Letter From the Director
More than one million Americans are diagnosed with cancer each year. Nearly 25% of these individuals will develop metastatic brain tumors during the course of their illnesses. Though the number of patients with primary brain tumors is smaller, there is evidence that the incidence of these kinds of brain tumors is rising.
Cleveland Clinic’s Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center serves patients from across the country and around the world. Our specialists, working in partnership with specialists from the Taussig Cancer Institute, offer a full range of advanced treatment options for adults and children with spinal cord and brain tumors, including surgery, chemotherapy, radiotherapy and radiosurgery, and innovative brain tumor clinical trials.
Rose Ella Burkhardt Brain Tumor Center physicians, surgeons, nurses and researchers work as a team, dedicating their lives to treating people with brain tumors. Our researchers are on the cutting edge to determine the mechanisms by which brain tumors occur and the best way to treat them with a minimum of side effects. Our staff physicians are not satisfied with current treatment options available for their patients; most malignant brain tumors cannot be cured. Physicians not only strive to find and use the best combination of current treatments for each patient, but, in collaboration with our researchers, they are actively developing new treatments.
The goal is give our patients hope for improved quality of life through the treatment of brain tumors, while moving forward toward a cure. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center is a fine combination of research and clinical care: a team working together to offer the best science and technology can offer for brain tumors, one patient at a time.
In 2010 Cleveland Clinic's Brain Tumor and Neuro-Oncology Center was renamed in honor of Rose Ella Burkhardt, who was a strong proponent of advancing the research and treatment of patients affected by brain tumors.
Gene Barnett, MD, MBA, FACS
Director, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center
View a summary of our treatment success rates, including data on patient volume.
What We Treat
Brain tumors can be diagnosed using computer technology that images the brain. Computerized tomography (CT) uses a computer and X-rays to make a 2-D axial image of the brain. Magnetic resonance imaging (MRI) creates a brain and brain tumor image using magnetic fields and radio waves. Magnetic resonance spectroscopy (MRS) shows the chemical composition of the brain. Other imaging techniques that may be used to assist in the diagnosis and treatment of a tumor include functional magnetic resonance imaging (fMRI), digital subtraction angiography (DSA), magnetic resonance angiography (MRA), positron emission tomography (PET), and single photon electron computerized tomography (SPECT).
In addition to their usefulness at the time of initial diagnosis, these technologies may also allow early detection of a brain tumor recurrence, which facilitates earlier treatment.
Most patients with a brain tumor undergo a biopsy, the surgical removal of a tissue sample from the tumor, either alone or as part of the surgical removal of a tumor. A neuropathologist examines the sample under a microscope to confirm the diagnosis, classify the tumor more specifically by the type of cells it contains, determine how abnormal the tumor cells are (histologic grade) and determine how quickly it is growing. The subtle but critical differences in cells that the pathologist detects under the microscope are crucial in making the correct diagnosis, which is used in determining further testing and appropriate brain tumor treatment for each patient. Today, the microscopic examination of some tumors may be extended by testing for changes in certain chromosomes and the presence or absence of certain molecules in the tumor cells, which can influence treatment.
- CT imaging of the brain and spine
- MR imaging of the brain and spine including MR perfusion and CSF flow and CSF leak studies
- Functional MR imaging
- Diffusion Tensor imaging
- MR spectroscopy
- Lumbar puncture
- Blood patch
- Image-guided percutaneous biopsy
- Diagnostic Angiography
- Interventional Angiography (stenting,embolization, thrombolysis, petrosal sinus sampling)
- Carotid Ultrasound
- Transcranial Doppler
- PET, CT and PET MR imaging
- Bone Scan and other Nuclear Medicine examinations
List of Treatments
- Brain Surgery
- Gamma Knife
- Personalized Medicine
- Radiation Necrosis Clinic
- Stereotactic Spinal Radiosurgery
List of Tumors
A brain tumor is any mass or growth of abnormal cells occurring in the brain tissue, skull, supportive tissue around the brain, cranial nerves, or the pituitary or pineal gland.
Brain tumors are classified as primary or secondary. Primary brain tumors develop from brain tissue or the areas surrounding the brain. Secondary, or metastatic, brain tumors are tumors that form from cancer cells that start in another part of the body, such as the breast or lung, and travel to the brain, usually by way of the bloodstream. Secondary brain tumors are more common than primary brain tumors.
Many experts believe that a brain tumor occurs when certain genes on the chromosomes of a cell become damaged and can no longer function properly. These genes normally regulate how often the cell divides (or if it divides at all) and repair genes that become defective. Among the genes they repair are those that tell a damaged cell that cannot repair itself to self-destruct.
Some people may be born with partial defects in one or more of these genes and environmental factors may lead to further damage. In other people, environmental factors may be the only cause of damage to the genes.
To learn more about the types of tumors we treat, please refer to the list below. The goal is to improve the treatment of these brain tumors, while moving forward toward a cure. The Rose Ella Burkhardt Brain Tumor Center is a fine combination of research and clinical care: a team working together to offer the best science and technology can offer for brain tumors, one patient at a time.
- Metastic Tumors
- Pediatric Tumors
- Pituitary Tumors
- Gliomas Tumors
- Glioblastoma Tumors
- Lymphomas Tumors
- Skull Base Tumors
- Spinal Tumors
In addition to conventional treatments, the Rose Ella Burkhardt Brain Tumor Center also offers innovative, investigational brain tumor treatment such as:
- small molecule therapies
- growth modifier treatment
- convection enhanced delivery of immunotoxins treatment
As research continues to enhance our understanding of the molecular makeup of tumors, small molecule drugs that target specific molecular pathways in tumors will play an increasingly important role in brain tumor treatment. The introduction of these small molecule therapies and the routine use of molecular and chromosomal testing helps to guide individual patient management. This approach to patient care puts the Rose Ella Burkhardt Brain Tumor Center at the forefront of individualized care and molecular management of brain and spine cancer.
If you or a loved one are being treated for a brain tumor, you may notice some difficulty with cognitive function during treatment. Whether those changes are subtle or are having a dramatic impact on your day-to-day life, you are not alone.
Cognitive symptoms are one of the most common problems that brain tumor patients experience. More than 90 percent of all people are affected at some point during their treatment. That is why Cleveland Clinic has integrated neuropsychology services into the care we offer at the Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center.
At Cleveland Clinic, our neuropsychology services can screen patients at the time of brain tumor diagnosis and again at regular intervals during treatment. This approach helps us sort out many factors that can play a role in any resulting cognitive symptoms, including:
- The presence of the brain tumor itself
- Side effects of treatment (surgery, radiation, chemotherapy)
- Emotional stress
- Fatigue, anemia, metabolic syndrome
- Other co-existing conditions that may occur (dementia, stroke)
Once the underlying cause of the cognitive symptoms has been determined, our team can discuss the most effective treatment strategy. Options may include:
- Medications to enhance attention, memory or mood
- Rehabilitation or other therapy
- Ongoing cognitive monitoring
Studies show that neuropsychology plays a critical role in evaluating the effectiveness of brain tumor treatments. In some studies, cognitive data has been shown to be more sensitive in detecting tumor progression than MRI imaging.
Due to its proximity to healthy brain tissue, tumors sometimes affect the areas of the brain that control hearing loss, memory or speech difficulty, or cause trouble walking or moving. Patients have benefitted from rehabilitation services offered by the physicians and therapists in the Department of Physical Medicine and Rehabilitation.
To learn more visit:
Make an Appointment
For our patients' convenience, the Burkhardt Brain Tumor Center offers same day or next day appointments at Cleveland Clinic main campus. To make an appointment please call 216.636.5860 or toll free at 866.588.2264.
Clinical Trials information: toll-free 866.223.8100
Patient Assistance Programs
Programs called PAPs (Patient Assistance Programs) provide free or low-cost prescription medicine to low-income people who are uninsured or under-insured and meet the guidelines. Most medicines are provided by the pharmaceutical companies who manufacture the medicine.
NeedyMeds – NeedyMeds is a 501(3)(c) non-profit with the mission of helping people who cannot afford medicine or healthcare costs. The information at NeedyMeds is available anonymously and free of charge.
If you are interested in AutoLITT/NeuroBlate as a treatment option for you or someone you love, please contact us at our dedicated AutoLITT/NeuroBlate phone line to arrange a consultation with a Burkhardt Brain Tumor Center physician.
Please call us locally at 216.636.5392 or toll-free at 888.273.1409.
Refer a Patient
Members of the Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center are available for consultation 24 hours a day, seven days a week. Our team of doctors is able to see patients with diagnosed or suspected brain tumors within 24 - 48 hours.
Consultations and/or hospital admissions:
- Weekdays 8 a.m. - 5 p.m.
Locally at 216.445.8971
Toll-free 800.556.5056, ext. 58971
- Nights & Weekends
- When calling for adult patients, please ask to speak with neuro-oncology staff or the chief neurosurgical or neurological resident on call.
- For pediatric patients, please ask to speak with the chief pediatric neurological resident on call.
Research & Clinical Trials
Brain Tumor Research
Advancing the care of brain tumor patients begins with a better understanding of the causes and mechanisms of tumor development. Basic science research efforts at the Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center are focused on identifying the genetic, cellular, and molecular biology of malignant and benign brain tumors, investigating the mechanisms of tumor formation. This enhanced understanding of tumor biology can lead to new therapeutic developments of brain tumor treatment.
The novel treatment strategies being investigated at Burkhardt Brain Tumor Center involve immunotherapy, targeting angiogenesis or using targeted therapies to attack the dysregulated or altered genetic changes that occur in tumor cells. Immunotherapy is a form of treatment that harnesses a person's immune system to fight diseases like cancer.
One example of the promising research being conducted by the Burkhardt Brain Tumor Center researchers and physicians involves further investigation of the process of apoptosis, or programmed cell death, as it presents in brain tumor cells.
Normally, when a cell acquires DNA damage that it cannot repair properly, the cell should eliminate itself through the process of apoptosis. Tumors result, in part, when genetic mutations occur and the apoptosis mechanism fails to eliminate the cell. Institute researchers are studying the mechanisms by which brain tumor cells have eliminated their ability to undergo apoptosis.
Cleveland Clinic researchers are also working to identify genes that could serve as molecular diagnostic and/or prognostic indicators, or potential therapeutic targets for glioblastoma and other gliomas. By enhancing the detailed understanding of the structure of tumor cells and the mechanisms that control their growth, researchers are striving to identify therapeutic agents that show the greatest promise to address individual tumor types, such as glioblastoma.
This research is coordinated through the Burkhardt Brain Tumor Center and the Lerner Research Institute and includes efforts in the Departments of Molecular Biology, Cancer Biology, Neuroscience and the Center for Surgical Research.
The goal of the Center for Translational Therapeutics is to perform pre-clinical testing of the most promising anti-cancer agents. One goal is to accelerate the lengthy and expensive process of testing new drugs targeted against brain tumors and to safely move them into clinical trials as quickly as possible, for the benefit of patients.
Physicians, researchers and scientists involved in this area work with both pharmaceutical companies and other medical institutions to identify, obtain and test new compounds. The Burkhardt Brain Tumor Center's multi-million dollar efforts, including an international search for all potential brain tumor-relevant therapies, have yielded several promising agents for testing.
Testing of new agents involves evaluating the toxicity and efficacy of these compounds in the laboratory and in animals that have brain tumors. In addition, we are also investigating the optimal route of delivery of these drugs.
Because many new therapeutic agents cannot penetrate the central nervous system, researchers are exploring alternative delivery methods. In addition to investigating the efficacy of oral delivery, researchers evaluate the efficacy of the agents when delivered intracerebrally-directly into the brain-via a specialized neurosurgical technique called convection enhanced delivery (CED).
The staff is focused on translating these pre-clinical results into Phase I and II clinical trials - giving the brain tumor patient more therapeutic treatment options by broadening the horizon of potential tools we may use to manage this deadly disease.
Our Center for Translational Therapeutics has started research projects with a number of pharmaceutical and biotechnology companies, ranging in size from small startup firms to some of the largest publicly traded companies. What these companies have in common are novel drugs that are close to or in clinical trial and which are rationally designed to be effective against malignant gliomas given the molecular and genetic makeup of these tumors.
Brain tumor clinical trials are designed to identify treatments that are potentially more effective and/or have fewer side effects than standard brain tumor treatments. Clinical trials are recommended for patients with tumors where results of treatment are generally poor, or that are considered incurable with conventional treatment. Clinical trials also are recommended for most pediatric patients with brain tumors.
Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center patients have access to numerous brain tumor clinical trials, many designed by Cleveland Clinic physicians, others as a part of multi-center trials in partnership with pharmaceutical companies or research consortia to further the care of brain tumor patients. The Burkhardt Brain Tumor Center actively participates in several of these clinical trial groups, including:
- Adult Brain Tumor Consortium (ABTC)
- Southwest Oncology Group (SWOG)
- Brain Tumor Trials Collaborative (BTTC)
- NRG Oncology
- Ohio Clinical Trials Collaborative (OCTC)
- American College of Surgeons Oncology Group (AcoSOG)
- Children's Oncology Group (COG)
These associations contribute to the exciting environment of clinical trial research and development, discussion and the sharing of data that is so important to the dynamic evolution of the therapeutic protocols of tomorrow's brain tumor treatments.
The Medical therapy based clinical trials focus on immunotherapy, other approaches that target the DNA replication of the tumor as well as the blood supply of the tumor. Novel drugs that target the dysfunctional or altered genetic pathways are often an area of active investigation in these clinical trials.
Ongoing surgical clinical trials are investigating the effectiveness of new approaches of specially designed laser probe to heat and destroy brain tumors and efficacy of the agents when delivered intracerebrally-directly into the brain-via a specialized neurosurgical technique called convection enhanced delivery (CED).
The Cancer Answer Line: 866.CCF.8100 (866.223.8100)
For Medical Professionals
The Cleveland Clinic Foundation alumni represent a vital constituency of physicians and scientists throughout the world who reflect the institution's commitment to excellence. The Cleveland Clinic Foundation is committed to continue serving as a resource to its alumni in their post-residency years by providing access to information and programmatic support necessary to assure their professional growth and success. The goal of these efforts is to bolster the bond between the institution and its alumni and create an atmosphere that encourages a commitment among alumni to offer support for, and to participate in the life of the institution.
Please keep in contact!
We want to stay on top of significant changes in your life. Have you moved? Taken on a teaching position? Received an academic promotion or professional recognition? Decided to retire? Have an interesting hobby or avocation you'd like to share? Your former CCF colleagues really want to know what you are up to. Please keep us informed and send photos! firstname.lastname@example.org
National Medical Meeting Receptions
The Cleveland Clinic Foundation Alumni Association together with the Departments of Neurology and Neurosurgery are pleased to sponsor alumni gatherings at the following major national medical meetings and other special events. All local alumni, as well as those attending the meetings, are cordially invited to these Alumni gatherings along with their spouse/companion.
Have you been diagnosed with cancer?
You should and know the facts about brain metastases. Brain metastases are treatable, but early detection is critical. Know the signs.
Know The Facts - B is for Brain
More than one million Americans are diagnosed with cancer every year. Approximately one-quarter of these individuals will develop metastatic brain tumors during the course of their illness. If you or a loved one have cancer B-Aware of the symptoms of brain metastasis and the available treatment options.
What is primary cancer?
Cancer can form in any organ or tissue in the body. The original tumor that forms is considered the primary cancer or primary tumor.
What is metastasis and how does it happen?
Metastasis means secondary cancerous growth formed by the movement of cancerous cells from a primary growth located elsewhere in the body. Cancer cells can break away from a primary tumor and enter the body’s bloodstream. This is the way in which cancer cells spread to other parts of the body.
When cancer cells spread and form a new tumor in a different organ, the new tumor is called a metastatic tumor. The cells in the metastatic tumor come from the original tumor. This means, for example, that if breast cancer spreads to the brain the metastatic tumor in the brain consists of cancerous breast cells (not brain cells). In this example, the tumor in the brain is metastatic breast cancer and not brain cancer.
Are certain primary cancers more likely than others to result in a brain metastasis?
Recent studies indicate that the most common origins of brain metastasis are cancers of the lung, breast, skin, kidney and colon.
What Symptoms to Look For
Like with most cancer diagnosis, early detection is key. Know the symptoms and talk to your oncologist about any abnormal changes that you experience.
Metastatic brain tumors present with the same symptoms as a primary brain tumor. This can include:
- Vision changes such as double vision or partial blindness
- Headaches possibly with nausea
- Numbness or tingling in part of the body
- Paralysis or difficulty moving any part of the body
- Inability to walk
- Difficulties with balance and an increased incidence of falls
- Difficulty speaking, including slurring words or incoherent speech
- Problems with mental acuity such as not being able to read or tell time
- Seizure or convulsions
Though most of these symptoms are of gradual onset, severe episodes can also occur.
Treatment Options - What To Do
Just like with most cancers, early detection and diagnosis can improve treatment options and results. These options vary from patient to patient and primarily depend on location, type and extent of the disease.
What treatment options are available if I am diagnosed with a brain metastasis?
The good news is, just like many other cancers, a brain metastasis can be treated. Although radiation to the whole brain was the traditional treatment, today surgery and radiosurgery are often the treatment of choice – either alone or in combination with conventional radiation. Chemotherapy may also be used in selected cases.
Can I treat my primary tumor brain metastasis simultaneously or separately?
If there are tumors elsewhere in the body, the brain metastasis will normally be the top priority, both because brain metastasis is life threatening and because the treatment is different from and often incompatible with treatment of tumors elsewhere.
Do You Still Have Questions?
If you have questions about your specific care you should speak directly to your oncologist.
If you have general questions about cancer, Cleveland Clinic is here to help you get the cancer information you need. Please contact us via Cleveland Clinic's Cancer Answer Line toll-free 866.223.8100, Monday – Friday, 8 a.m. – 4:30 p.m.
Two oncology clinical nurse specialists and their staff can provide information and answer questions about cancer. If desired, appointments can be scheduled with one of the expert physicians at Cleveland Clinic.
Brain tumor patients and their families face many tough decisions, exhausting treatment, and periods of rehabilitation. In order to deal with the changes a brain tumor brings to one's life, the support staff at Cleveland Clinic's Taussig Cancer Institute and the Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center focuses on coping and healing.
Cleveland Clinic's Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center is dedicated to providing state-of-the-art medical and surgical treatments for patients with brain tumors. We also realize you may have other concerns about how this illness may affect your family, your job or your ability to carry out other daily activities. You are not alone. In the past, we have found our Brain Tumor Support Group to be helpful in dealing with these concerns.
The Support Group provides the opportunity to share experiences and to socialize with others in similar situations. Nurse practitioners assist the group, provide information and answer questions regarding treatments, medications, available resources and other important issues.
- When: Check back for 2017 dates
The fourth Wednesday of the month from 5 p.m. - 7 p.m.
- Where: Cleveland Clinic, Taussig Cancer Institute (Building R)
Conference Room R3-027 on the 3rd floor.
- Who: Open to all brain tumor patients, family members and friends.
- Parking: Free parking at either garage (bring ticket to be stamped).
90th Street visitor’s garage (P4)
Euclid Avenue visitor’s garage (P1)
We are dedicated to helping you face the challenges associated with your diagnosis and treatment. Listed below are some of the patient support services and programs available through Cleveland Clinic Taussig Cancer Institute.
- Art Therapy
- Cancer Answer Line
- Chemo Care
- Financial Services
- High Tea at Taussig
- Patient Resource Center
- Reflections Wellness Program
- Scott Hamilton Cares Program
- Social Work
For More Support Group Information
Kathy Lupica, MSN, CNP
800.223.2273, ext. 51787