The treatment plan that we recommend depends on the type of cancer a patient has. A new and promising treatment for glioblastoma multiforme and single-site metastatic brain tumors involves implantation of a Gliadel wafer. This wafer releases chemotherapy directly into brain tumors. The drug is gradually released into the brain, which allows for local doses of chemotherapy, prevents systemic toxicity and minimizes side effects.
One course of treatment often recommended for patients with glioblastoma multiforme starts with surgery, during which the tumor is debulked and a Gliadel wafer implanted (if the patient chooses this option). This is followed by high-dose 3-D conformal radiation which allows for the delivery of radiation to the tumor while minimizing the effect on normal tissue. Other brain tumors are typically treated with surgery (without implantation of the wafer) and 3-D conformal radiation therapy. If residual tumor remains after radiation therapy, chemotherapy is administered.
Diagnosis and Evaluation
Typically the patient's first appointment is scheduled with a neurosurgeon. Depending on the type and stage of their cancer, patients may also be scheduled to see a medical oncologist and/or a radiation oncologist. If more than one specialist sees the patient, these physicians will discuss the patient's case and work together to develop a treatment plan. The primary physician managing the patient's care will discuss the treatment plan with the patient and answer any questions s/he might have. The patient may be offered the opportunity to participate in a clinical research trial if it appears that it would be a good option. Since most patients have already had a workup prior to being seen in the neuro-oncology clinic, tests and scans are generally not scheduled for the first visit. If surgery is required, a date will be set. Patients requiring chemotherapy will be instructed as to what to expect and how to manage care at home.
After being evaluated by a radiation oncologist, if radiation treatment is planned, the treatment, procedures and side effects will be explained. The patient may be scheduled for simulation. This process involves using x-ray images to plan radiation treatment so that the target treatment area is precisely located and marked. After simulation, a radiation therapist gives the patient the date and time when treatment will begin.
Arrangements may also be made for the patient to meet support service providers. These might include a social worker, a financial counselor, a chaplain, a patient counselor, or a nutritionist, depending on the patient's needs and interests. Patients will have an opportunity to visit the Cancer Patient/Family Resource Center where they can obtain information about their diagnosis and learn about support groups and resources for individuals with cancer.
The neuro-oncology cancer conference is held on the same day as the clinic. Program members from neurosurgery, medical oncology, radiation oncology, neuropathology, neuroradiology, and endocrinology discuss current cases and treatment regimens. The treatment plan that was recommended for each patient seen in clinic is thoroughly reviewed and discussed and a final plan is established. Patients are contacted after the conference either to confirm the preliminary plan or to discuss the final one.
The nurse coordinator will follow the patient with the managing physician through all of his/her care at UNC. She will ensure continuity in the patient's care if s/he needs to see multiple cancer specialists and receive different types of treatment. Letters will be sent to the patient's local physician to inform him/her of the patient's treatment plan and status.