Our hospital is using a new brain tumor treatment system called "Optune."^Ⓡ" (Alternating Current Electric Field Tumor Treatment System) can be prescribed.

To all medical institutions

We would like to express our sincere gratitude to our registered physicians and local doctors for your ongoing support and understanding in our collaboration with our hospital. We would like to introduce the new brain tumor treatment system, "^OptuneⓇ" (alternating current electric field tumor treatment system), which is now available for prescription at our hospital.

Our approach to brain tumors

Diseases handled by the Cerebrovascular Center (Cerebrovascular / Neurology, Neurosurgery, Neuroendovascular Therapy) include stroke (cerebral infarction / cerebral hemorrhage / subarachnoid hemorrhage), trauma, functional diseases (facial spasm, trigeminal neuralgia, etc.), degeneration. It covers a wide range of diseases (Parkinson's disease, etc.). At the Tobu Hospital we treat patients mainly in the hyperacute stage of stroke and severe head injuries in cooperation with the ER / emergency department. On the other hand, Neurosurgery actively accepts and treats diseases such as brain tumors.

In general, "brain tumor" is a general term for tumors that occur in the head, and actually includes various tumors. From the viewpoint of tumor development, (1) brain parenchymal tumor (tumorized brain tissue itself), (2) peri-brain tissue-derived tumor (tumorized surrounding tissue such as medulla and bone), (3) metastatic brain tumor It can be divided into (metastasis of malignant tumors of other organs), and each is further classified into pathological (histological) malignancy (beneficial / malignant tumor) and congenital / acquired. The actual treatment is to make a treatment plan by preoperatively diagnosing the target tumor from image diagnosis by CT / MRI, test results such as tumor markers, and functional tests. Treatment is a combination of Surgery treatment (tumor removal), chemotherapy, and radiation therapy. The tumor is reduced by surgery to reduce the burden on the brain parenchyma, and the treatment plan including post-treatment is appropriately modified based on the pathological diagnosis.

A major difference between brain tumor treatment and other organs is that the types of chemotherapy that are effective are very limited due to the presence of the blood-brain barrier. Therefore, the weight of surgical treatment and radiation therapy is very high in this area. In the past, tumor removal and irradiation were often performed to the maximum extent possible, but in recent years, the policy has been to remove and irradiate as much of the tumor as possible without worsening neurological function. At our hospital, we treat almost all brain tumors, including primary malignant brain tumors such as glioblastoma, metastatic brain​ ​tumors from lung cancer and digestive cancer, and benign tumors such as meningiomas and acoustic neuromas, through safe and reliable surgery that aims to preserve neurological function using neuronavigation, neuromonitoring, and intraoperative fluorescence diagnosis, chemotherapy, and radiation therapy that aims to protect the nerves using intensity modulated radiation therapy (IMRT) and stereotactic radiation therapy (Cyberknife).

Glioblastoma

Although we provide effective brain tumor treatment using the above-mentioned treatment techniques and equipment, there are some diseases for which the current standard treatment does not provide sufficient therapeutic effects. A representative example is glioblastoma, the most malignant brain parenchymal tumor. Standard treatment is craniotomy, tumor removal, and post-treatment (about 6 weeks) with chemotherapy (temozolomide) and radiation therapy (whole brain irradiation). After that, chemotherapy (temozolomide, called Stupp regimen) is performed approximately every 4 weeks, and any treatments are added as necessary. However, although it has been extended from before, the average survival time from onset is still only 15months, making it a highly malignant disease with an extremely poor prognosis. Moreover, although about 10 years have passed since the above standard treatment was proposed, there are currently no chemotherapy or immunotherapy that has shown further effectiveness. Gene therapy using viruses and cells (HSVtk, yCD, Toca 511, etc.) is promising in animal experiments, but it is thought that it will take some time before it can be put into practical use.

TTFieldsTherapy (Tumor Treating Electric Field Therapy)

Under such circumstances, an electric field-based treatment method developed by an Israeli doctor has emerged. An electric field is not a current or magnetism, but a force field around electricity, which is like gravity. ^Optune® (Fig. 1) generates a low-intensity AC electric field called Tumor Treating Fields (TT field for short) in the brain by attaching an adhesive sheet with a ceramic plate called an array to the head (Tumor Treating Fields (TT field for short)). Figure 2). The force of this electric field affects the microtubules in rapidly growing tumor cells, inhibits cell division, and acts to kill the tumor cells (Fig. 3). The electric field affects rapidly dividing tumor cells, but has little effect on slowly dividing normal cells.

Figure 1) Optune Ⓡ

Figure 2) Generate a TT field in the array of heads

Fig. 3) Tumor-killing effect of TT field

​^Optune® is a non-invasive, localized treatment that targets only tumor cells, and does not increase the systemic side effects of chemotherapy, such as nausea, loss of appetite, and reduced blood cell counts.

In fact, in a clinical trial (EF-14 trial) conducted overseas targeting newly diagnosed glioblastoma following surgery and chemotherapy with radiation, Optune^Ⓡand temozolomide chemotherapy combination group The two-year and five-year survival rates of the ... 13%, 5%) (Figure 4). Optune^Ⓡ The combination of these drugs slows the growth of tumor cells and the time to recurrence, and is currently the only additional treatment for glioblastoma that has surpassed the results of standard treatment. ^Ⓡ (NCCN ^Ⓡ)'s treatment guidelines for glioblastoma list Optune + temozolomide therapy as a category 1 recommendation.

Figure 4) High survival rate of blue graph (optune + temozolomide therapy)

What is Tumor Treatment Electric Field Therapy?

When to Start Tumor Treating Field Therapy

In the case of initial glioblastoma (also known as glioblastoma, a malignant brain tumor that occurs in the brain), the standard treatment is to remove the tumor by surgery as much as possible, followed by radiation therapy combined with temozolomide after surgery, and then maintenance chemotherapy with temozolomide. Tumor treatment field therapy begins at the same time as starting maintenance chemotherapy with temozolomide (covered by insurance).

In the case of recurrent glioblastoma, surgery, radiation therapy, chemotherapy, etc. are performed if possible, and then treatment with tumor treatment electrofield therapy is started. However, it is not covered by insurance and is free medical treatment.

What is tumor treatment electric field therapy?

​Apply four electrode pads, called arrays, to a cleanly shaved scalp.

It is a treatment method that delays or stops the division of tumor cells by connecting the array and the main body and applying an electric field to the tumor cells in the brain through the array.

Unlike medicines, the treatment is effective only while the power is on, so continuous treatment as much as possible is recommended (use is recommended for an average of 18 hours or more per day).​

When the hair grows, there is a space between the array and the scalp, which acts as a resistance and the array does not function properly, so it is necessary to carefully shave and replace the hair each time the array is replaced. There are individual differences, but they can exchange about twice a week. It is difficult to replace the array by yourself, so we need the support of Registered Nurse Please refer to the video below for an overview of the treatment.

What support system do you have during treatment?

A Device Support Specialist (DSS) is available 24 hours a day to assist with the use of your device, answer questions about the device, view device logs of how many hours of therapy you have performed, and provide that information to your physician.

How can I live my daily life while undergoing treatment?

Treatment is done at home. You can do daily work and housework while treating, and enjoy going out and traveling.

During treatment, the hair is carefully shaved and an electrode pad called an array is attached, but it is possible to wear a wig or hat.

You can board an airplane and travel with the array still attached, so you can even go on trips.

Adverse events requiring attention

In clinical trials conducted overseas, there was no fact that tumor treatment electric field therapy increased the side effects of temozolomide. Chemotherapy can affect normal cells throughout the body because the drug is distributed throughout the body through the bloodstream, whereas tumor therapy electric field therapy is a topical treatment that targets the tumor and does not affect the brain or normal cells throughout the body. Hmm.

It is a topical treatment that targets tumors and does not affect normal cells in the brain or throughout the body.	Drugs such as chemotherapy are distributed throughout the body through the bloodstream and can affect normal cells throughout the body.

• Tumor Treatment The main side effect of electric field therapy is skin inflammation at the site of the array. In clinical trials, about half reported skin disorders, but all symptoms were mild to moderate and could be addressed by topical treatment or temporary discontinuation of treatment. ..
• In rare cases, headaches, weakness, falls, fatigue, muscle spasms, and skin ulcers may occur.

Source: Provided by Novocure Co., Ltd.