, like abnormally, it prevents that replication from happening. So, with wound healing, it would sort of be a different... a different issue.

Deborah Howell (Host): Okay. Alright, well we want to thank you very, very much for your time today. It's a very exciting time in medicine, and we look forward to further advancements coming out of your corner.

Asif Harsolia, MD: Thank you so much, and it was very nice talking to you today.

Deborah Howell (Host): Dr. Harsolia, finding the time to talk to us about the CyberKnife and the multidisciplinary approach to neurological oncology. It's a lot of big words, but it's a very good thing if you are a patient. It's been a total pleasure to speak with you today. We learned a lot. I am Deborah Howell. Please do join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a lovely and healthy day, everybody.