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UTSW researcher explores a "cooler" approach to treating brain cancer

MRI of the brain shows left frontal glioblastoma

Doctors use surgery, chemotherapy, and radiation to treat a malignant brain cancer called glioblastoma. But it often returns. Dr. Syed Faaiz Enam, a Resident in Adult Neurology at UT Southwestern Medical Center, explains to KERA's Sam Baker why he thinks cooling brain tumor cells could be effective.

Why is glioblastoma difficult to treat?

One of the things with cancers, especially something like glioblastoma, is that it is invasive. When you're working in the brain, you're always going to have some cells left over because you can only reset what you can see and you can only radiate, which you can kind of that region.

And then when you apply chemotherapy, you're going to kill only those cells that are sensitive to chemotherapy. And so any cells that already have some resistance, they'll become the predominant cell. And then when they become the predominant cells and they’ll recur.

Your research has focused on cooling or lowering the temperatures of cancer cells. So what exactly does that accomplish? 

Tumor cells are constantly using resources and producing things. And because of this, they're also highly replicative, meaning they create lots of copies of themselves and that's how they grow and spread.

With hypothermia, the idea was something we can do that would reduce the metabolism, reduce the cell division, and reduce everything of the tumor cells that would still be safe. That way you're not just targeting one or two targets or one or two molecules. You're affecting multiple pathways at the same time in the tumor.

And so it's harder for the tumor to, you know, evolve around it or develop resistance around it. And at the same time, as long as, you know, the temperature is a good, safe region, it should be safe for the other cells of the brain as well since there's not as much cell division in the brain.

How exactly do you cool the cells?

We were able to make a device that uses something called a thermoelectric plate. It's similar to a heat pump where you apply power or electricity to this plate and it pulls heat. And so then we had a heat sink and a fan that would blow that into the surrounding air.

And so that's how we did it in rats. We had this probe that would go in the tumor, and then we had a plate that would pull that heat that was powered, and then get thrown out into the air with a heatsink and a fan.

But in patients, of course, you can't do that and you cannot imagine a patient wearing a big heat sink or a fan on their head.

And so what I'm working on now is instead of using a fan to blow the heat out into the air, I'm distributing that heat through the body, through the skin, with a different kind of system so that ultimately this could be a fully implantable system for patients.

The human brain could withstand that?

You know, people have been exploring cooling the brain for a really long time. The first part of even trying to cool tumor cells was one line in a paper that was back in 1959.

In the sixties or so, people started exploring hypothermia. And then in the nineties especially, they started using brain cooling to help end stroke and brain injuries.

There's still been a lot of debate as to how protective it is, but there is some evidence to suggest certain levels of hypothermia might be protective.

As far as you know at this point, could this be done on any case of glioblastoma or has the study run into limitations of any type? 

Chances are whenever we start any trials, it's going to be we're going to first do standard-of-care therapy, would do surgery, chemotherapy, and radiation.

Then chances are from there, when the tumor most likely recurs, at least early on, that when we would intervene with this device, when you know, when there are no other options. Ultimately, of course, if things get better, we could start sooner, and probably early on we would be targeting tumors that are more superficial and more contained.

Eventually, as this device becomes more and more patient-centric, we envision that we'd be able to get to deeper tumors and deeper regions where we might not be able to reject those tumors, but we might be able to put a probe down in that deeper region. But those are far in the future.

Sam Baker is KERA's senior editor and local host for Morning Edition. The native of Beaumont, Texas, also edits and produces radio commentaries and Vital Signs, a series that's part of the station's Breakthroughs initiative. He also was the longtime host of KERA 13’s Emmy Award-winning public affairs program On the Record. He also won an Emmy in 2008 for KERA’s Sharing the Power: A Voter’s Voice Special, and has earned honors from the Associated Press and the Public Radio News Directors Inc.