>> WE HAVE ONE OF THE LARGEST BRAIN TUMOR PROGRAMS
IN THE WORLD.
>> RADIATION THERAPY IS THE CORNERSTONE OF TREATMENT
FOR BRAIN TUMORS.
CHILDREN HAVE BRAINS THAT ARE IN DEVELOPMENT.
THERE ARE ALL SORTS OF STANDARD MATURATION
PROCESSES THAT ARE GOING ON.
WE KNOW THAT RADIATION THERAPY CAN INTERFERE
WITH THESE.
THE BRAIN, IN FACT, IS ONE OF THE MOST SENSITIVE ORGANS
IN THE BODY TO THE EFFECTS OF RADIATION THERAPY.
SO WHEN YOU TAKE A SENSITIVE ORGAN TO BEGIN WITH,
AND THEN YOU COMPOUND THAT WITH THE FACT THAT
THE CHILD'S BRAIN IS IN DEVELOPMENT
AND IS PARTICULARLY SUSCEPTIBLE TO RADIATION THERAPY,
THAT'S AN IMPORTANT CONSIDERATION FOR US.
SO RADIATION SIDE EFFECTS CAN BE PRETTY PROFOUND
IN CHILDREN.
AND WHEN WE SAY WHAT ARE THE EFFECTS,
THE MOST PROMINENT ONE THAT WE DEAL WITH IS THINKING.
HOW WELL ARE YOU ABLE TO THINK,
TO REMEMBER, TO PUT TOGETHER IDEAS,
TO DO ABSTRACT REASONING, ALL THE KINDS OF THINGS THAT
ARE NECESSARY FOR LEARNING IN SCHOOL AND IN LIFE.
THE FUNCTIONAL CONSEQUENCE OF THIS IS THAT SOME
OF THE CHILDREN THAT ARE RADIATED AT VERY YOUNG AGES
MAY BE SO COGNITIVELY IMPAIRED THAT THEY CAN'T LIVE
A NORMAL LIFE, THEY CAN'T LIVE AN INDEPENDENT LIFE,
THEY CAN'T FUNCTION IN SCHOOL NORMALLY.
THEY MAY NOT EVEN BE ABLE TO HOLD A JOB.
ONE OF THE MOST IMPORTANT ADVANTAGES OF PROTON
RADIATION THERAPY IS NOT AT THIS POINT,
IN TERMS OF MAKING A PATIENT LIVE LONGER BECAUSE IT KILLS
THE TUMOR BETTER.
BUT RATHER, HAS THE POTENTIAL TO MAKE
THE PATIENT WHO LIVES LONGER, LIVE BETTER BECAUSE
THE AMOUNT OF NORMAL BRAIN THAT IS GETTING RADIATED
IS MARKEDLY REDUCED.
THAT HAS THE POTENTIAL TO MAKE A TREMENDOUS DIFFERENCE.
IT'S NOT LIKE WE'RE REDUCING THE DOSE TO NORMAL BRAIN;
WE'RE ELIMINATING THE DOSE TO LARGE PORTIONS OF NORMAL BRAIN.
SO WHAT WE CAN SAY IS THAT IF NORMAL BRAIN IS NOT GOING
TO GET ANY MEANINGFUL RADIATION,
THEN THERE'S STRONG REASON TO SUSPECT THAT MANY
OF THESE ISSUES IN TERMS OF COGNITIVE OUTCOMES,
THINKING OUTCOMES, LEARNING OUTCOMES SHOULD BE
SIGNIFICANTLY IMPROVED OR MAYBE EVEN ELIMINATED.
YOU CAN'T TAKE A STANDARDIZED APPROACH;
YOU CAN'T JUST LOOK UP IN A BOOK IN THIS KIND
OF SITUATION AND SAY, "OH, YES, THIS IS WHAT WE SHOULD DO."
IT TAKES A LOT OF DISCUSSION AND IT TAKES A LOT
OF OUR DISCUSSION,
AND THINKING AND ARGUING AND DECIDING AND COMING BACK
AND COMING AT IT AGAIN BEFORE WE COME UP WITH A FINAL PLAN.
WE HAVE A TEAM; NO ONE PERSON CAN DO THIS.
THIS TEAM REALLY COMES TOGETHER BETWEEN
NEUROSURGERY AND THE PEOPLE WHO ARE INVOLVED DIRECTLY
IN TERMS OF HELPING US CONTROL THIS TUMOR BY TAKING IT OUT
WITH RADIATION ONCOLOGY, WITH OUR NURSE PRACTITIONERS,
OUR SOCIAL WORKERS, OUR ONCOLOGISTS WHO REALLY
ARE THE PEOPLE WHO START WITH THE PATIENT
AND PROVIDE THE LONGITUDINAL CARE ALL THE WAY THROUGH
THE ENTIRE TIME, THROUGH THE TIME
AT WHICH A PATIENT SAYS, "I'M DONE BECAUSE I'M OUT
10 YEARS AND I'VE NEVER SEEN MY TUMOR COME BACK
AND I'M READY TO GO TO COLLEGE."