Treatment for Brain Tumors

There are a number of different treatments for brain tumors. Most brain tumors are treated with a combination of multiple different types of therapy. The exact location and type of brain tumor will dictate which treatments are recommended.

Surgery
Surgical resection is recommended for the majority of brain tumors. It is rare that a primary brain tumor can be cured without a surgical resection. However, the location of the brain tumor will dictate whether or not surgery is an option. Some tumors are seated in places in the brain that are just too dangerous to operate on, and surgery cannot be employed. The risks to the patient from surgery depend on the location and size of the tumor. Talk to your neurosurgeon about the specific risks of your planned surgery.

Chemotherapy
Chemotherapy is the use of anti-cancer drugs that go throughout the entire body. These drugs may be given through a vein or with pills by mouth. One of the special challenges in treating brain tumors with chemotherapy is that there is a natural barrier between the brain and the blood, which blocks many medications from entering the brain. Only certain chemotherapy drugs can cross this blood-brain barrier to treat disease in the nervous system. One of the new ways that chemotherapy can be delivered for brain tumors is by implantation on a biodegradable wafer that is inserted by the neurosurgeon into the space left behind after surgery (called the tumor bed ). The chemotherapy wafer can then deliver high doses of chemotherapy to a localized area. Chemotherapy wafers are only approved for certain brain tumors, although future research may prove this approach useful for more diseases.
For advanced brain tumors (Stage IV also known as Glioblastoma Multiforme) the most commonly used chemotherapy is known as Temozolamide, an alkylating chemotherapy. It has been shown to be effective when used with radiation after surgery. Additional temozolamide is given about four weeks after completing radiation and chemotherapy, usually for 6 months.
There are many other different chemotherapy drugs used for brain tumors, and your medical oncologist can explain why he or she recommends one particular regimen over another in your case.

Radiation
Radiation therapy uses high energy rays (similar to x-rays) to kill cancer cells. Radiation can come from an external source (called external beam radiation therapy ), and it requires patients to come in 5 days a week for up to 6-8 weeks to a radiation therapy treatment center. The treatment takes just a few minutes, and it is painless. External beam radiation therapy is often employed for brain tumors, both as primary treatment for unresectable tumors and in addition to surgery.
Radiation therapy can also be given to a very focused area of the brain using a technique called stereotactic radiosurgery. Stereotactic radiosurgery requires a patient to have a head frame attached, so that a precise map can be made of the patient's head. Radiation is then focused from a variety of different angles to deliver a large radiation dose to the tumor or tumor bed. This can be performed using the same machine that delivers external beam radiation or by a special machine called a gamma knife.
Radiation can also be given internally by implanting high strength radioactive sources in the vicinity of the tumor or the tumor bed. This is called brachytherapy. This can be done with radioactive seeds which are placed directly into the tumor bed or by using a balloon like device, known as a GliaSite, which can be placed into the cavity left after the surgery. The balloon is connected to a small “button” (also known as a port) which is placed under the skin of the scalp. Your physician can then perform a brain CT and determine how much radiation is needed to treat the tumor bed. The port can be accessed with a needle through the skin, which allows the physician to inject a radioactive liquid into the balloon, which can then treat the tumor bed. After injecting the radioactive liquid, you usually need to stay in the hospital while the radiation is working (usually about 5 days). The radioactive liquid is then removed and, often times, the balloon is then removed surgically.
Occasionally, your physician may recommend a type of radiation known as Intensity Modulated Radiation Therapy (IMRT) for treatment. If the brain tumor is close to critical structures within the brain which are more sensitive to radiation damage, such as the nerves of the eyes or the brainstem, IMRT can be used to avoid these structures. IMRT is not beneficial in ever case and your physician can discuss this treatment option with you further.
Your radiation oncologist can answer questions about the utility, process, and side effects of any of the above mentioned types of radiation and can recommend the best type of radiation therapy in your particular case.

Follow-up testing
Once a patient has been treated for a brain tumor, he or she needs to be closely followed for a recurrence. At first, the patient will have follow-up visits fairly often. The longer he or she is free of disease, the less often he or she will have to go for checkups with examinations. The doctor will decide when to obtain follow-up MRI scans or PET scans.
Clinical trials are extremely important in furthering our knowledge of this disease. It is though clinical trials that we know what we do today, and many exciting new therapies are currently being tested. Talk to your doctor about participating in clinical trials in your area.
This article is meant to give you a better understanding of brain tumors. Use this knowledge when meeting with your physician, making treatment decisions, and continuing your search for information. You can learn more about other brain tumors on OncoLink through the related links to the left.