Welcome to BIDMC Neurology

BIDMC – Neurology Fellowship: Neuro-Oncology

General Overview

The neuro-oncology division treats patients with primary brain and spinal tumors, metastases to the central nervous system, and neurologic complications that arise from treatments. The division consists of neuro-oncologists, neuro-oncology nursing specialists, clinical research staff members, resident or fellow, as well as basic and translational research staff members. The neuro-oncologists Drs. Eric T Wong and Erik Uhlmann evaluate and treat patients, as well as refer these patients to specialists in neurosurgery, radiation oncology and medical oncology for management of their disease. Established patients are also seen and provided with supportive care by our neuro-oncology nurse practitioners Loretta Barron, NP and Sandy Chikel, NP as well as our neuro-oncology nurse specialist Julianne Bloom, RN. A multidisciplinary brain tumor conference that takes place on Mondays serves to review the management of various patients with neuro-oncologic disorders. In this venue, expert inputs from neurosurgery, neuroradiology, radiation oncology, neuropathology, endocrinologist, nursing and research staffs provide valuable discussions on patient management. It is also an opportunity for teaching residents and fellows who are learning neuro-oncology.

Primary Brain and Spinal Tumors: Patients with a type of primary brain tumor called glioblastoma are routinely invited to participate in protocol treatments. These patients are treated with the latest drugs or device undergoing testing under the close monitoring in human clinical trials. For example, Beth Israel Deaconess Medical Center performed the critical basic science and clinical investigations that enabled the FDA approval of treatment called tumor treating electric fields for recurrent and newly diagnosed glioblastoma. As a result, our institution has the most experience with this device. We are still improving and refining this modality of treatment at the present time by continuing investigations in both clinical and laboratory domains.

Patients with primary central nervous system lymphomas are treated with high-dose methotrexate with and without the combination of rituximab. About two-thirds of patients can achieve a complete response and led productive lives. One of them, Tom DesFosses, even helped organized a yearly bikathon for fund raising to enhance brain tumor and cancer research at Beth Israel Deaconess Medical Center.

Metastatic Tumors to the Central Nervous System: This category of tumors includes various types of metastases from systemic malignancies, including brain metastases, leptomeningeal metastases, and spinal epidural metastases. Treatment may consist of a combination of surgery, radiation or chemotherapy. Frameless sterotactic radiosurgery is the latest modality of radiation that delivers precisely targeted treatments to brain and vertebral metastases.

Side Effects from Treatments: Side effects from radiation and chemotherapy are common in the population of patients with neurologic tumors. This is due to the low tolerance of nervous tissues from radiation and cytotoxic chemotherapies. As a result various subtle manifestations of brain dysfunction, such as communicating hydrocephalus, radiation-induced encephalopathy, and radiation-induced myelopathy or neuropathy, can cause significant disability in patient. There are medications and procedures that can help to reverse the neurologic signs and symptoms.

Clinical Research: Therapeutic clinical research is an integral part of treatment for neurologic malignancies. Our research nurse Mary Ellen Bowers and clinical research assistants Janlyn Murphy and Foti Andreo help lead some of the most innovative treatments at Beth Israel Deaconess Medical Center for our patients with primary and metastatic brain tumors. For example, immunotherapies that restore our patient’s own immune capabilities to attack tumor cells are regularly being tested. These immunotherapies come in various forms, including tumor cell-derived personalized vaccines, peptide-based vaccines, monoclonal antibodies, small molecule modulators of the immune system, that are being tested here. In addition, tumor treating electric fields are being tested in metastatic tumors, as well as combinations with immune therapies and conventional chemotherapies.

Basic and Translational Research: The basic and translational efforts at Beth Israel Deaconess Medical Center are directed at three fronts. First, Dr. Kenneth Swanson is spearheading the cell biology research of tumor treating fields on dividing tumor cells. He led the discovery of the electric field effect on a protein Septin, which has an extremely large dipole moment, and it is critical for the proper separation of the dividing cell’s cytoplasm into two daughter cells (Gera N, et al PLoS One 2015;10(5):e0125269). This results in a number of downstream effects on cancer cells including apoptosis, aberrant mitosis, and eventual immunogenic cell death. Second, Dr. Erno Sajo and Edwin Lok from the University of Massachusetts in Lowell are studying electric field mapping by using computational methods to precisely map the electric field distribution inside the brain (Lok E, et al. Exper Rev Med Devices 2015;12:717-726; Wong ET, et al. Curr Treat Options Oncol 2015;16:40). This effort will undoubtedly improve our understanding of the electric field effect on tumors within the brain.

Drs. Eric T Wong and Erik Uhlmann are also leading translational efforts to identify markers for brain tumors. Dr. Wong uses patients’ cerebrospinal fluids to look for biomarkers to help determine precisely the biological state of various types of brain tumors. He and his team uses various techniques, including antibody-based multiplex ELISA, metabolites based metabolomic profiling and DNA/RNA-based exosomes (Lok E, et al. Melanoma Res 2014;24:120-130; Locasale JW, et al. Mol Cell Proteomics 2012;11:M111.014688; Chen WW, et al. Mol Ther Nucleic Acids 2013;2:e109). Dr. Erik Uhlmann is pursuing basic research on non-coding RNA to develop new microRNA-based treatments for malignant glioma and meningioma.

Teaching in Neuro-Oncology:  Teaching is an integral part of the neuro-oncology division. Neurology residents are welcome to join the multidisciplinary brain tumor conference on Mondays. Residents are welcome to bring difficult cases to discuss management and treatment issues. In addition, didactic teaching is offered to neurology resident once per month in resident teaching sessions. In these didactic sessions, the neuro-oncology attending physicians go over cases that contain various teaching elements so that residents can function more effectively when managing patients with cancer in the emergency room and on the wards. More importantly, residents who may want to learn more about neuro-oncology may elect to rotate in the brain tumor or neurology clinics with a specific attending.

Beth Israel Deaconess Medical Center is also accredited by the United Council of Neurologic Specialties to offer a two-year fellowship in neuro-oncology.

Fellowship:

Trainees in neurology residency programs are invited to apply one year before the starting date, which is typically July 1. During the first year, fellows undergo intensive training in managing patients with active neuro-oncologic disorders and working closely with an attending neuro-oncologist or other specialists. Rotations in neurosurgery, radiation oncology, neuropathology, neuroradiology, medical oncology, pediatric neuro-oncology and palliative care are interspersed within the fellowship period. The second year is devoted to research, in either the clinical or basic science domains, while the fellow follows his or her patients in the outpatient clinics or in-patient wards while providing neuro-oncology coverage for the medical center.

Interested candidates should contact:

Ms. Deborha Cooper by email at dcooper@bidmc.harvard.edu or by regular mail at Brain Tumor Center, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 (Tel: 617-667-1665).