By Darryl E. Owens of The Sentinel Staff
It was 8 a.m. Monday when a team of Florida Hospital doctors drilled through the skull and probed the sickened brain of James Nebus, an RV resort operator from Naples. In one of those moments when art and life collide, doctors extracted a tumor from his brain and filled the cavity with a half-dozen wafers packed with a potent chemotherapy drug—the same procedure millions witnessed last week on television's ER.

Known as Gliadel Wafer therapy, the procedure allows doctors to insert wafers into the brain the size of a Certs candy that act much the way as medicated pads for corns. Implanting the wafers in the brain immediately after the tumor is removed puts the medication directly where it can do its good and minimizes side effects associated with chemotherapy taken orally or intravenously.
Using the wafers with surgery has shown promising results in trials. Not only has the therapy boosted survival rates, it has also slowed the relentless rate at which tumors recur.

The wafers, doused with the chemotherapy drug carmustine, are used to treat about 4,000 patients each year in the United States with recurrent brain tumors. But doctors are now looking at using the wafers as a first-line attack, when tumors are first discovered and removed.
ER cast the wafer therapy as a potential cure for Dr. Mark Green. But doctors caution that while the experimental treatment has shown encouraging results, it is not a lifesaver.

" This is the worst of all the brain tumors, the most invasive," says Dr. Phillip G. St. Louis, the Florida Hospital neurosurgeon who performed Nebus' operation. "The wafer therapy takes a disease process that normally robs a family of a loved one in two to three months and extends the life of that person -- and, more important, extends the quality of life. He can go back and the family can enjoy him with his speech and memory intact."

Nebus, 66, had taken the news of his brain cancer with grace, saying he would accept as much time as God gave him. But when he learned that the wafers could buy him months, he agreed to the surgery.

His troubles started in December, when he noticed backfires in his speech. He slurred his words -- ruck for truck -- and suffered memory lapses. Nebus dismissed those symptoms as just signs of aging and shrugged off the mild pain pulsing above his left eye.

Then, two weeks later, while playing a hand of euchre with his regular foursome at Rock Creek RV Resort & Campground in Naples, Nebus couldn't remember the rules of the card game he so loved.
Nebus aced a memory test given by his doctor, but to be on the safe side, the doctor ordered a magnetic resonance imaging test. It was Ivy Jean Nebus, his wife of 41 years, who took a somber phone call later that day: cancer.

She waited until the day after Christmas to break the news to her husband. A tumor the size of a small tangerine had taken up silent residence in his brain. It had chewed through the wiring, short-circuiting his speech and memory.

About 35,000 tumors that begin in the brain are diagnosed in the United States each year. Of these, glioblastomas like Nebus' are the most common. They usually develop in the cerebrum, the brain's nerve center. They are so lethal that even with aggressive treatment, patients typically survive less than a year. Without treatment, life can be measured in weeks.
Nebus learned of the wafer therapy from a friend whose roommate's mother was treated with it. He sought out St. Louis.

The doctor outlined the procedure: A ring of tiny holes would be drilled into the skull. A saw would connect the dots, loosening the bone from the skull. A styluslike device would plot a 3-D map for removing the tumor. Then the wafers would be placed to continue killing any cancer. Surgery would take three hours. Nebus would be awake for part of the surgery so St. Louis could be sure he had not damaged vital functions.

Nebus spent the night before surgery with his wife; daughters Jan and JoAnne; and son John at Cirque du Soleil and Planet Hollywood. "We wanted to keep his mind off everything," his wife said.
Just before 8 Monday morning, doctors clamped his head into a stabilizing device. St. Louis drew an S-shape in purple ink on the skull and traced the line with his scalpel. With the skin exposed, he drilled the holes and clipped out the bone. Shards of bone flew like a swarm of gnats.

Nebus was brought out of sedation, although his pain was controlled by medication. Doctors began probing Nebus' brain.
" Tell me your name," they asked him. "Do you know what day it is?"
Nebus answered flawlessly.

With a whoosh of water, doctors unearthed the tumor. Milky white, vein-lined and mushy, the tumor looked foreign next to the tannish-white normal brain tissue that was firm like thick gelatin.
St. Louis removed the tumor, then inserted the wafers. With the brain and skull patched, St. Louis told the family the good news. Ivy Jean still had questions about her husband's prognosis, which St. Louis said time will determine. For Ivy Jean, that was good enough for now. "I'm thankful, " she said, "for each day we have."
Copyright 2001, Unauthorized reproduction prohibited.

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