The Brain Tumor Center (BTC) under the direction of Drs. Daniel F. Kelly, MD, and Garni Barkhoudarian, MD, and the John Wayne Cancer Institute are committed to improving the lives of patients with brain tumors, pituitary tumors and related disorders through research and education. Our recent and ongoing research efforts are summarized below:
1. Preoperative Somatuline Depot™ Therapy for patients with Acromegaly - upcoming
Patients who have a growth hormone-secreting pituitary adenoma causing acromegaly may benefit from pre-operative medical therapy with Somatuline Depot™, a somatostatin analogue. This medication may improve hypertension, cardiac function, diabetes mellitus control and lung function prior to surgery and may thereby reduce the risks of endonasal surgery. This medication may also decrease adenoma size and thereby facilitate a more complete tumor removal, improving post-operative remission rates. Study participants will be given 3 injections of Somatuline Depot™ (once every 4 weeks) prior to surgery and their response to therapy will be monitored immediately prior to surgery and for one year after surgery. This study is actively enrolling new patients (April, 2013).
2. Brain and Pituitary Tumor Biomarker Studies
This is an ongoing study aimed at gaining a better understanding of tumor genetics and growth patterns to plan more effective treatments beyond surgery. All patients undergoing removal of a brain, skull base or pituitary tumor (such as aglioma, metastatic brain tumor, pituitary adenoma, meningioma, chordoma or craniopharyngioma), are asked to participate. For participants, a portion of their tumor specimen removed at surgery is placed in a tumor repository. Tumor cells are then studied for specific genetic markers that may indicate their aggressiveness or potential responsiveness to various therapies such as a chemotherapy, immunotherapy or radiosurgery. This is study is being performed in collaboration with Dr. Dave Hoon, Director of Molecular Oncology at JWCI.
3. Impact of Executive Functioning Impairment on Quality of Live in Patients with Brain Metastases or Meningiomas
This ongoing study is evaluating specifically how metastatic brain tumors (a malignant tumor) and meningiomas (benign tumors) differentially affect higher brain functions (executive functions) such as planning, organization, impulse control, emotional regulation, attention, concentration etc. This study will also look at how problems with these executive functions can affect patient quality of life before and after treatment for their tumor(s). This study plans to show the importance of understanding patients’ strengths and weaknesses in these functions. The outcomes of this study will help develop more effective therapies and improve quality of life.
4. Rhinological Outcomes in Endonasal Pituitary Surgery: A Multicenter Observational Cohort Study
Patients undergoing endonasal removal of a pituitary adenoma are asked to participate in this prospective study both before and after their surgery. The goal of this study is to compare the relative impact on nasal and sinus function and pain for patients undergoing a fully binostril endoscopic tumor removal versus a single nostril microscopic and endoscope-assisted tumor removal. Given that over 95% of patients operated on by Dr. Kelly and Dr. Barkhoudarian have a fully endoscopic binostril approach, most patients enrolled in this study at Saint John’s Health Center, will be enrolled in the fully endoscopic arm of the study. By participating, patients will also gain better insights into their own recovery. Other participating institutions include the Barrow Neurological Institute, The Ohio State University Department of Neurological Surgery and the Chicago Institute of Neurosurgery.
5. Hypopituitarism (Pituitary Gland Dysfunction) in Retired Professional Football Players
Pituitary gland and related hormonal dysfunction is a known consequence of severe traumatic brain injury (TBI). The impact of repeated mild TBI (concussion) that may occur in contact sports is less clear. In this study we studied the relationship between concussion, subsequent hormonal function, neurobehavioral deficits and quality of life (QOL) in retired NFL players. From a database of 2800 retired NFL players, 75 retirees with poor quality of life, age 30 – 65 years were studied with hormonal, neurobehavioral and QOL testing from early 2009 to June 2012. Overall, 16 players (21%) had evidence of pituitary gland hormonal dysfunction (either growth hormone deficiency or testosterone deficiency). Compared to the 59 retirees without hormonal abnormalities, the 16 hormonally deficient retirees had a higher ratio of concussions to games, suggesting that concussions massed closer together may confer greater risk of pituitary gland damage. They also had average lower scores on QOL surveys and on an erectile dysfunction survey. Additional QOL testing suggested that low growth hormone and related hormone levels (IGF-1) are associated with increased physical limitations and healthcare and lifestyle accommodations. This pilot study strongly suggests that pituitary gland damage may be a significant and common event in professional football players with lasting QOL consequences. Further studies are needed and being planned to better define the risk factors and impact of sports-related concussion and pituitary hormonal dysfunction. The results of this study are in the process of being published. This study was sponsored by National Operating Committee on Standards for Athletic Equipment (NOCSAE) and by Pfizer, Inc. Co- Principal Investigators: Daniel Kelly (JWCI) and Kevin Guskiewicz (University of North Carolina).
6. Ongoing Retrospective Studies
We are constantly looking for ways to improve the surgical and medical therapy we provide to our patients. Hence, we are actively involved in reviewing the numerous surgical operations and medications we offer our patients. We study patient outcomes including tumor remission or cure, improvement of pre-operative symptoms, post-operative management, and rate of certain complications. A list of our most recent publications can be found here.
7. Skull-base Anatomy Microdissection Laboratory
An integral component of cutting edge neurosurgery is an intimate understanding of the microsurgical anatomy of our patients. To further our knowledge in this field, we have established the Skull-base Anatomy Microdissection Laboratory. This facility offers our fellows and researchers a high-quality facility equipped with state-of-the-art neuronavigation, endoscopy, microscopy, instrumentation and HD video recording technology to perform high quality microsurgical dissections. Such an effort will improve our understanding of the relevant anatomy and its variations across patients. In addition, it will serve as an important training venue for our rotating surgical fellows. This project has been supported by in-kind donations from: Stryker, Karl Storz Endoskope, Surgical West, Inc., and Mizuho.
To learn more about our research efforts and clinical trials, please contact:
Charlene Chaloner, RN
Brain Tumor Center Research Nurse Coordinator
Phone: 310-582-7457 // Fax: 310-582-7495
E-mail: chalonerc@jwci.org
Daniel F. Kelly, MD
Director and Professor
Brain Tumor Center and Pituitary Disorders Program
John Wayne Cancer Institute at St. John’s Health Center
Phone: 310-582-7450 // Fax: 310-582-7495
Email: kellyd@jwci.org
Garni Barkhoudarian, MD
Assistant Professor
Brain Tumor Center and Pituitary Disorders Program
John Wayne Cancer Institute at St. John’s Health Center
Phone: 310-582-7450 // Fax: 310-582-7495
Email barkhoudariang@jwci.org