Dartmouth-Hitchcock Norris Cotton Cancer Centercancer.dartmouth.edu/neuro-brain/documents/Neuro... · Dartmouth-Hitchcock Norris Cotton Cancer Center. ... The Neuro-Oncology program

C L I N I C P R O F I L E

NEURO-ONCOLOGYDartmouth-Hitchcock Norris Cotton Cancer Center

201111-246

Dartmouth-Hitchcock Medical Center, the Best of Both Worlds

Norris Cotton Cancer Center is headquartered

at Dartmouth-Hitchcock Medical Center

(DHMC), a teaching and research hospital of

The Geisel School of Medicine at Dartmouth.

DHMC provides advanced care for complicated

conditions like brain cancer for patients from

New England, New York, and beyond.

Neuro-OncologyCenter of ExcellenceThe Neuro-Oncology program at Dartmouth-

Hitchcock Norris Cotton Cancer Center is

recognized for its innovative approaches,

advanced technology, and exceptional staff.

In the serene setting of rural New Hampshire,

Ivy League physician scientists and biomedical

engineers have amassed resources and

knowledge unmatched in North America:

●● Access to emerging therapies and procedures in a leading cancer research center though all phases of clinical trials.

●● A National Cancer Center (NCI)-funded $10 million neurosurgical operating suite with real-time, intraoperative MRI/CT.

●● Advanced 3-D imaging technology at an institution that has pushed the horizons of radiology since 1896.

●● A unique pairing of a linear accelerator with an adjacent hyperbaric chamber to explore the benefits of the oxygenation of tumor cells to enhance benefits of radiation.

●● A close-knit interdisciplinary team working side-by-side to coordinate complex care plans involving many subspecialities.

An Exceptional Program

The Referral Process

Our practice is to see patients within days of

diagnosis. Following this appointment, we keep

the referring physician and the primary care team

informed of the treatment plan and clinical course.

Please let us know if you are interested in

participating in our interdisciplinary Neuro-

Oncology tumor board. The staff at Norris Cotton

Cancer Center is committed to working closely

with you. You will be supplied with a detailed

treatment summary. If at any time you have any

questions, please call (603) 650-6312 to speak with

the treating physician.

To refer a new patient by telephone, call

(603) 650-6312

To refer by fax:

(603) 653-0610

2 3An Exceptional Program

An Exceptional Program An Exceptional Program

A New Generation of Radiation Oncology

With new technology, radiation oncologists use

radiation therapy as an alternative to standard

surgery.

●● Stereotactic radiosurgery with the Trilogy™

system combines high definition X-ray and CT

imaging with precise radiation delivery so a

radiation oncologist can perform radiosurgery.

●● Computer-assisted volumetric resection using

OR navigation allows for more precise surgery.

●● Computer-assisted stereotactic radiosurgery,

together with laser instruments, can help

physicians locate and target deep brain tumors

more accurately than traditional techniques.

●● Intensity-Modulated Radiation Therapy

(IMRT), known as 3-D conformal radiation

therapy, uses computer-generated images

to plan and deliver tightly focused radiation

beams to cancerous tumors while preserving

healthy brain tissue.

Advanced imaging provides information about the blood supply to brain tumors.

4 5

Molecular Pathology Analysis of Tumor Samples

Pathology plays an increasing role in

understanding cancer. The advanced technology

of our molecular pathology laboratory

allows us to perform sophisticated tests to

diagnose and characterize brain tumors.

Immunohistochemistry, cytogenetic testing,

and molecular profiling, as well as genomic

sequencing are now part of clinical practice.

Tissue samples can provide discriminating

information to diagnose, classify, and

prognosticate lesions so treatment can target

specific mutations.

Treatment Planning

The Neuro-Oncology program team reviews

each patient’s case in terms of history, radiologic

studies, and pathologic diagnosis at tumor board.

The team, in consultation with the patient and

family, identify the most effective treatments. We

incorporate decision aids into our practice to help

patients make informed decisions about treatment

options.

A Pioneer in Diagnostic ImagingThe first step in developing an evidence-based

long-term treatment plan for each patient is a

complete diagnostic workup.

Dartmouth was home to the first clinical X-ray

ever performed in the U.S. Today, traditional

X-rays are supplemented by fluoroscopy, advanced

magnetic resonance imaging (MRI), magnetic

resonance spectroscopy (MRS), computed

tomography (CT), ultrasound, nuclear imaging

(PET, PET-CT, and SPECT), interventional

radiology treatments, and 3-D imaging. As one

of America’s premier radiological centers, we

leverage all of our medical imaging abilities to

diagnose Neuro-Oncology patients.

Brain cancer differs from other types of tumors

because diagnosis and treatment may affect

cognitive and behavioral changes in a patient.

Our neuropsychologist assesses the extent of

any impairment during the course of the disease,

and makes recommendations that can enhance

patients’ quality of life. The neuropsychologist

collaborates with a speech pathologist to design

cognitive rehabilitation when indicated.

The Future of Neurosurgery is Here

Intraoperative MRI and CT Dartmouth’s Center for Surgical Innovation is

a high tech pavilion. The skillful integration of

equipment, mechanical systems, and configuration

allows the surgeon to have access to an overhead

rail-mounted MRI and CT scanner within

configurable operating rooms. This outstanding

intraoperative imaging before, during, and after

complex procedures greatly improves precision

and safety— by increasing the assurance of the

completeness of resection. Advanced functional

imaging allows for strategic brain tumor biopsy,

real-time imaging during resection of brain

tumors, and the opportunity to check for brain

shift following a craniotomy.

Advanced Neurosurgical TreatmentsDartmouth is a leading institution in North

America on the use of fluorescence-guided

neurosurgery to selectively tag brain tumor tissue

with fluorescent dye. This technology allows

surgeons to visually discriminate between normal

and tumor tissues to improve the accuracy of a

tumor resection.

(See page 7, at right.)

An Exceptional Program An Exceptional Program

Neurosurgical Pituitary Procedures We also offer sophisticated, minimally invasive

approaches for pituitary tumors.

●● Transsphenoidal Microneurosurgery: A direct

approach through the nostrils to enter the

sphenoid sinus behind the nose for resection

of pituitary tumors. The tumor can then be

removed while the normal brain structures are

protected.

●● Endoscopic pituitary surgery: A minimally invasive approach to reach pituitary tumors without cutting the face or the skull. A neurosurgeon inserts an endoscope, equipped with a microscope, camera, and light, through the nose to remove the tumor.

6 7

computer generated rendering

A Glowing Pink Brain Tumor is Easier to RemoveTo better

differentiate

between tumor

cells and healthy

tissue, surgeons

give patients

an oral dose of

the chemical

5-aminolevulinic acid (ALA). An enzyme

metabolizes ALA, producing the fluorescent

protein protoporphyrin IX (PpIX). Tumor

cells have metabolisms that are different

than normal cells—so they accumulate more

PpIX—and therefore fluoresce or “glow”

when exposed to blue light.

A team of Dartmouth researchers and

surgeons developed a probe and later a

wide-field imaging system that combines

violet-blue and white light to simultaneously

analyze both the concentration of PpIX and

four other tumor biomarkers.

Our imaging technology reads how light

travels when it hits the tissue, sends

quantitative information to a computer, runs

it through an algorithm, and identifies which

tissue is cancerous and which is not.

This allows us to do more precise and radical

surgical excision of a malignant brain tumor

while leaving healthy tissue unharmed.

Shared Decision Making

The stakes are high when facing treatment for a

brain tumor. The risks associated with treatment can

be serious, such as changes in mental functioning,

fertility, or balance. Through shared decision

making, we use validated clinical tools to help

patients and families explore treatment options.

Shared decision making is a process that occurs

over a series of counseling sessions at the clinic and

requires patients and families to review and discuss

materials at home. Though the process can vary

depending on each case, patients and families often

take the following steps to make a decision.

●● Evaluate benefits and risks of each treatment

option.

●● Clarify personal values as they relate to the risks

and benefits.

●● Determine if they have enough information and

support to make a decision.

●● Make a decision.

●● Check the certainty of their decision.

This process helps ensure that patients are

confident and comfortable with their choices.

An Exceptional Patient Experience An Exceptional Patient Experience

Supporting Patients and Families Each patient in the Neuro-Oncology program is

treated in a patient-centered environment that

respects and appreciates the individual and family.

We offer a wide array of education, support, and

expressive arts programs to help soothe anxiety and

manage pain while improving coping skills.

I enjoy going to see my team. They are friendlier

than you expect a doctor to be. They greet me like,

‘Hey how are you doing? It’s nice to see you.’ I think

they are happy to see me and I feel the same way.

I have gotten to know them a little bit too. It helps

that the care has turned out so well. I speak highly of

them to everyone.”

- Ben, 28 years old, New Hampshire

I’ve felt pretty well cared for throughout the process

and have tremendous respect and gratitude for Dr. Fadul

and the other folks I received treatment from. When I was

first diagnosed and considering options, I checked out a

lot of experimental therapies—clinical trials. It turned out

the one I chose was Dr. Fadul’s own program. It seemed

intuitively sensible to me. I was very glad that I went

through the study. I think it helped me out.”

- Tony, 52 years old, Vermont

Think about how scary this can be for the patient. Many patients diagnosed with brain cancer are people who have been healthy all their lives. Abruptly they start having headaches or have a seizure, prompting diagnostic tests that show brain cancer. It comes from nowhere. It’s shocking. This is the mental and emotional state of patients initially diagnosed with brain cancer.”

- Camilo Fadul, MD, Neuro-Oncology Program Leader

Patients and families can take advantage of free classes like mindfulness meditation, expressive arts, and Tai Chi as part of our Patient and Family Support Services program. We also offer support groups, massage, and Reiki.

8 9

An Exceptional Professional Staff

Engineered for TeamworkAt Dartmouth, we fundamentally believe in the

power of teams to develop clinical solutions for

individuals and populations. Our operational

structure and physical space nurtures team

science—putting professionals from different fields

in daily contact with one another to ask tough

questions and find the answers. Innovation evolves

when there is a wide range of perspectives at the

same table.

NEURO-ONCOLOGY PROGRAMDartmouth-Hitchcock Norris Cotton Cancer Center One Medical Center Drive Lebanon, NH 03756

Phone: (603) 650-6312 Fax: (603) 653-0610

cancer.dartmouth.edu/brain

From Bench to BedsideResearchers and clinicians collaborate to apply

scientific findings to improve cancer care. Neuro-

Oncology patients have the opportunity to

participate in clinical research for new medications

and surgeries.

From Bench to Bedside

Our researchers are conducting clinical trials to

study the interaction between brain tumors and

the immune system. This information will allow

the development of more effective therapeutic

options for glioblastomas, the most frequent and

lethal primary brain tumor. These studies not only

take advantage of the cellular immune response by

vaccination, but also explore the humoral immune

armamentarium by eliciting an antibody response.

Pushing New Advances in Imaging

Researchers from the Thayer School of

Engineering and the Geisel School of Medicine

at Dartmouth have spearheaded new technology

in navigational tools used in the operating room,

developing more precise and safer surgical

procedures for patients with brain tumors. Studies

using fluorescence to aid in surgical excision have

allowed removal of tumor tissue that would have

otherwise been left behind.

Mapping Genetic Signatures

In another area researchers are using brain tissue

to identify biomarkers that can help individualize

treatment plans and and guide the therapeutic

approach.


The Neuro-Oncology team is comprised of

specialists from:

●● Neuro-Oncology

●● Radiation Oncology

●● Neurosurgery

●● Neuroradiology

●● Neuropathology

●● Neuropsychology

●● Palliative Care

●● Nursing

●● Social Work

Patients see each member of the team so their

questions can be answered by the appropriate

specialist. These visits are coordinated for their

convenience, with diagnostic testing usually done

the same day.

10 11

NEURO BASIC SCIENCE

Specialties●● Neuro-Oncology/Brain Tumor Program

●● Hematology/Oncology

●● Pediatric Cancer Program

●● Pediatric Hematology/Oncology

Medical SchoolMD, Albert Einstein College of Medicine, New York, NY, 1973

ResidencyChildren’s Hospital Boston, Boston, MA, Pediatrics, 1973-75

FellowshipNational Cancer Institute, National Institutes of Health, Bethesda, MD, Pediatric Hematology/Oncology, 1981-84

Board CertificationPediatrics, 1982

Joined Staff in 2001

Practice NoteGenetics, hematology/oncology, pediatric hematology, pediatric oncology.

Mark A. Israel, MD Director, Norris Cotton

Cancer Center

NEUROSURGERY


●● Endocrine Tumors Program

●● Hematology/Oncology

●● Lymphoma/Leukemia Program

●● Neurology

Medical SchoolMD, School of Medicine, Universidad del Rosario, Bogota, Colombia, 1980

ResidenciesHospital Militar Central, Universidad del Rosario, Bogota, Colombia, Rotating, 1979-80

Hospital Militar Central, Universidad del Rosario, Bogota, Colombia, Neurology, 1981-84

Dartmouth-Hitchcock Medical Center, Lebanon, NH, Neurology, 1992-94

FellowshipsVanderbilt University School of Medicine, Nashville, TN, Neurology, 1984-85

Cornell University Medical Center/Memorial Sloan-Kettering Cancer Center, New York, NY, Neurologic Oncology, 1985-87

Board CertificationNeurology, 2006, 1996


Practice NoteNeurologic complications of systemic cancer, primary brain tumors.

Camilo E. Fadul, MDNeuro-Oncology Program Leader

NEURO-ONCOLOGY


●● Neurosurgery

●● Neurosurgery–Cancer

●● Surgical Oncology

Medical SchoolMD, Dartmouth Medical School, Hanover, NH, 1975

InternshipUniversity of Utah School of Medicine, Salt Lake City, UT, General Surgery, 1975-76

ResidencyDartmouth-Hitchcock Medical Center, Lebanon, NH, Neurosurgery, 1978-82

Board CertificationNeurological Surgery, 1985


Practice NoteBrain tumors, epileptic disorders, stereotactic and functional neurosurgery, trigeminal neuralgia.

David W. Roberts, MDSection Chief, Neurosurgery


Medical SchoolMD, University of Pittsburgh School of Medicine, Pittsburgh, PA, 1994

InternshipSt. Joseph Mercy Hospital, Ann Arbor, MI, Internal Medicine, 1994-95

ResidencyUniversity of Michigan Medical Center, Ann Arbor, MI, Neurology, 1995-98

FellowshipThe University of Texas - M.D. Anderson Cancer Center, Houston, TX, Neuro-Oncology, 1998-99

Board CertificationNeurology, 1999, 2009


Practice NoteNeuro-oncology, primary brain tumors, neurologic complications of cancer, metastatic brain tumors, end-of-life care, palliative care in neurology, headache, post-concussion care, immunologic neurological disease.

Lara Ronan, MD

OU

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EA

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Brain Surgeons are Schooled in Continuous Quality ImprovementEight years ago Neuro-Oncology Program

Leader Camilo Fadul, MD, reached out to The

Dartmouth Institute for Health Policy and

Clinical Practice. Dr. Fadul wanted his team

to learn from the Microsystems Academy, a

Dartmouth program that helps provider groups

improve patient care.

Mark Israel, MD, Evelyn Schlosser, MPH, RN,

and David Roberts, MD, sponsored a quality

improvement team to measure best practice

indicators. With a goal of reducing process

variation and maximizing safety and efficiency,

the group made a flow chart of how patients

enter and move through the program. From

this schematic chart, they selected the initial

diagnostic assessment and care planning phase

for the scope of their project. They established

a set of 10 best-practice indicators to measure.

During the pilot, compliance rose from 66 to

91 percent. Today the team continues to isolate

processes for quality improvement projects.

The team is now focused on acute care with

radiation and chemotherapy, adding 20 new

best practice measurements to its quality

dashboard. By involving patients and families,

the team ensures that the measurements

assessed are patient centered.


Culture of CaringWe track key clinical outcomes and measure

performance to improve patient care and safety.

With sophisticated quality tools and approaches—

and dedicated quality experts through Dartmouth-

Hitchcock’s Value Institute—the Neuro-Oncology

program holds itself to the highest standards of

quality care.

The program uses quality improvement

performance measurements based on best practice

indicators.

12 13


●● Neurosurgery


●● Spine Oncology Clinic

Medical SchoolMD, Columbia University College of Physicians and Surgeons, New York, NY, 2003

InternshipDartmouth-Hitchcock Medical Center, Lebanon, NH, General Surgery, 2003-04

ResidencyDartmouth-Hitchcock Medical Center, Lebanon, NH, Neurosurgery, 2004-09

FellowshipCleveland Clinic, Cleveland, OH, Spine Surgery, 2009-10


Practice NoteCervical, thoracic and lumbar spine surgery, head and spine injuries, spinal disorders, spinal tumors.

S. Scott Lollis, MD

OU

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EA

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●● Endocrine Tumors Program

●● Neurosurgery


●● Spine

●● Surgical Oncology

Medical SchoolMD, University of Virginia School of Medicine, Charlottesville, VA, 1993

InternshipUniversity of Virginia Health Sciences Center, Charlottesville, VA, General Surgery, 1993-94

ResidencyUniversity of Virginia Health Sciences Center, Charlottesville, VA, Neurosurgery, 1994-2000

Board CertificationNeurological Surgery, 2003


Practice NoteBrain tumors, general neurosurgery, pituitary surgery, spinal injuries, spinal surgery, spinal tumors.

Nathan E. Simmons, MD

NEUROSURGERY

RADIATION ONCOLOGY

NEURORADIOLOGY

OU

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EA

M

14 15


●● Breast Cancer Program

●● Lymphoma/Leukemia Program

●● Melanoma/Skin Cancer Program



●● Spine Oncology Clinic

Medical SchoolMD, Stanford University School of Medicine, Stanford, CA, 2003

EducationPhD, Stanford University School of Medicine, Stanford, CA, 2007

ResidencyStanford University Medical Center, Stanford, CA, Radiation Oncology, 2004-08

Board CertificationRadiation Oncology, 2009


Practice NoteBreast cancer, CNS oncology, and lymphoma.

Lesley A. Jarvis, MD, PhD



Medical SchoolMD, University of Arizona College of Medicine, Tucson, AZ, 2007

Education

PhD, University of Arizona, Tucson, AZ , Cancer Biology, 2005

InternshipTucson Hospital’s Medical Education Program, Tucson, AZ, Transitional, 2007-08

ResidencyUniversity of Arizona Health Sciences Center, Tucson, AZ, Radiation Oncology, 2008-12


Practice NoteIntensity modulated radiation therapy, stereotactic radiosurgery.

Thomas C. Sroka, MD, PhD


●● Head & Neck Cancer Program

●● Lung/Esophageal/Thoracic Cancer Program

●● Melanoma/Skin Cancer Program


●● Prostate & Genitourinary Cancer Program


Medical SchoolMD, Harvard Medical School, Boston, MA, 1992

EducationPhD, Harvard University, Boston, MA, 1997

InternshipNew England Deaconess Hospital, Boston, MA, Medicine, 1992-93

ResidencyMassachusetts General Hospital, Boston, MA, Radiation Oncology, 1993-98

FellowshipMassachusetts General Hospital, Boston, MA, Radiation Oncology, 1998-99

Board CertificationRadiation Oncology, 2010,1999


Practice NoteCNS oncology, genitourinary cancer, head and neck cancer, intensity modulated radiation therapy, lung tumors, prostate brachytherapy, stereotactic radiosurgery.

Alan Charles Hartford, MD, PhD

Section Chief, Radiation Oncology (Interim)


●● Head & Neck Cancer Program

●● Radiology

●● Radiology–Cancer

Medical SchoolMD, Albany Medical College, Albany, NY, 1990

InternshipAlbany Medical Center, Albany, NY, Medicine, 1990-91

ResidenciesUniversity of Florida Health Science Center, Gainesville, FL, Radiology, 1992-96

University of Florida Health Science Center, Gainesville, FL, Ophthalmology, 1991-92

FellowshipJohns Hopkins Hospital, Baltimore, MD, Neuroradiology, 1996-98

Board CertificationDiagnostic Radiology, 1996

Neuroradiology, 2001


Clifford Belden, MDChair, Department of

Radiology

NEURORADIOLOGY

ADDITIONAL PROVIDERS

Specialty●● Neuropsychology

EducationPhD, University of Victoria, Victoria, BC, Canada 1994

InternshipLong Island Jewish Medical Center, New Hyde Park, NY, Clinical Psychology (Neuropsychology), 1991-92

FellowshipUniversity of Rochester Medical Center, Rochester, NY, Clinical Neuropsychology, 1995-97


Practice NoteBrain imaging research.

Specialty●● Advanced Practice Nursing

EducationMSN, University of Pennsylvania, Philadelphia, PA , 2011

Board CertificationAdult Nurse Practitioner, 2011

Joined Staff in 2011 Practice NoteHematology/Oncology Program

Lymphoma/Leukemia Program

Specialty●● Social Work

EducationUniversity of New Hampshire, MSW 1997

Board CertificationNew Hampshire Board of Mental Health Practice Licensed Independent Clinical Social Worker (LICSW)

Joined Staff in 1997 Practice NotePsychosocial oncology, patient and family centered care, family caregivers

Heather Wishart, PhD

Melissa C. Davis, APRN, MSN

Linda Mason, MSW, LICSW

Continuing Care Manager


●● Radiology

Medical SchoolMD, University of Pittsburgh School of Medicine, Pittsburgh, PA, 1993

EducationPhD, Carnegie Mellon University, Pittsburgh, PA, 1993

InternshipUniversity of Pittsburgh Medical Center, Pittsburgh, PA, Internal Medicine, 1993-94

ResidencyMassachusetts General Hospital, Boston, MA, Radiology, 1994-98

FellowshipsMassachusetts General Hospital, Boston, MA, Neuroradiology, 1998-99

Massachusetts General Hospital, Boston, MA, Interventional Neuroradiology, 2004-05

Board CertificationDiagnostic Radiology, 1998

Neuroradiology, 2010, 2000


Practice NoteCerebral aneurysms, AVMs, stroke, cerebral perfusion, brain tumors, head and neck tumors, interventional neuroradiology, neurointerventional surgery.

Clifford J. Eskey, MD, PhDDirector, Neuroradiology

NEURO-ONCOLOGY PROGRAMDartmouth-Hitchcock Norris Cotton Cancer Center

One Medical Center DriveLebanon, NH 03756

Phone: (603) 650-6312Fax: (603) 653-0610

cancer.dartmouth.edu/brain

Expertise you Can Trust

Affiliations

A teaching and research hospital of The Geisel School of Medicine at Dartmouth.

Optics in Medicine Laboratory at Dartmouth A program comprised of researchers at the Thayer School of Engineering at Dartmouth, the Geisel School of Medicine at Dartmouth, and Dartmouth’s Arts and Sciences Graduate Programs. The Optics in Medicine Laboratory studies aspects of tissue spectroscopy and imaging using both visible and near-infrared light.

Designations

Norris Cotton Cancer Center is one of only 41 centers nationwide to earn this designation.

NCI Center of Quantitative Imaging Excellence One of 15 institutions identified by a National Institutes of Health peer review process for excellence in conducting clinical trials in which there is an integral molecular and/or functional advanced imaging endpoint in brain and body imaging.

Dartmouth-Hitchcock Medical Center has earned the Joint Commission’s Gold Seal of Approval.

Clinical Research Memberships

ALLIANCEFOR CLINICAL TRIALS IN ONCOLOGY

The Alliance for Clinical Trials in Oncology represents the merger of three legacy cooperative groups: American College of Surgeons Oncology Group (ACOSOG), Cancer and Leukemia Group B (CALGB), and North Central Cancer Treatment Group (NCCTG).

NRG Oncology represents the merger of three unique and complementary research areas: National Surgical Adjuvant Breast and Bowel Project (NSABP), Radiation Therapy Oncology Group (RTOG), Gynecologic Oncology Group (GOG).

ECOG-ACRIN Cancer Research Group is a cooperative group that was formed by the merger of the Eastern Cooperative Oncology Group (ECOG) and the American College of Radiology Imaging Network (ACRIN).

Cancer Immunotherapy Consortium, an international association of the Cancer Research Institute, comprised of pharmaceutical/biotech companies and academic institutions that share a common interest in immunotherapy research and development. Cancer Immunotherapy Trials Network (CITN) employs the collective expertise of top academic immunologists to conduct multicenter research on immunotherapy agents capable of unleashing patient immunity to fight their cancer.

Documents

Dartmouth-Hitchcock Norris Cotton Cancer Centercancer.dartmouth.edu/neuro-brain/documents/Neuro... · Dartmouth-Hitchcock Norris Cotton Cancer Center. ... The Neuro-Oncology program