It has been a difficult year for Elena Marcu, who learned in February after two biopsies that she had Stage 4 glioblastoma, the most common form of brain cancer.
As part of a clinical trial, Ms. Marcu has received five cancer treatments with an approach known as "microbubble-enhanced ultrasound."
It involves using tiny air bubbles that act as a contrast agent to enhance visibility being injected into a patient's bloodstream where they then circulate to the brain. When ultrasound waves are applied to the brain, the microbubbles absorb the energy and cause cells in the blood-brain barrier - a gatekeeper to the brain - to pull apart. A temporary window is then created for therapeutics to enter the brain.
Ms. Marcu's most recent cancer treatment took place last week; the next one is scheduled for Dec. 17. Now she and her daughter Cristina Marcu are drawing some hope from findings in a newly released study in the Lancet Oncology. It shows, for the first time, use of microbubble-enhanced ultrasound could help patients live longer.
Cristina said they are encouraged the findings could mean "we will have more time."
The Lancet findings were released on Monday, a decade after researchers at Sunnybrook Health Sciences Centre used microbubble-enhanced ultrasound to open the blood-brain barrier for the first time in history.
Nir Lipsman, a neurosurgeon at Sunnybrook who has championed the use of the technology, said the brain exists in a privileged space in the body. He said it is protected by a physical barrier that wraps around fine blood vessels of the brain, like cling wrap.
This is positive because it is important to protect the brain from large compounds, such as environmental toxins, said Dr. Lipsman, a senior investigator for the multisite clinical trial published in the Lancet.
But, he explained, it is a double-edged sword. The barrier also prevents treatments from entering the brain, which makes brain cancer and neurodegenerative diseases such as Parkinson's and Alzheimer's difficult to address.
Sunnybrook researchers say the medication temozolomide is a standard chemotherapy drug used to treat glioblastoma, but studies show less than 20 per cent reaches patients' brains.
Overcoming the blood-brain barrier has been a goal of clinicians and scientists for many decades, Dr. Lipsman added.
The use of microbubbles and a focused ultrasound opens the blood-brain barrier temporarily and allows for therapeutics to be administered, Dr. Lipsman said. The barrier then closes back up.
He said there have been significant advances to better understand glioblastoma, but there have not been meaningful improvements to survival rates.
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Many Canadians became more acquainted with how aggressive glioblastoma is when Tragically Hip front man Gord Downie shared his medical journey with the brain cancer before he died at 53 in 2017.
The new findings published in the Lancet involved a trial of 34 patients who received repeated microbubble-enhanced focused ultrasound treatments to open the blood-brain barrier before standard chemotherapy was administered (infusions of temozolomide).
Participants were matched to a selected control group of 185 glioblastoma patients in Boston with similar characteristics who received temozolomide without microbubble-enhanced ultrasound.
Results showed that trial participants, on average, lived 31 months compared with 19 months in the control group. It also said at the median follow-up, 44 months, that 40 per cent of patients were still alive.
"For us, it's the culmination of, I wouldn't hesitate to say, decades of work where we've long believed and thought that we can use ultrasound enhanced blood-barrier opening to safely and effectively deliver therapeutics," Dr. Lipsman said.
"What we've been searching for is, yes, evidence of safety and that we can do this. But also evidence that we can make a meaningful difference, potentially, in the illnesses that we're trying to treat."
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Ms. Marcu's tumour is about 2.6 centimetres by 1.4 centimetres large. If it is unable to shrink, the goal is to ensure its size remains the same, Cristina said.
Ms. Marcu said she is also open to participating in other clinical trials.
Trials, according to Dr. Lipsman, are engines of discovery and innovation and require funding and infrastructure to move ahead as safely and judiciously as possible.
"This is the mechanism that we have as a medical community to take treatments, from ideas to the bedside, from a concept to making a difference in patient's lives," he said.