As brain tumors grow, they face a critical decision: to push against the brain or to extend finger-like projections that invade and destroy surrounding tissue. This dichotomy in growth patterns is not just a biological curiosity but a potential key to improving patient care strategies.
Previous research has highlighted that tumors exerting mechanical force on the brain cause more neurological dysfunction than those that primarily destroy tissue. Now, a collaborative team from the University of Notre Dame, Harvard Medical School/Massachusetts General Hospital, and Boston University has unveiled a groundbreaking technique to measure a tumor’s mechanical force, alongside a model to estimate the extent of brain tissue loss. Published in Clinical Cancer Research, this study could significantly influence surgical and post-surgical patient care.
Understanding Tumor Mechanics
The research team, led by Meenal Datta, assistant professor of aerospace and mechanical engineering at Notre Dame, has introduced a method that integrates seamlessly into neurosurgical procedures. “During brain tumor removal surgery, neurosurgeons take a slice of the tumor, put it on a slide, and send it to a pathologist in real-time to confirm what type of tumor it is,” explained Datta. “By adding a two-minute step to a surgeon’s procedure, we were able to distinguish between a glioblastoma tumor versus a metastatic tumor based on mechanical force alone.”
Datta and her colleagues collected data from 30 patients, utilizing preoperative MRIs and craniotomies with Brainlab neuronavigation technology. This technology offers real-time, 3D visualization during surgeries, allowing surgeons to measure the bulge caused by brain swelling from the tumor’s mechanical forces before resection.
Mechanical Force and Its Implications
The study’s findings reveal that when a tumor exerts more mechanical force, the resulting brain swelling is more pronounced. Conversely, tumors that invade and replace tissue cause less swelling. This distinction is crucial for tailoring patient care strategies, as it provides insights into the tumor’s behavior and potential impact on the brain.
The researchers developed computational models using a point system of measurements and biomechanical modeling. These models can help doctors quantify a patient’s brain bulge, assess the mechanical force exerted by the tumor, and estimate the amount of brain tissue lost.
“Knowing the mechanical force of a tumor can be useful to a clinician because it could inform patient strategies to alleviate symptoms,” said Datta. “We’re hoping this measurement becomes even more relevant and that it can help predict outcomes of chemotherapy and immunotherapy.”
Broader Applications and Future Research
To further explore the implications of mechanical force, the research team conducted animal modeling on three different brain tumors: breast cancer metastasis to the brain, glioblastoma, and childhood ependymoma. In the case of breast cancer metastasis, the team observed that a reduction in mechanical force preceded visible changes in tumor size during chemotherapy treatment.
“In this model, we showed that mechanical force is a more sensitive readout of chemotherapy response than tumor size,” Datta noted. “Mechanics are sort of disease-agnostic in that they can matter regardless of what tumor you are looking at.”
This discovery suggests that mechanical force measurements could serve as an early indicator of treatment efficacy, potentially guiding adjustments in therapeutic approaches.
Collaborative Efforts and Future Directions
The study was funded by prestigious institutions including the National Institutes of Health and the National Science Foundation. Co-lead authors Hadi T. Nia at Boston University, Ashwin S. Kumar at Massachusetts General Hospital and Harvard Medical School, and Saeed Siri at Notre Dame, along with other collaborators, contributed to this pioneering research.
Datta, who is affiliated with several research institutes at Notre Dame, hopes that the models developed in this study will continue to enhance the understanding of mechanical forces in tumor growth and their implications for patient care.
As the medical community continues to explore the role of tumor mechanics, this study represents a significant step forward in the quest to improve outcomes for patients with brain tumors. The integration of mechanical force measurements into routine clinical practice could revolutionize how neurosurgeons and oncologists tailor treatment strategies, ultimately leading to more personalized and effective care.
