Join Now
Sign In
Lawrence Recht, MD
LawrenceRechtMD (Physician - Neurosurgery (Verified) )| Communities: Brain Cancer | Answers: 8 |
| Member Since: Aug. 2012 |
Ask LawrenceRechtMD a question:
0
Cc:
Twitter
Facebook
Professional Statement
Dr. Lawrence Recht, Director of Adult Neuro-Oncology, received his medical degree from Columbia University College of Physicians and Surgeons in New York City. He completed his training as a Resident in Neurology at Columbia Presbyterian, Neurological Institute of New York. His interest in helping people with brain tumors led him to additional training and completion of a Fellowship in Neuro-Oncology at Memorial Sloan Kettering Cancer Institute in New York.
As an attending in Neurology with a specialty in Neuro-Oncology, Dr. Recht moved to the University of Massachusetts Medical School where he spent 19 years caring for patients and working in his research lab to try to find a cure for brain tumor. During this time Dr. Recht became convinced that it was better for patients to find out how and why a brain tumor evolved so that it could be treated earlier rather than directing his efforts toward treating the tumor after it had already caused disability.
In 2004, Dr Recht relocated to Stanford to work on furthering his research on Early Detection of Brain Tumor and to develop an expanded Adult Neuro-Oncology Program.
Belief in hope and quality of life drives Dr. Recht and his team's practice of caring for patients and families with brain tumor and neurologic complications of cancer. Clinical studies are also provided and available for patients with specific conditions who are interested in adding experimental treatments to their care.
Efforts in Dr. Recht's research laboratory are directed towards applying early detection strategies to the treatment of brain tumors. In addition, other work in his laboratory is directed at reversing the damaging side effects of treatment-related brain injury.
As an attending in Neurology with a specialty in Neuro-Oncology, Dr. Recht moved to the University of Massachusetts Medical School where he spent 19 years caring for patients and working in his research lab to try to find a cure for brain tumor. During this time Dr. Recht became convinced that it was better for patients to find out how and why a brain tumor evolved so that it could be treated earlier rather than directing his efforts toward treating the tumor after it had already caused disability.
In 2004, Dr Recht relocated to Stanford to work on furthering his research on Early Detection of Brain Tumor and to develop an expanded Adult Neuro-Oncology Program.
Belief in hope and quality of life drives Dr. Recht and his team's practice of caring for patients and families with brain tumor and neurologic complications of cancer. Clinical studies are also provided and available for patients with specific conditions who are interested in adding experimental treatments to their care.
Efforts in Dr. Recht's research laboratory are directed towards applying early detection strategies to the treatment of brain tumors. In addition, other work in his laboratory is directed at reversing the damaging side effects of treatment-related brain injury.
Professional Info
Credential: MD
Primary specialty: Neurosurgery
Secondary specialty: Neuro-Oncology
Medical school: Columbia Presbyterian Medical Center
Residency: University of Minnesota School of Medicine, New York Presbyterian Hospital
Internship: University of Minnesota School of Medicine
Fellowship: Memorial Sloan-Kettering Cancer Center
Research interests: Our laboratory focuses on two interrelated projects: (1) assessment of glioma development within the framework of the multistage model of carcinogenesis through utilization of the rodent model of ENU neurocarcinogenesis; and (2) assessment of stem cell specification and pluripotency using an embryonic stem cell model system in which neural differentiation is induced.
Hospital affiliation: Stanford Cancer Institute
Practice address:
875 Blake Wilbur Dr Rm CC2221
Stanford, CA
94305-5826
Practice phone number: (650) 725-8630
LawrenceRechtMD Activities
There are two questions posed here. First, it is very difficult to follow ongoing studies for progress, since they are rarely reported unless the result is exceptionally good (or bad). The one place that I wouldn’t consult is the media, however. News stories always attract attention (which is understandable) and provoke many calls to physicians. However, these studies are being aired (in my opinion) more because they seem newsworthy (or the impact of a good public relations group) rather than because they truly are the most exceptional; they are in essence an unpaid advertisement.
To address the second question, I know of no studies that are specifically addressing brain metastasis from triple negative breast cancer, which is becoming a particularly important issue in this group of patients. I do expect such studies to be available soon because it is becoming a particularly difficult clinical issue.
To address the second question, I know of no studies that are specifically addressing brain metastasis from triple negative breast cancer, which is becoming a particularly important issue in this group of patients. I do expect such studies to be available soon because it is becoming a particularly difficult clinical issue.
New answer by LawrenceRechtMD (Physician - Neurosurgery (Verified))
1
Answer |
9 months ago
Depending on your level of sophistication, there are a few ways to do this. For one with a reasonably high level of knowledge, consulting the “clinical trials.gov” website (just search with Google). I just did this thirty second ago and found 1202 studies listed for brain metastasis, 83 specifically for breast cancer. I generally wouldn’t recommend such an approach, however, since it can be daunting for the layperson and unless you’re an expert, hard to choose among them. I therefore would recommend that the best way to do this is probably to talk with your oncologist. If this is not possible, you can contact one of the breast cancer foundations dedicated to patient support, such as the Susan Komen Foundation.
New answer by LawrenceRechtMD (Physician - Neurosurgery (Verified))
1
Answer |
9 months ago
Lymphoma specialists generally administer methotrexate via either a lumbar puncture or reservoir in a regimen that is timed with the rest of the chemotherapeutic regimen. Up to six doses can be administered. Sometimes, physicians will use liposomal Ara-C (Depocyt), which has a much longer half life (2 weeks compared to several hours for methotrexate) instead. Radiation is not used for prophylaxis.
New answer by LawrenceRechtMD (Physician - Neurosurgery (Verified))
1
Answer |
9 months ago
A general rule is that the closer the lymphoma resembles leukemia, the more likely that CNS relapse will occur. Therefore, in particularly aggressive lymphomas, such as Burkitt’s and lymphoblastic lymphoma, prophylaxis should be administered to all patients. In the more common diffuse large B cell lymphoma, prophylaxis is generally reserved for patients with involvement of the bone, bone marrow, stomach or GI tract in general and testes, because such involvement correlates with a higher frequency of CNS relapse. More indolent follicular lymphomas do not require prophylaxis.
The addition of Rituxan to the basic lymphoma regimen (i.e., R-CHOP) has probably decreased eventual CNS relapse rates in high risk patients.
The addition of Rituxan to the basic lymphoma regimen (i.e., R-CHOP) has probably decreased eventual CNS relapse rates in high risk patients.
New answer by LawrenceRechtMD (Physician - Neurosurgery (Verified))
1
Answer |
9 months ago
Not every clinician practices the same way. Gliadel represents a way to administer BCNU, a nitrosourea, directly into a brain tumor cavity. The upside of this is that it increases local concentration of drug; the downside is that it requires a near total excision (and another surgery when it’s being used in recurrence). Many practitioners throughout the US use this and believe it’s effective. My own view is that it does not seem to be superior to IV BCNU (other than causing less marrow suppression), so we do not use this approach at Stanford.
New answer by LawrenceRechtMD (Physician - Neurosurgery (Verified))
1
Answer |
9 months ago
BCNU and CCNU are “alkylating agents”, which kill cells by breaking DNA. They are part of a class of drugs called “nitrosoureas”. These compounds penetrate the brain readily because they are small and fat soluble, making them attractive agents for brain tumor. They were actually the primary chemotherapeutic agent used in GBM before temozolomide and are still frequently used, although they tend to be more toxic (especially towards the bone marrow) than temozolomide. The two agents themselves are very similar in action; BCNU is administered IV while CCNU is an oral agent. They are generally used now as a second line agent after recurrence occurs.
New answer by LawrenceRechtMD (Physician - Neurosurgery (Verified))
1
Answer |
9 months ago
Temozolomide is also an “alkylating agent” that kills cancer cells by disrupting DNA. It is the standard first line agent versus glioblastoma and is administered both upfront with radiation and after radiation is completed. It is an oral, well tolerated drug. It primary side effects are constipation and fatigue; marrow suppression occasionally occurs, but is much less frequently encountered compared to nitrosoureas. Its relatively benign side effect profile enables the clinician to often rechallenge patients with the drug, especially when relapse occurs after a long interval.
New answer by LawrenceRechtMD (Physician - Neurosurgery (Verified))
1
Answer |
9 months ago
The foundation for glioblastoma treatment includes surgery, radiation and the chemotherapeutic agent, temozolomide. The first step (after patient stabilization) is maximal safe debulking by the surgeon. The key here is “safe”; there is no need to sacrifice function for better survival (since there is no evidence that this improves outcome). Therefore, this may range from a visually total tumor removal to a biopsy (when tumors occur in inaccessible areas). Once pathologic confirmation is received, standard treatment next involves a combination of involved field radiation (using a dose of approximately 60 Gy to the area of MR enhancement with a 2 cm field extension, a process that takes approximately six weeks) and temozolomide chemotherapy (75 mg/M2 every day for 42 days). We prefer to get this started within a month of radiation, although there is evidence that delays up to six weeks do not impact outcome. Once radiation is finished, a rest period of 2-4 weeks ensues after which patients are restarted on temozolomide, which is administered at a dose of 150 mg/M2 for five days out of 28). Chemotherapy treatment then continues for at least 6 and often 12 months, depending on tolerance).
Bevacizumab (Avastin) plays an important role in treatment, although the precise timing of its initiation remains controversial. At Stanford, we generally reserve its usage until time of recurrence, unless patients are requiring high doses of steroids for mass effect (at which time we would start earlier).
Once recurrence occurs, there are no standard treatments (other than Bevacizumab). It is at this point that we tend to offer patients entry into experimental protocols; if they decline or are not eligible, we generally administer a nitrosourea such as CCNU in addition to Bevacizumab.
Bevacizumab (Avastin) plays an important role in treatment, although the precise timing of its initiation remains controversial. At Stanford, we generally reserve its usage until time of recurrence, unless patients are requiring high doses of steroids for mass effect (at which time we would start earlier).
Once recurrence occurs, there are no standard treatments (other than Bevacizumab). It is at this point that we tend to offer patients entry into experimental protocols; if they decline or are not eligible, we generally administer a nitrosourea such as CCNU in addition to Bevacizumab.
New answer by LawrenceRechtMD (Physician - Neurosurgery (Verified))
1
Answer |
9 months ago
LawrenceRechtMD's Profile
Newsletters
Sign up for email updates of the latest news, best answers, and featured experts.
Benefits
Custom health, wellness, & medical offers including clinical trials, market research opportunities, & new programs.
Share TalkAboutHealth
To share TalkAboutHealth with friends, type their email addresses here (separated by commas):
From:
Add a personal note here:
Please join TalkAboutHealth and you will be able to ask questions.
Your question to LawrenceRechtMD:
2) Background Info (optional): What context or background information is relevant to this request?
Notes:
The more clear and thorough your request, the more likely you will receive support.
Many of our members are learning from this information or english might not be their first language. Please use standard english and spell out all words. For example, use 'you' instead of 'u'.
The more clear and thorough your request, the more likely you will receive support.
Many of our members are learning from this information or english might not be their first language. Please use standard english and spell out all words. For example, use 'you' instead of 'u'.
Newsletters
