Shining a Light on Brain Tumours: An Interview with Neuroradiologist Dr Geert Lycklama

June 8th marks World Brain Tumour Day. This day serves as a reminder to raise awareness about brain tumours and the vital role of medical professionals in their diagnosis, treatment, and management. There are 100 distinct types of primary brain tumours, each presenting its unique array of symptoms, treatment options, and prognoses. Unlike many other cancers, brain tumours often induce enduring and profound physical, cognitive, and psychological effects that can significantly alter patients' lives. In anticipation of this important day, we had the privilege of speaking with Dr Geert Lycklama, an expert in neuroradiology and neuro-intervention. Dr Geert Lycklama, has authored and co-authored over 100 articles on MS, stroke, and other neuroradiology subjects and has also taught at the Unilabs Academy. He shared his insights and expertise on the topic.

What are the most common types of brain tumours, and how do they differ in terms of location, severity, and treatment options?

The most common benign brain tumour, and the most frequently encountered intracranial tumour in general, is meningioma, a tumour originating from the tissue layers outside the brain and thus located outside the brain parenchyma. This tumour is usually completely treated with surgery, sometimes followed by radiotherapy. The prognosis for this type of tumour is excellent. 

The most common malignant brain tumour is metastasis. With the increasing incidence of cancer in the population, intracranial metastases are becoming more common. Treatment for these lesions has improved over the years, and many patients can remain stable through combinations of surgery, chemotherapy, immunotherapy, and radiotherapy. 

The most common malignant primary brain tumour is glioblastoma, the most aggressive type of tumour originating in the brain parenchyma (glioma). In addition to glioblastoma, there are many other types of gliomas, as well as other primary brain tumours such as ependymoma. Treatment for glioma usually involves surgery to remove as much of the tumour as possible. Depending on the subtype, this may be followed by a combination of radiotherapy and chemotherapy. Unfortunately, complete removal of a primary brain tumour is often difficult, and the prognosis for the most aggressive primary brain tumours remains poor. 

In some cases of primary brain tumours, a ‘wait and scan’ approach may be recommended, as some cases have a very benign natural course. There is a wide variation in the behaviour of brain tumours, and treatment options vary. Therefore, for each patient, the treating team creates a personalised treatment plan.

Can you explain your role as a neuroradiologist in diagnosing and monitoring brain tumours?

The role of a neuroradiologist varies depending on the stage of the ‘patient journey’.

In the diagnostic phase, the neuroradiologist plays a critical role in detecting abnormalities on CT and MRI scans. Another important task of the neurologist is to differentiate between tumours and ‘tumour mimickers’, as many conditions may mimic a tumour on brain scans (e.g., abscess or brain infarct).

In the work-up phase, the neuroradiologist assists with treatment planning by acting as a consultant to the neurosurgeon and radiotherapist to optimise tumour delineation.

In the follow-up phase, the neuroradiologist plays an important role in monitoring recurrent disease. As therapy outcomes improve, early and late treatment effects on follow-up MRI scans are becoming more common, and they can sometimes resemble recurrent tumours. Differentiating between therapy-related changes and recurrent tumours is difficult and requires optimal use of modern MRI techniques, as well as an experienced neuroradiologist.

Can you discuss any recent advancements or innovations in neuroradiology that have improved the detection or treatment of brain tumours?

Recent advancements in neuroradiology include the development of new and improved MRI scanners, employing new techniques such as MR perfusion imaging and MR spectroscopy. Another recent development is artificial intelligence, which holds promise in neuro-oncology, for helping the neuroradiologist both in detecting and characterising brain tumours.

As both a radiologist and a teacher, how do you balance your clinical responsibilities with teaching and research?

I always remember what my old teacher, Prof Jaap Valk (who recently passed away at the age of 95) always said: “If I encounter something I don’t understand, I write a book about it”. For me, this always reminds me that teaching and research are great ways of learning and improving as a doctor. Being a doctor requires continuous learning, and although we learn every day by doing our clinical work, being involved in research and teaching is also important. 

Can you share any insights or advice for patients and caregivers navigating the imaging process and understanding the results when dealing with brain tumours?

The main advice I would like to give to patients and caregivers is that it is always important to interpret imaging results within the context of the clinical setting. Neuroradiologists typically interpret a patient’s images without direct patient interaction, so it’s important to understand that the radiological report is just one component of the treatment and monitoring process. Treating physicians are the ones who should communicate the interpretation of diagnostic procedures to patients and caregivers. This has become particularly relevant with the advent of digital patient portals, where patients and caregivers can read imaging results directly from their medical records. It's essential to discuss these findings with the treating physicians to gain a comprehensive understanding of the diagnosis and treatment plan.