Humanity has planted flags on the moon, but a moon shot for brain cancer has yet to be realized.
Diagnosis known, we gradually stopped removing more tumor. The more tumor you remove, the longer the average survival time, however lean it may be. But the pursuit of surgical perfection sometimes comes at a cost. In the brain, where critical human functions are packed into millimeters of tissue, removing more tumors and potentially damaging healthy tissue risks loss of strength, speech, eyesight, memory, and more. In glioblastoma, tumor cells that are inches away from the tumor mass and far beyond the reach of tweezers almost guarantee the cancer will recur. Surgical perfection is imperfect. She wanted to keep her strength.
We sewed the dura shut and then re-plated its bone. We carefully closed the layers of her skin. A short time later she was extubated and we took her to our neurological intensive care unit to recover.
“I have seven years to spend with my sister, and a lot of young people die these days, so I try to be pragmatic,” she had told me the day before. Negotiate.
Forty years ago, the median survival time for glioblastoma was four and a half months. Since then, researchers have characterized the genetics of glioblastoma and studied various vaccines, chemotherapy, immunotherapies, cell therapies, new imaging modalities, targeted radiation therapies, and innovative forms of drug delivery to treat the disease. Lots of steps.
The median survival time is now around 15 months. Only a small percentage of patients survive more than five years.
Defeatism is a common feeling among neurosurgeons, but you remain determined, for your patients and for yourself. The next morning our patient was in a good mood, recovered well, with good strength. We carefully shared the diagnosis with her.
“Just my luck,” she said with a smile. She seemed to be expecting it.
Some sibling cancers can be explained by genetics. But that’s not the case with glioblastoma. As for her sister and many others, it was really just bad luck.