keilly's story

L to R: Dr. Christopher McPherson,
Keilly and Dr. John Tew

A map of Keilly's brain made by fusing
three types of images: magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI),
and diffusion tensor imaging (DTI).
(Click for larger image)

Keilly's brain scans: before surgery, left,
with tumor circled; at right, after surgery.

In a perfect world, Keilly would be reading her beloved Harry Potter books and weaving her own tales of wizards and magic at the Dreyfoos School of the Arts, a prestigious Florida high school where she excelled in creative writing. Instead, the 16-year-old is battling glioblastoma multiforme, a malignant brain tumor that only rarely strikes children.

Keilly, her family, and her doctors have been struggling against the aggressive "tumor without borders" since her diagnosis in July 2009. Following the surgical removal of a portion of the tumor in Jacksonville, Fla., her treatment continued with radiation and participation in a chemotherapy clinical trial involving erlotinib (Tarseva®) at St. Jude Children's Research Hospital in Memphis. When it became evident that the chemotherapy was not helping, Keilly was removed from the trial and referred to Joe DiMaggio Children's Hospital in Hollywood, Fla., where doctors suggested that Keilly be treated with palliative care and bevacizumab (Avastin®), which is designed to arrest the formation of blood vessels that bring oxygen and nutrients to a tumor, thereby slowing its growth. The tumor had, after a period of calm, re-emerged, larger than ever and in a new location.

That's when Keilly and her parents decided the best chance was a second surgery, so they contacted Dr. John Tew, a neurosurgeon at the Mayfield Clinic and the Brain Tumor Center and the University of Cincinnati Neuroscience Institute. Dr. Tew, Dr. Christopher McPherson (also with the Mayfield Clinic and UC Brain Tumor Center) and the Center's Tumor Board, a multidisciplinary team of specialists, had periodically reviewed and discussed Keilly's case during the previous year. Keilly's parents, Brenda and Steve, believed Dr. Tew and his team were their best source of hope.

"We had been in contact for more than a year with Dr. Tew, and we were using him as our 'ace in the hole'' when all other options were bad choices," Brenda said. "He kept telling us he thought he could resect (remove the tumor), but we tried chemo and radiation first because we didn't want to do more surgery if there are other options. And when the tumor shifted or morphed, that's when we decided our choice needed to be more radical."

Because Avastin® can interfere with wound healing, Keilly's surgery could not take place until the drug had passed through her system over a period of several weeks. Finally, in July 2010, Keilly and her family traveled to Cincinnati for surgical removal of the aggressive tumor, which had grown to the size of a fist.

Dr. James Leach, a neuroradiologist, created a map of Keilly's brain by fusing three types of images: magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), and diffusion tensor imaging (DTI). The data was installed into a surgical guidance computer whose function is similar to a global positioning system. By revealing the tumor's relationship to areas associated with speech and movement, Dr. Tew and Dr. McPherson were able to chart a safe pathway to the tumor.

Aided by the brain mapping and the tumor's location – almost all of it was on the left side of Keilly's brain - Drs. Tew and McPherson removed 95 to 99 percent of its mass during a four-hour operation. Following surgery, Keilly underwent five fractionated radiotherapy treatments, overseen by Dr. Jessica Guarnaschelli, to eradicate the tumor fragments that extended into the other side of her brain.

"This place has been very encouraging for us," Keilly's father said, "although we have a long way to go."

"For the first time I feel hopeful," Keilly's mother said. "I feel like maybe we can get to the other side."