Surgery is still one of the most straight-forward treatments in oncology. It feels intuitively simple: in order to kill the “enemy” – the tumor – the diseased tissue must be removed. It shouldn’t be more rocket science than that.
Complications start with details: how much tissue should be removed? Well, just the tumor. What if there is no any well-defined boarders of the tumor? Just like in the case with brain cancers, for instance. There are honestly speaking “fifty shades of grey” here, and to be on the safe side the surgeon has to remove not only the darkest parts – the most well-visualized tumor, the core, – but even the surrounding parts, that are nearly “white”. Because nearly tumor-free in brain can mean a super fast recurrence and much more aggressive growth of a new tumor after surgery. This is why a term “total resection” exists among neurosurgeon jargon, meaning that both the visible tumour and a certain depth of surrounding area were removed, as it was proved that this type of resection prolongs life substantially compared to “partial” resection – when only visible tumour or its parts were removed. Do you also see a problem here?
Brain surgery is a very harmful procedure – every millimeter of a brain tissue removed can be crucial for physical and cognitive functions of the patient. The more tissue is being removed, the more invalidizing impact it can make to the patient. On the other side, the removing of more tissue prolongs the life expectancy. What to choose? It can feel like choosing between plaque and cholera.
Skilled surgeons can define what part of brain can be relatively safely resected and what part is extremely critical for the patient. Video below demonstrates a case with a tricky surgical operation when tumor is located very close to a speech centrum.
https://youtu.be/blEaFzZ-jO4 (more detailed video in Russian without subtitles: https://www.youtube.com/watch?v=4Kb_hu7DEXo&feature=share)
Yes, there is an even better choice! Temodex – local chemotherapy that is applied in the wound of the resected tumor directly after surgery and in this way keeps residual tumour cell proliferation at bay. Temodex affects predominantly fast growing cancer cells and was shown to be very successful to prolong life and minimize recurrent tumour growth. Is the problem solved? Happy ending? Well, we are only in the beginning of the process of registering Temodex in the rest of the world, and both we and coming patients hope and pray for that process to go as smooth as possible. But the movie has just started – buy more popcorn and follow new steps in the story of clinical development of Temodex!