The brain tumors Albert H. Kim, MD, PhD, sees are often the
most difficult to treat. As a physician-scientist, he attacks them on
two fronts – the operating room and the laboratory.
Dr. Kim is the newest member of
the Washington University School of Medicine Department of Neurological
Surgery. As a skull base and oncologic neurosurgeon, he often operates
on tumors located deep in hard-to-access parts of the brain.
“Malignancies are always bad,” he says.
“But with brain tumors, it’s as much about location as it is about
being benign or malignant since the brain controls so much of what we
do, controls so much of who we are.”
Advances in technology have made the
surgery safer and more precise, says Dr. Kim. These include stereotactic
guidance systems that act like GPS to guide surgeons through the
brain, and surgical suites equipped with MRI machines which allow
surgeons to make images during a procedure to make sure the maximum
amount of tumor is removed without damaging brain tissue.
Additionally, advances in mapping brain function, spearheaded here by
neurosurgeons, have made tumor surgery safer.
Still, these procedures are often risky and are notoriously grueling for both the surgical team and the patient.
“But it’s important to emphasize that
surgery is just one component of the whole problem,” Dr. Kim says.
“[Brain tumor] is not just a surgery problem. It’s a medical oncology
problem. It’s a radiation oncology problem. Also, often these patients
have other pre-operative conditions that require the help of other
smart people - internists and cardiologists, for instance - to make
sure they can withstand the treatment.”
Despite the technological and treatment advances, however, many brain cancers are, essentially, not curable, he says.
Glioblastoma multiforme, for instance,
is the most common and most aggressive of malignant brain tumors.
Because the tumor’s borders are very indistinct, it’s difficult, if not
impossible, for surgeons to remove every bit of it without damaging
surrounding brain tissue.
“Cancer generally is just a very
difficult, complex problem,” Dr. Kim says. “Of course a [brain tumor]
cure would be great. But there are a lot of things we need to know, a
lot of things we need to examine, a lot of things we need to test to
cure brain tumors. An equally good goal perhaps would be to control
these tumors.”
Turning brain tumors into a manageable,
chronic disease by using currently available technologies, and then
developing a drug to prevent regrowth or spread of the cancer cells
“would be a great achievement,” he says.
And so, Dr. Kim approaches the problem on a molecular level in his lab.
“My focus in the past has been on
development of the brain,” he said. “I want to take advantage of what we
know about how the brain develops to confront malignant tumors of the
brain.
For instance, by studying the biology of
glioblastoma - “the worst player in the spectrum of tumors called
gliomas” - he and other scientists hope to discover a window of
susceptibility that will let them control the tumor and “make a real
impact for these patients,” he says.
Dr. Kim trained in neurosurgery at
Harvard Medical Center’s Brigham and Women’s Hospital, followed with a
fellowship in skull base and cerebrovascular surgery at the University
of Miami’s Jackson Memorial Hospital.
He was drawn to Washington University,
he says, because of the Department of Neurosurgery’s long history of
expertise in treating difficult tumors and “high density” of
physician-scientists. Also, the resources and staff of Barnes-Jewish
Hospital and the Siteman Cancer Center offer a full spectrum of care and
support for patients and their families.
Dr. Kim looks forward to working in both
the operating room and lab during the next few years. Increased
funding and renewed interest in advancing understanding of the brain
and treatment of brain tumors will lead to significant advances, he
feels.
“As devastating a group of diseases as this is,” says Dr. Kim, “this is an exciting time. It’s a time of hope.”
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