Brain Tumor: Types of Treatment
In brain tumour care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatment. This is called a multidisciplinary team. Your care team may include a variety of other healthcare professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counsellors, dietitians, rehabilitation specialists, and others. It is essential to have a care team specializing in caring for people with a brain tumour, which may mean talking with medical professionals beyond your local area to help with diagnosis and treatment planning.
The common types of treatments used for a brain tumour are described below. Your care plan may also include treatment for symptoms and side effects, an essential part of your medical care.
Treatment options and recommendations depend on several factors:
- The size, type, and grade of the tumour
- Whether the tumour is putting pressure on vital parts of the brain
- If the tumour has spread to other parts of the CNS or body
- Possible side effects
- The patient’s preferences and overall health
Some types of brain tumours grow rapidly; other tumours grow slowly. Considering all these factors, your doctor will discuss how soon treatment should start after diagnosis.
Treatment options include those described below, such as surgery, radiation therapy, chemotherapy, and targeted therapy.
Surgery may be the only treatment needed for a low-grade brain tumour, especially if all of the cancer can be removed. Radiation therapy and chemotherapy may be used if a visible tumour remains after surgery. Treatment for higher-grade tumours usually begins with surgery, radiation therapy, and chemotherapy. Your exact treatment plan will be developed with your healthcare team.
Successfully treating brain tumours can be challenging. The body’s blood-brain barrier protects the brain and spinal cord from harmful chemicals. However, this barrier also keeps out many types of chemotherapy. Surgery can be complicated if the tumour is near a delicate part of the brain or spinal cord. Even when the surgeon can remove the original tumour, parts of the tumour may remain too small to be seen or removed during surgery. Radiation therapy can also damage healthy tissue.
Surgery
Surgery is the removal of the tumour and some surrounding healthy tissue during an operation. It is usually the first treatment used for a brain tumour. It is often the only treatment needed for a low-grade brain tumour. Removing the tumour can improve neurological symptoms, provide tissue for diagnosis and genetic analysis, help make other brain tumour treatments more effective, and, in many instances, improve the prognosis of a person with a brain tumour.
Rapid advances in surgery for brain tumours have been made, including using cortical mapping, enhanced imaging, and fluorescent dyes.
- Cortical mapping allows doctors to identify areas of the brain that control the senses, language, and motor skills.
- Enhanced imaging devices give surgeons more tools to plan and perform surgery. For example, computer-based techniques, such as image-guided surgery (IGS), help surgeons accurately map out the tumour’s location. However, this very specialized technique may not be widely available.
- A fluorescent dye called 5-aminolevulinic acid can be given orally the morning before surgery. This dye is taken up by tumour cells. Doctors can use a special microscope and light to see the cells that have taken up the shade during the surgery. This helps doctors safely remove as much of the tumour as possible.
In addition to removing or reducing the brain tumour’s size, surgery can provide a tissue sample for analysis using a biopsy. For some tumour types, the biopsy results can help determine if cancer medications or radiation therapy will be helpful.
Sometimes, surgery cannot be performed because the tumour is located in a place the surgeon cannot reach or near a vital structure. These tumours are called inoperable or unresectable.
.
Radiation therapy
Radiation therapy uses high-energy X-rays or other particles to destroy tumour cells. Doctors may use radiation therapy to slow or stop the growth of a brain tumour. It is typically given after surgery and possibly along with chemotherapy. A radiation oncologist is a doctor specializing in radiation therapy to treat cancer. The most common radiation treatment type is external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen, or schedule, usually consists of several treatments offered over a set period.
External-beam radiation therapy can be directed at a brain tumour in the following ways:
- Conventional radiation therapy. The treatment location is determined based on anatomic landmarks and X-rays. This technique is appropriate in certain situations, such as whole-brain radiation therapy for brain metastases. For more precise targeting, different styles are needed. The amount of radiation given depends on the tumour’s grade.
- 3-dimensional conformal radiation therapy (3D-CRT). Using images from CT and MRI scans, a 3-dimensional model of the tumour and healthy tissue surrounding the tumour is created on a computer. This model can aim the radiation beams directly at the tumour, sparing the healthy tissue from high doses of radiation therapy.
- Intensity-modulated radiation therapy (IMRT). IMRT is a type of 3D-CRT (see above) that can more directly target a tumour. It can deliver higher doses of radiation to the cancer while giving less to the surrounding healthy tissue. In IMRT, the radiation beams are broken up into smaller beams, and the intensity of each of these smaller beams can be changed. This means that the more intense beams, or the beams giving more radiation, can be directed only at the tumour.
- Proton therapy. Proton therapy is an external beam radiation therapy that uses protons rather than X-rays. At high energy, protons can destroy tumour cells. Proton beam therapy is typically used for tumours when less radiation is needed because of the location. This includes tumours that have grown into nearby bone, such as the skull base and those near the optic nerve.
- Stereotactic radiosurgery. Stereotactic radiosurgery uses a single dose of radiation given directly to the tumour and not healthy tissue. It works best for a tumour only in 1 area of the brain and certain noncancerous tumours. It can also be used when a person has multiple metastatic brain tumours. There are many different types of stereotactic radiosurgery equipment, including:
- A modified linear accelerator is a machine that creates high-energy radiation by using electricity to form a stream of fast-moving subatomic particles.
- A Gamma Knife is another form of radiation therapy that concentrates highly focused beams of gamma radiation on the tumour.
- A CyberKnife is a robotic device used in radiation therapy to guide radiation to the tumour, particularly in the brain, head, and neck regions.
- We fractionated stereotactic radiation therapy. Radiation therapy is delivered with stereotactic precision but divided into small daily doses called fractions and given over several days or weeks, in contrast to the 1-day radiosurgery. This technique is used for tumours close to sensitive structures, such as the optic nerves or brain stem.
Short-term side effects from radiation therapy may include fatigue, mild skin reactions, hair loss, upset stomach, and neurologic symptoms like memory problems. Most side effects go away soon after treatment is finished. Also, radiation therapy is usually not recommended for children younger than five because of the high risk of damage to their developing brains. Longer-term side effects of radiation therapy depend on how much healthy tissue received radiation and include memory and hormonal problems and cognitive (thought process) changes, such as difficulty understanding and performing complex tasks.
Therapies using medication
Treatments using medication are used to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is presented this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.
This type of medication is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. A neuro-oncologist may also give it
Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). It may also be given through a catheter or port, which are used to make IV injections easier. If you are given oral medications, ask your healthcare team how to store and handle them safely.
The types of medications used for a brain tumour include:
- Chemotherapy
- Targeted therapy
Chemotherapy is the use of drugs to destroy tumour cells, usually by keeping the tumour cells from growing, dividing, and making more cells.
A chemotherapy regimen, or schedule, usually consists of a specific number of cycles over a set period. A patient may receive one drug at a time or a combination of different drugs given at the same time. The goal of chemotherapy can be to destroy tumour cells remaining after surgery, slow a tumour’s growth, or reduce symptoms.
As explained above, chemotherapy to treat a brain tumour is typically given after surgery and possibly with or after radiation therapy, mainly if the cancer has returned after initial treatment. Some drugs are better at going through the blood-brain barrier. These are the drugs often used for a brain tumour. Patients are monitored with a brain MRI every 2 to 3 months while receiving active treatment. Then, the time between MRI scans increases depending on the tumour’s grade.
Targeted therapy
In addition to standard chemotherapy, targeted therapy is another way doctors use medication to treat cancer. Targeted therapy is a treatment that targets the tumour’s specific genes, proteins, or the tissue environment that contributes to a tumour’s growth and survival. This type of treatment blocks the growth and spread of tumour cells and limits the damage to healthy cells.
Not all tumours have the same targets, and some may have more than one target. To find the most effective treatment, your doctor may run tests to identify your tumour’s genes, proteins, and other factors. This helps doctors match each patient with the most effective treatment whenever possible.
Approved by the Cancer.Net Editorial Board,
