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Drug that illuminates brain tissue advances tumor treatment

December 29, 2014


MIAMI ó Last year, Shawn Monti and his wife, Kathy, drove two hours from their home in Port St. Lucie, Fla., to the University of Miami Sylvester Comprehensive Cancer Center in complete silence.

Shawn, 46, father of five, had just been diagnosed with glioblastoma, a fast-growing brain tumor. Doctors told him he had six months to live.

Today the Palm Beach County sheriffís deputy is alive and hopeful after undergoing surgery at Sylvester in which doctors injected sodium fluorescein, an FDA-approved drug that illuminates brain tumor tissue, making it glow neon green under a UV light. This helps doctors delineate the good tissue from the cancerous tissue, which can be difficult to discern in the brainís complex folds.

Dr. Ricardo Komotar, the surgeon who performed the procedure on Monti, said this type of technology is a "game changer" for brain tumors, especially with tumors located in critical areas like Montiís. His tumor was next to his motor strip, part of the brainís frontal lobe that controls movement.

"The goal is to take out as much of the tumor as possible, while leaving as much healthy tissue (as possible) behind," said Komotar, an assistant professor of neurological surgery and co-director of Surgical Neuro-oncology at Sylvester. "I think if you donít have this technology, youíre not going to be as aggressive as youíd like."

Sodium fluorescene has been used for more than a decade, primarily in eye treatments. Only recently, however, has it been used by surgeons for treating brain tumors. With recent studies showing success in this field, doctors at Sylvester believe it will become the standard of care for brain tumors.

Removing as much of the tumor as safely as possible is key to maintaining the quality of life.

"Itís just another piece of the pie," said Komotar, who performed the three-hour operation while Monti was under conscious sedation, a combination of sedatives and anesthetics to help the patient relax (sedative) and block pain (anesthetic). This allowed the doctors to monitor his motor functions and strengths. "You need to have a comprehensive approach to these tumors."

Without the sodium fluorescein, Monti likely would not have undergone brain surgery, other than a biopsy, because Komotar said it would have been too difficult to differentiate between the healthy cells and the tumorous ones. As a result, chemotherapy would not have been that successful in eradicating the tumor.

Today, an MRI scan does not show any evidence of the tumor. But Montiís battle with glioblastoma is not over. He will continue to receive radiation and chemotherapy to help prevent the tumor from recurring. 

"I feel great," said Monti, who jokes when he sees video footage of his surgery. "Hereís proof that I have a brain. Itís been called into question many times."

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