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Treatment Options

Surgery

Surgery is often the first treatment used. Unfortunately not all brain tumors can be removed. Still, it is helpful when even a small piece of the tumor (biopsy) can be removed to diagnose and guide treatment. Surgery is often followed by radiation or chemotherapy. These options are used to kill cancer cells left behind.

Radiation Therapy

Radiation can kill cancer cells or keep them from growing. Radiation is also used to relieve symptoms if the tumor presses on certain areas of the brain. The way radiation therapy is given depends on the type and location of the tumor. The types of radiation therapy used to treat brain and spinal tumors include:

  • External beam radiation therapy (EBRT) - This option is similar to an X-ray, but it gives the higher doses needed to treat brain tumors. To protect normal brain tissue, doctors try to deliver the lowest possible dose of radiation. To make sure the radiation gets to the tumor and avoids healthy tissue, your radiation oncologist may use:
    • Three-dimensional conformal radiation therapy (3D-CRT): 3D-CRT focuses several radiation beams at the tumor at once. The beams are directed by a computer with details on the tumor’s location.
    • Intensity modulated radiation therapy (IMRT): IMRT also uses a computer to deliver radiation. The intensity of the radiation can be targeted to protect healthy tissue.
    • Proton beam radiation therapy: Protons are different than X-rays, and are less likely to damage healthy tissue. Most cancer centers don’t offer proton radiation. It is used mainly for chordomas and brain tumors in children and young adults.
  • Stereotactic radiosurgery - This is a type of radiation therapy, not a type of surgery. It is sometimes called gammaknife, X-Knife, or CyberKnife radiation. It can be given in just one or two sessions.
  • Brachytherapy - This procedure involves putting radioactive material inside or near the tumor.
  • Whole brain and spinal cord radiation therapy (craniospinal radiation) - This type of radiation is used if the tumor has spread to the spinal cord covering (meninges) or into cerebrospinal fluid.

Chemotherapy

Chemotherapy uses drugs to stop the growth of cancer cells. It either kills the cells or stops them from dividing. It is called a “systemic” treatment because it can kill cancer cells throughout your body. Some types are better at going through the blood-brain barrier than others. Chemotherapy is given in cycles. Some of the drugs used to treat brain tumors include (alone or in combination):

  • Carboplatin
  • Carmustine (as a wafer)
  • Cisplatin
  • Cyclophosphamide
  • Etoposide
  • Irinotecan
  • Lomustine
  • Methotrexate
  • Procarbazine
  • Temozolomide
  • Vincristine

Targeted Molecular Therapies

Targeted therapies focus on correcting or stopping specific cell signals known to help cancer cells grow and spread. These drugs work by stopping, for example, the blood supply to a tumor or by blocking a growth signal in cancer cells. These drugs can destroy cancer cells with less harm to healthy cells, and cause fewer side effects. These drugs can be used to deliver cancer-killing drugs (like chemotherapy) directly to cancer cells.

Targeted therapy drugs are designed to work with a specific molecular target. Not all brain tumors have the same targets. Tests are used to learn which genes, proteins, or other factors may be “targeted” in your tumor.

The U.S. Food and Drug Administration (FDA) has approved two targeted drugs for brain tumor treatment. Avastin® (bevacizumab) is approved for recurrent glioblastoma and Afinitor ® (everolimus) for subependymal giant cell astrocytoma.

Tumor Treating Fields

Tumor Treating Fields (TTF) is a new innovation for treating brain tumors. These are electrodes placed on the head to treat glioblastomas. The electrode pads are placed over a solid brain tumor with a type of “cap”. This wearable device delivers low frequencyelectric currents that can block cells from dividing. It can stop or delay cancer cells from growing. It causes few side effects.

TTF is an FDA-approved wearable device for glioblastoma. Clinical trials have shown an approximately 3-month survival benefit when it is used in newly-diagnosed glioblastoma in conjunction with temozolomide chemotherapy.

Immunotherapies

These are vaccines or drugs that stimulate the immune system to kill cancer cells. They are being studied to see if they can treat primary and secondary brain tumors.

Drugs to Help with Symptoms

Brain tumors can cause swelling, headaches, seizures and hormonal problems. To help with these problems your doctor may prescribe:

  • Corticosteroids - to reduce swelling
  • Anti-seizure medications

Clinical Trials

Clinical trials are research studies used to develop new treatments for brain and other tumors. They are important because they offer new options. Some clinical trials focus on treatment, others aim to improve a patient’s quality of life.