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Treatment & Rehabilitation

A team of specialists will work together to treat a brain or spinal cord tumor. This team can include a neurosurgeon, neuro-oncologist, radiation oncologist, medical oncologist, neurologist, and endocrinologist. These doctors will discuss your tumor and treatment options as a team. Your options will depend on the type and size of tumor, whether it is benign or malignant, its location, and how far it has spread.

After getting advice from one team, you may want to get a second opinion from another team. A second opinion can help you learn your options and gain a better sense of what to do.

Several types of treatment are used to treat brain or spinal cord tumors. These include surgery, radiation therapy, chemotherapy, or a wearable device. A number of experimental targeted molecular therapies and vaccines or drugs designed to stimulate the immune system are undergoing investigation in clinical trials. Medications may be used to manage symptoms, such as headaches, swelling around the tumor or seizures.

Brain & Spinal Cord Tumor Treatments

Several treatments are used for brain or spinal cord tumors. These include surgery, radiation therapy, chemotherapy, immunotherapy or a wearable device. A number of experimental targeted molecular therapies, immunotherapies, and drugs are available through clinical trials.

Surgery

Surgery is often the first treatment used to remove as much of the tumor as possible. If the tumor(s) cannot be removed, at least a small sample will be used for a biopsy to diagnose and guide treatment. Surgery may be followed by radiation or chemotherapy to kill cancer cells left behind.

Radiation therapy

Radiation is used to destroy cancer cells, keep them from growing, or relieve symptoms. The way radiation therapy is given depends on the type and location of the tumor. The types used to treat brain and spinal tumors include:

  • External beam radiation therapy (EBRT) – EBRT directs high doses of radiation to the tumor(s). To protect normal brain tissue, radiation oncologists will chose the option that will work best for you:
    • 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. It is used mainly for chordomas and brain tumors in children and young adults. Most cancer centers don’t offer proton radiation.
  • Stereotactic radiosurgery - This is not surgery, but a type of radiation therapy. It is sometimes called gammaknife, X-Knife, or CyberKnife radiation. It can be given in just one or two sessions to target and destroy tumor tissue.
  • Brachytherapy - This treatment places radioactive material inside or near the tumor to kill cells.
  • Whole brain and spinal cord radiation therapy (craniospinal radiation) - This 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 a “systemic” treatment, affecting cancer cells throughout your body (and some healthy cells). They tend to cause well-known side effects. Some chemotherapy types are better at going through the blood-brain barrier than others.

Chemotherapy drugs are used alone or with others, in cycles, to treat brain tumors:

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

Targeted Molecular Therapies

Targeted therapy drugs are designed to work with a specific molecular target. They can find and stop specific cell signals known to help cancer cells grow and spread. These drugs work by targeting, for example, the blood supply to a tumor or by blocking a growth signal. They can destroy cancer cells with less harm to healthy cells. Some targeted therapies are used to deliver chemotherapy more directly to cancer cells.

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) 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-frequency electric 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 used with temozolomide chemotherapy. It is available for newly-diagnosed glioblastoma patients after standard surgery and radiation treatments. It may also be used for patients whose glioblastoma returns after treatment.

Immunotherapy

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

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.

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

Rehabilitation for Physical Symptoms

Physical symptoms like weakness, difficulty speaking, stiffness, problems with movement, etc. can be relieved with rehabilitative treatment (rehab). Every person with a brain tumor deserves to function well and should be evaluated for rehab.

Try to find a physical, occupational, and speech therapist who has worked with neurological disorders (rather than only sports injuries, for example):

  • Physical therapists help patients improve walking, balance and strength. Some people experience permanent mobility problems. Physical or occupational therapists will offer exercises to support your range of motion. They make sure your body has proper positioning to help decrease pain and stiffness.
  • Occupational therapists teach patients how to manage changes and regain skills for daily activities, such as cooking, writing, and driving.
  • Speech therapists help people overcome problems with language. They teach patients how to improve their speech process and adjust how they verbalize or otherwise express ideas. Speech therapists also help with eating and swallowing caused by oral motor problems.
  • Cognitive therapists help people develop exercises and strategies to overcome problems with thinking and memory that may result from the brain tumor.

There are devices and exercises that can be prescribed. Handrails, grab bars and bath or shower chairs are some. There are also tools to help with eating, dressing, and computer access. The Americans with Disabilities Act was created, in part, to help people with a disability go back to work with reasonable accommodations.