Ask the Expert: What is the Role of Lasers in the Current Management of Malignant Brain Tumours?

Lasers are one of the newer technologies used to treat malignant gliomas using minimally or non-invasive strategies. The other technique utilizes focused ultrasound. Both technologies use hyper-thermia to kill tumour cells, which essentially means the glioma is killed by heat.  

In fact lasers have been used in medicine for decades; what has made them more effective is the ability to monitor their effect. This is done by a real-time MRI scan which monitors the temperature of the brain/tumour during laser treatment. In this way, the surgeon can eradicate a large volume of tumour cells and also protect the normal brain. In a similar way, focused ultrasound will target deep brain tumours and direct high heat to the tumour, but spare the normal brain.
These two technologies are slowly replacing the standard operation: open craniotomy. They are usually done with a very short hospital stay and have significantly less risks than open craniotomy. They are very good at quickly killing a large volume of tumour, but do not actually remove the tumour tissue. This dead tumour tissue is evidently reabsorbed by the body like any other scar tissue.
The other major benefit of using heat to kill brain tumours is that it leads to better penetration of chemotherapy drugs into the brain. Many effective chemotherapy drugs are not used in brain tumours because they cannot penetrate into the brain (by what is called the blood-brain-barrier).  After the tumour is lasered, the area around it shows to have increased absorption of chemotherapy drugs for up to 6-8 weeks. This is one additional benefit of using laser or ultrasound to kill tumour cells.  
The use of laser is still very young, but rapidly growing with most major brain tumour centres in North America adopting the technology. Because of its youth we are still learning for how it is best deployed in the entire strategy to control and cure brain cancer. While much of the early usage has been for recurrent tumours, we are now using the laser as the first treatment, instead of surgery.
Canadians have taken a strong lead in the advance of both technologies, with ongoing research on their benefits and application. It is expected that access to both technologies will greatly increase and be more readily available to all Canadians.
Dr. Brian Toyota is head of the Division of Neurosurgery at University of British Columbia and Vancouver General Hospital. Dr. Toyota serves on the Editorial Board for the Canadian Journal of Neurosciences, World Neurosurgery; Co-Chairs the Royal College Specialty Committee, Neurosurgery and also serves on the Examination Board for the Royal College for Neurosurgery.
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