Surgery is the most common treatment, however, there are some brain tumors that it may not be possible to remove. However, even for tumors that cannot be removed, obtaining a small piece of the tumor (biopsy) can be very helpful in helping to make a diagnosis and guiding treatment. Surgery is often followed by radiation or chemotherapy, which is used to kill cancer cells that may have been left behind.
Radiation can kill cancer cells or keep them from growing. Radiation may also be used to relieve symptoms if the tumor is pressing on certain areas of the brain that are causing you to have headaches or seizures. The way the radiation therapy is given depends on the type of tumor and where it is in the brain. The types of radiation therapy used to treat brain and spinal tumors include:
- External beam radiation therapy (EBRT) - This procedure is similar to an X-ray, but it is able to give the higher doses needed to treat brain tumors. High doses of radiation therapy can damage normal brain tissue, so doctors try to deliver the radiation to the tumor with the lowest possible dose to normal surrounding brain areas. To make sure the radiation gets the tumor and avoids as much healthy tissue possible, your radiation oncologist may use:
- Three-dimensional conformal radiation therapy (3D-CRT): This procedure focuses several radiation beams at the tumor at once. The beams are directed by a computer which has evaluated the location of the tumor.
- Intensity modulated radiation therapy (IMRT): This procedure also uses a computer to deliver radiation. The intensity of the radiation can be adjusted to target the tumor while protecting healthy tissue.
- Conformal proton beam radiation therapy: Protons are different than X-rays, and are less likely to damage healthy tissue. Most cancer centers do not offer proton radiation. It is used primarily for chordomas.
- Stereotactic radiosurgery - Although it includes the word surgery, this is really another type of radiation therapy. It is sometimes referred to as gammaknife, X-Knife, or CyberKnife radiation. It differs from other types of radiation, because it can be given in one session, although some doctors prefer to use a couple of 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 covering of the spinal cord (meninges) or into the surrounding cerebrospinal fluid.
Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It is called a “systemic” treatment because it is able to kill cancer cells throughout your body. Chemotherapy is given in cycles. Some of the chemo drugs used to treat brain tumors include (alone or in combination):
Targeted Molecular Therapies
These are drugs that block specific molecular targets on tumor cells. Bevacizumab is an antibody that is commonly used to treatment glioblastoma.
Tumor Treating Fields
These are electrodes placed on the head to treat glioblastomas.
These are vaccines or drugs which stimulate the immune system that 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