Proton therapy helped treat grad student’s extensive meningioma

Erin Bremmer was working on her graduate degree in clinical mental health counseling at Southern Oregon University in Ashland, Oregon, when the double vision she’d been experiencing now and then suddenly worsened.

It was right before Thanksgiving in 2023 and her husband, Ryan, took her to the emergency room where the ER team took brain scans and sent them to specialists in Portland, Oregon for interpretation.

They discovered that a benign meningioma (a tumor growing in the membrane surrounding the brain) was putting pressure on the cranial nerve at the base of Bremmer’s skull, which is involved in eye movement.

A woman smiling at the camera in front of tree, wearing a Seattle sweatshirt. — Erin Bremmer poses at Green Lake. Photo courtesy of Erin Bremmer

She went to see a neurologist after her diagnosis and was told the tumor was inoperable due to its location; treatment would involve radiation only. The prognosis sounded dire to her, so she asked about proton therapy, which Ryan and her father had learned about while researching treatment options for meningioma.

Since there were no proton therapy centers in Oregon, Bremmer reached out to two proton centers in California, where she grew up. Neither option worked out, so she scheduled a consultation with Yolanda Tseng, MD, a radiation oncologist who specializes in brain and central nervous system tumors at Fred Hutch Cancer Center – Proton Therapy.

“I was about to have the consult with Dr. Tseng, when the office called and requested I get additional MRIs,” said Bremmer. “I was confused because they wanted to see images of my face and my neck. When I met her, Dr. Tseng referenced my brain and neck tumor! Dr. Tseng told me that the original scan showed the meningioma continuing past the scan and she wanted to see how far down my neck the tumor went. Several doctors had looked at the scan and Dr. Tseng was the first one to notice.”

Bremmer’s case was evaluated in conjunction with Fred Hutch neuro-oncologist, Jerome Graber, MD, MPH. Because Bremmer had experienced some issues around her left ear since 2016, Graber requested all of her old MRIs to review, which showed that her tumor extended past the ear, too.

“No one since [the first MRI in] 2016 had noticed the tumor!” said Bremmer.

Based on Tseng and Graber’s reviews and recommendation, Bremmer met with Fred Hutch and UW Medicine surgeon Manuel Ferreira, MD, PhD, at the Alvord Brain Tumor Center at UW Medical Center - Montlake. Ferreira said he could do a debulking surgery on her tumor, a procedure that would remove part of the tumor to take pressure off her cranial nerve, likely resolving her double vision.

“It was amazing. All this time I had thought surgery wasn’t an option at all, because I might end up needing breathing and feeding tubes and that without surgery, I would never get my normal vision back!” said Bremmer. “But I did! Since Dr. Ferreira did the debulking surgery, my vision has improved. It did cause other unforeseen problems, though.”

While the debulking surgery in May 2024 helped with her vision, it did make swallowing and speech much more difficult. At first, she could barely manage to take sips of water and spoonfuls of applesauce. Her physicians credit Bremmer’s tenacity in avoiding the need for a feeding tube. She’s had to do a lot of therapy since the surgery to regain speech and the ability to eat, but Bremmer is undaunted.

“Dr. Tseng, Dr. Graber and Dr. Ferreira saved my life,” she said.

A couple smiles at the camera in front of a fireplace. — Erin Bremmer and her husband, Ryan, on Erin's birthday in February 2025. Photo courtesy of Erin Bremmer

Bremmer has a large, supportive family who took turns staying with her in Seattle as she underwent treatment. Through a network of friends, they put her in touch with other people who’d had brain tumors, including another proton therapy patient in Seattle.

“I hung out with them a lot. It helped so much to talk to others who’ve been through it. They are some of the most positive people,” said Bremmer. “It motivated me to get healthy, to get back to school and help others. Having been through such an ordeal helps me relate to others who are going through trauma.”

Bremmer asked Tseng if she could proceed with proton therapy as soon as possible even though she wasn’t fully healed from the surgery. She wanted to return to graduate school in the fall. Tseng considered the advantage to having protons immediately was that post-surgery, the tumor was as small as it was ever going to be and agreed.

Bremmer said she struggled a lot with proton therapy. It wasn’t until near the end of her six-week treatment that her integrative medicine provider, Shannon Fogh, MD, discovered that her thyroid was “going bananas,” as Bremmer put it. Thyroid hormones play a vital role in regulating metabolism and energy levels, which directly impact mood and overall well-being.

In her case, Bremmer experienced emotional swings as well as strange smells and sensations while the proton beam was on. She also suffered from intense nausea and some hearing loss.

In addition to her providers, others in her care team supported her throughout treatment.

“I want to give a shoutout to Ruben and Tiffany, my radiation therapists. Everyone tried their best to help me, to listen, to get me resources,” said Bremmer. “And once I was referred to integrative medicine, the acupuncture helped me so much.”

Before or after her daily treatment, Bremmer tried to walk as much as possible, something that’s recommended to help in recovery. She enjoyed walking around Green Lake, as well as doing yoga in the mornings. Her goals each day were to eat and move.

In October, after having finished with protons in late August, she went back to graduate school. This June, she and Ryan will both graduate, and they plan to move back to Orange County to start helping others as mental health counselors. She will also have a follow-up scan done in June and said she is feeling positive about it.

"I'm proud of Erin and that, despite these twists and turns with determining the extent of her tumor and diagnosis, she moved forward one step at a time through treatment, recovery and now remission,” said Tseng. “It's a blessing to work with our multidisciplinary team — Drs. Graber and Ferreira — to ensure that our patients receive the best care."

“No one chooses a brain tumor, but you can choose how you move forward,” said Bremmer. “How you react to it, by staying as healthy as you can, being mindful, making room for self-care. Once, while I was struggling with graduate school after protons, I called my nurse, Steve, about something I don’t even remember.

“But I do remember what he said when I was emotional. ‘Most people don’t even aspire to go to grad school, but you just finished surgery and radiation and you are doing it. You can give yourself some grace.’ It was really helpful advice and helped me remember that I am still a patient, and I deserve to give myself some grace.”