A New Way to Diagnose Glioma Brain Tumors
Pathology is a field that’s rapidly evolving, in parallel with advances in precision medicine and a trend toward sub-specialization. Daniel Brat, MD, PhD, a neuropathologist who has spent nearly two decades studying diffuse gliomas, is spearheading this evolution within the arena of brain tumor diagnostics while straddling the line between scientific investigation and the practice of medicine.
Daniel Brat, MD, PhD, is a neuropathologist and scientist who has spent nearly two decades studying diffuse gliomas — the most common type of brain tumor — and the mechanisms that drive their progression. His basic and translational research has led to a number of breakthrough findings, including the identification of a novel way of classifying gliomas based on their genetic makeup. His work has had an enormous impact in the field of diffused gliomas, the most common type of primary brain tumor that affects both adults and children.
Daniel Brat: “Diffuse gliomas are a family of primary brain tumors, and they're characterized by a neoplastic glial cells. So cancerous glial cells, which are basically normally the glue of the brain, glial means glue. For whatever reason, these cells become transformed and infiltrate the brain individually as malignant glioma cells. They come in a large number of types based on the way they look under the microscope and by the molecular makeup and, based on those features, they behave very differently. "
The one thing these tumors have in common is that they can't be completely respected by a neurosurgeon, so there's always residual tumor left in after the operation. This leads to recurrence of the disease and, in spite of being treated by radiation therapy and chemotherapy, is ultimately fatal.
Daniel Brat: "But the life expectancy ranges from six months to over 20 years, and the responsiveness of these diseases to chemotherapy and radiation therapy also varies tremendously based on their molecular makeup. So they are a devastating group of diseases. I think most people are aware that John McCain, for example, has a diffuse glioma, the highest-grade form Glioblastoma. Ted Kennedy had a Glioblastoma, which is in this family, and Bo Biden, Joe Biden's son also had a Glioblastoma. So, these tumors aren't that common, we pay a lot more attention to them when they occur and famous people, but the unfortunate fact is that there's about 15,000 of these types of tumors that occur in the U.S. every year and almost all of them are ultimately fatal."
In the past five years, there has been a very large shift in our understanding of the diffuse gliomas, and it is one of the diseases that has been almost completely redefined based on the genetic makeup of the classes. Brat was a lead on an investigation by the Cancer Genome Atlas Project, which was a very large, multi-institutional, international study of specific forms of cancer. They determined that these diseases were better classified by their molecular makeup, then by the way they looked under the microscope.
Daniel Brat: “It completely shifted the way we make diagnoses. In fact, based on our findings, we determined that these tumors could really be classified by a relatively small number of molecular markers that would define diseases, and those new diseases and their definitions were incorporated into the World Health Organization classification of brain tumors ... that was a big step for the World Health Organization to take.”
Read more about Brat's contribution to changing how to classify gliomas based on their genetic makeup, published in the New England Journal of Medicine in 2015.
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Academic/Research, Multiple specialties
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Credit Designation Statement
The Northwestern University Feinberg School of Medicine designates this Enduring Material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Daniel Brat, MD, PhD, has nothing to disclose. Course director, Robert Rosa, MD, has nothing to disclose. Planning committee member, Erin Spain, has nothing to disclose. Feinberg School of Medicine's CME Leadership and Staff have nothing to disclose: Clara J. Schroedl, MD, Medical Director of CME, Sheryl Corey, Manager of CME, Jennifer Banys, Senior Program Administrator, Allison McCollum, Senior Program Coordinator, and Rhea Alexis Banks, Administrative Assistant 2.