Treatment
Treatment for brain tumors depends on factors including the tumor's type, grade, size, location, whether it has invaded other parts of the brain, and whether it has spread outside the brain and/or central nervous system. Treatment for brain tumors may include surgery, chemotherapy, radiation therapy, and targeted therapy. You may be closely monitored before given any treatment to observe any changes in your condition. Your doctor will develop a specific treatment plan for you and explain his or her expectations and any possible side effects of the treatment. Here are some treatments your doctor may recommend for your brain tumor:
Surgery
Surgery is the primary treatment for most brain tumors. Even when the cancer is widespread and aggressive, your doctor may still perform surgery in order to identify the type of tumor and/or remove as much of the tumor as possible. This treatment may help relieve symptoms and prevent complications caused by the tumor pressing on or invading healthy tissue. Removing as much of the tumor as possible may also help the effectiveness of chemotherapy and radiation treatments. The most common surgery for brain tumors is a craniotomy, in which a neurosurgeon removes a part of your skull and removes your tumor through the opening. A piece of the tumor may be sent for "frozen section" or rapid analysis by another doctor, the pathologist, for preliminary determination of which type of tumor is present. After a craniotomy, your doctor usually closes the opening by securing the removed piece of bone with metal clips. These clips are often made of a special type of metal called titanium that will not prevent you from having MRI imaging in the future to follow up on your brain tumor.
Radiation Therapy
During radiation therapy, high-energy rays are used to kill cancer cells in the area being treated. Many brain tumors form in deep or delicate parts of the brain that make them impossible to remove without causing serious damage. Doctors specializing in the use of therapeutic radiation (radiation oncologists) often use radiation therapy as the primary treatment for brain tumors that cannot be surgically removed. These doctors may also use radiation therapy to destroy any cancer cells that remain after surgery. All of the techniques described below use an external source of radiotherapy (external beam radiotherapy), which means you will not be radioactive following this treatment. In all of these approaches, your radiation oncologist will use MRI images (if available) combined with CT images obtained at time of simulation for radiation treatment planning. Immobilization devices will be used to keep your head in the same position for daily treatment of radiation. These devices may include a mask for most treatments or a minimally invasive head frame for some types of very-focused (stereotactic) radiotherapy.
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Three-dimensional conformal radiation therapy (3D-CRT)
3D conformal radiotherapy uses CT images to map out or “simulate” the tumor and normal tissues so that a few X-ray beams can be shaped to conform to the target. The radiation dose to the tumor and normal tissues can be measured as a function of volume. Because of the limited number of X-ray beams, some nearby normal tissues may receive the same dose as the tumor.
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Intensity-modulated radiotherapy (IMRT)
Intensity modulated radiotherapy (IMRT) uses even more X-ray beams and beam angles to permit variations in the dose pattern so that the tumor will receive a higher total dose than the normal tissues.
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Proton beam radiation therapy
Proton beam radiotherapy is a type of external beam radiotherapy that uses heavy positively charged particles (versus X-rays) that have a limited penetration in tissue. (X-rays pass all the way through the body.) This type of radiation can allow better sparing of nearby normal tissues than either 3D conformal or IMRT due to the shorter path of the proton beam.
- Please see Understanding Proton Therapy for more information
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Stereotactic radiation therapy
Stereotactic radiotherapy is a technique used to deliver very focused beams or arcs of radiation to produce a high dose to a small tumor target, with sharp dose fall off to protect the nearby normal tissues. Unlike the other treatments discussed above, stereotactic radiotherapy is delivered in one or just a few treatments.
Additional Treatments
Your doctor may also recommend any of the following treatments:
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Targeted Therapy
Some brain tumors contain cells that overexpress certain genes and proteins, which cause the tumor to grow more rapidly and act more aggressively. Targeted therapy specifically identifies and damages these cells, preventing the proteins from fueling cell growth.
Chemotherapy
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to eliminate cancer cells. Most conventional chemotherapy drugs are not effective against brain tumors because they cannot penetrate the blood-brain barrier. Your doctor may use some forms of chemotherapy in combination with surgery and radiation therapy to treat some aggressive tumors. For a brain tumor, you may receive chemotherapy by mouth (orally) or by injection into your bloodstream (intravenously), or your doctor may place several wafers (discs with the chemotherapeutic agent incorporated into them) near the tumor after surgery. These wafers release chemotherapy drugs into the brain slowly as they dissolve. This approach allows your doctor to concentrate the drug at the tumor site so it doesn't cause side effects throughout the body.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase (phase I) clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may identify a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
Immunotherapy is a new cancer treatment that stimulates the body's immune system to attack cancer cells. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy. Immunotherapy is being studied for the treatment of some types of brain tumors. Cancer vaccines are uncommon, but are also currently being studied in clinical trials.
