Prouty Chronicle, Prouty Chronicle 2025

Redefining 
Brain Cancer Care

The focus of treatment for brain metastasis has shifted from simple survival to improved quality of life, too.

Surgeons at work in the operating room.

Neurosurgeon Linton Evans, MD, MED ’10, RES ’17 (right) blends compassion and cutting-edge technologies to give patients with brain tumors more time and a better quality of life. Photo credit: Mark Washburn

Published: 
By Lara Stahler
5 min read
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Unsatisfied with simply accepting what’s available, Dartmouth Cancer Center (DCC) neurosurgical oncologist Linton T. Evans, MD, MED ’10, RES ’17 is redefining what is possible in caring for patients with brain tumors.

Treatment options for brain metastases—tumors that spread to the brain from primary cancers like lung or melanoma—have improved dramatically over the past two decades, thanks to advances in surgery, radiation, immunotherapy, and targeted therapy. And now, Evans says, the focus has shifted from merely extending survival to preserving quality of life over potentially many years.

Unfortunately, the standard of care for glioblastoma—the most aggressive form of primary brain cancer—hasn’t changed much. “But with newer technologies in the operating room, we’re better able to maximize safe tumor removal while being much more aware of neurocognitive outcomes,” Evans says. “We also have some exciting clinical trials on the horizon.” And Prouty Pilot seed funding has laid the groundwork for these critical advances.

Smarter, safer surgeries

Through unique collaborations, clinicians and researchers routinely connect their expertise to augment technology. “We are constantly asking, ‘How can we make this better?’” Evans says. The answer may be designing new fluorescent molecules, improving imaging probes, or leveraging machine learning to enhance image interpretation—work they hope will make brain tumor surgeries safer and more precise.

One example is the CONVIVO confocal laser microscope system, which lets neurosurgeons see cellular details of brain tissue in real time during surgery. While it is usually used for gliomas, “our team here has a different perspective about its real potential,” Evans says. He and pathologist George Zanazzi, MD, PhD, are preparing to publish their results from using the laser microscope in skull-base tumors, where achieving clear margins is especially critical.

Evans is also spearheading a first-in-human clinical trial concept that could extend the reach of laser interstitial thermal therapy (LITT), a minimally invasive method that involves inserting a laser fiber into the tumor and using heat delivery to destroy tumor cells. While effective, LITT has limits: Heat doesn’t spread far, and nearby critical brain structures can be damaged. To overcome this, Evans is testing ThermoDox, an encapsulated chemotherapy that only activates at tumor sites when heated.

Evans is as excited about the trial as he is about how it emerged. “I was teaching a class at Thayer [Dartmouth’s School of Engineering] with fellow researcher Jack Hoopes, DVM, PhD, who told me he was ‘meeting with some folks who have a heat-sensitive chemotherapy and it might be an interesting project.’ This drug had been tried in other cancers, but methods for monitoring the heat were lacking. So we met with the inventor of ThermoDox and told him we actually had a great way, that we use routinely, of measuring the amount of heat and monitoring where it was going by using LITT with MRI [magnetic resonance imaging].”

Embedded Treatment

Radiation at the Time of Surgery

In 2023, neurosurgical oncologist Linton T. Evans, MD, MED ’10, RES ’17, treated the first patient at Dartmouth Cancer Center (DCC) with GammaTile, a postage stamp-sized device embedded with radiation seeds that can be placed directly into the brain cavity at the time of tumor surgery. Known as “brachytherapy,” the tile delivers highly localized radiation immediately after tumor removal. The benefit? Sparing healthy tissue and reducing weeks of travel for radiation treatments—especially valuable for patients in rural northern New England.
DCC has now treated 15 patients with GammaTile—more than Evans initially expected. “We also participated in a multi-center clinical trial comparing GammaTile to standard post-operative radiation in patients with brain metastases, and are preparing to join an upcoming trial studying the use of GammaTile for patients with newly diagnosed glioblastoma.”
With many more cases under its belt, DCC is now considered a GammaTile Center of Excellence—one of very few in New England. Evans says, “It’s exciting to see this become a real option for patients who face major travel burdens.”

Through the Cancer Center’s bench-to-bedside program, Evans and Hoopes secured funding to test how accurately they can predict where heat—and a drug that has never been used in the brain before—goes. While Hoopes recently passed away, a loss deeply felt among the DCC research community, Evans will continue what they started, with hopes to finish preclinical testing, submit an application to the FDA, and launch the trial within a year. “It’s been a very rewarding collaboration,” he says, “going from hanging around after a class at Thayer to bringing safer, less toxic, and more effective LITT-based treatment to patients with brain tumors.”

In addition to an environment that lends itself to fortuitous meetings, Evans credits Dartmouth’s Center for Surgical Innovation and DCC funding for “making all of this possible in a way that isn’t at other places,” he says.

Evans is also launching a fluorescence-guided surgery clinical trial for patients with newly diagnosed glioblastoma. The trial will use a novel Dartmouth-designed fluorescent dye that sharpens the contrast between tumor and healthy brain, helping surgeons remove more cancer while preserving function. As important as the dye itself, Evans notes, is developing the systems to visualize it effectively—a task well-suited to Dartmouth engineers’ tremendous expertise.

Envisioning more for patients

As technology improves, Evans appreciates having more nuanced conversations with patients and the expanding ability to tailor treatment plans to individual needs and preferences. “With the technology we have, we can treat patients the right way for them,” he says.

He envisions a future where improved technology and surgical precision, smarter drug delivery, and minimally invasive techniques give patients more time and better quality of life.

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