Surgeon frustrated made-in-Manitoba brain surgery unavailable in Canada

A Canadian neurosurgeon is frustrated that a Manitoba woman battling brain cancer might need to pay tens of thousands of dollars in a U.S. hospital for an innovative treatment developed by researchers in this province.

Anastasie Hacault has launched a fundraising campaign to pay for NeuroBlate laser-based surgery because it currently isn't offered anywhere in Canada. The surgery could cost about $150,000.

Dr. Brian Toyota, head of neurosurgery at Vancouver General Hospital at University of British Columbia, treated more than two dozen patients using the NeuroBlate laser-based technology developed by by Mark Torchia and Richard Tyc of the University of Manitoba.

It allows surgeons to target tumours in hard-to-reach areas of the brain with precision.​

It was licensed for use in Canada in 2013 and a donation of about $400,000 brought the machine to VGH. Toyota showed the results to the B.C. Ministry of Health, which said it wanted more cost analysis.

"They didn't look that carefully, but at the end of it said, before we can make it a budgetary supported procedure, that they would want more cost analysis studies to be done," said Toyota.

Since then, the program is on hold. The machine and software are there, but so far, the ministry and hospital haven't committed to supporting it.

"When I spoke to them two weeks ago, they did some research and said they don't think, the technology doesn't have enough proof that it works. And it's sort of the position we're in."

Gavin Wilson, director of public affairs for Vancouver Coastal Health, said NeuroBlate is no longer funded in B.C. because there are other options for patients.

"We are exploring options for further research on the use of NeuroBlate for Laser Interstitial Thermal Therapy. It is our hope that the collection of more data in a clinical trial will support a more definitive evaluation of Laser Interstitial Thermal Therapy and clearly identify its potential benefits for patients. We would reconsider funding Neuroblate if the research demonstrates clear benefits over and above existing treatments," Wilson said in an email.

Could prolong Hacault's life

Hacault was diagnosed in 2012 and given three to five years to live. The surgery could prolong her life.

"I'm willing to fight as long as it takes, I just need the tools," she told CBC News.

Essentially it allows health-care providers to "cook" a cancerous brain tumour while protecting the healthy tissue surrounding it.

Toyota said two similar units were purchased for pediatric patients in Toronto and Montreal, and there are currently about 150 units in the United States, but none are available for adults in Canada.

"I think that where it really admittedly irks me is to know that this was developed in Canada and Canadian patients are struggling to get access to it when they are candidates for its use," said Torchia, who developed the technology but no longer works for the company that sells it.

Neil Berrington, a neurosurgeon with the Winnipeg Regional Health Authority and a U of M professor, said the number of patients who would be candidates for the surgery is potentially as small as five or six per year, meaning that for the moment, it's probably better to have those patients treated abroad.

"It's many thousands of dollars per case and the hardware itself is expensive too," he said.

The individual probes cost about $12,000 each.

Currently, Canadian patients are referred to a clinic in Cleveland, Ohio, Berrington said.

Berrington said it's still not clear exactly who would benefit from the technology and to what extent. "It's a very appealing technology, if you look at it it seems like a great idea, but that really doesn't mean that it's going to benefit our patients."

Toyota, however, believes that patients who have been deemed inoperable might benefit the most from this technology. Toyota said the NeuroBlate "makes the inoperable operable."

"If you're one of the five per cent, I think it's very much worth it. And I don't think Canadian health care should go that direction of dictating what someone's life is worth. It's not worth $12,000. That doesn't seem just."

Berrington also challenged the notion that NeuroBlate surgery was less invasive than other surgeries.

"You're deploying heat deep inside the brain, so the only thing that is less is the incision is small and you're not traversing brain tissue to go where you're going. But you're deploying a laser beam deep inside the brain and causing a heat lesion."

Falling behind?

Berrington said Manitoba is becoming a centre for Gamma Knife treatment, which uses a blast of radiation rather than laser-emitted heat to destroy tumours.

Toyota believes the profit-driven U.S. system might be part of the reason the new technology has been adopted there more quickly than in Canada.

"The Canadian health care system is not profit-driven, still with the same goal of providing optimum patient care, but I think not necessarily with that same kind of monetary perspective that the U.S. hospitals have."

Toyota doesn't want to see Canada fall behind other countries when treating cancer.

"I think Canadians should be part of that wave of innovation and not waiting for it to settle out. Because by then of course a new technology would have arisen. And then you're caught in that same cycle. Always being behind. Or, if you have the money, going to where it is."