Treatment options for a brain tumor depend on the type, location, and size of the tumor and may include surgery, radiation, chemotherapy or often a combination of these options. Treatment can be postponed in some cases if a tumor appears to be growing slowly and is not causing symptoms. Although there are initial standard-of-care treatment plans for most tumors, in some cases, experimental therapies may be recommended if standard therapies are unsuccessful.
Surgery is usually the first step in the treatment of brain tumors. The purpose of surgery is to obtain tissue to verify the diagnosis. Additional goals of surgery are to relieve symptoms, decrease pressure on the brain or spinal cord, and minimize the size of the tumor that will need to be treated with radiation or chemotherapy. Importantly, recent data suggests that extensive removal of a brain tumor improves long-term treatment outcomes. Therefore, the goal of surgery is to remove as much of a tumor as possible without damaging healthy brain tissue. Although complete removal of all tumor cells is an ultimate goal, this is often not possible in many brain tumors due to invasion into the brain or microscopic amounts of cells that cannot be seen. Therefore, in many cases patients will need additional therapy after surgery.
Types of brain tumor surgeries
Biopsy: If the tumor is in a part of the brain where removal would cause considerable neurological damage, a biopsy may be taken. A biopsy is a surgical procedure in which a small opening is made in the skull and a needle is inserted into the tumor to obtain a sample of tumor cells. The tumor cells are examined under a microscope by a pathologist who establishes a diagnosis so that appropriate treatment can be recommended.
Resection: A resection is surgical removal of as much of a tumor as possible. This often requires a craniotomy, which is the removal of a piece of the skull so that the neurosurgeon can gain access to the tumor. The piece of skull is replaced after the resection and held in place by thin pieces of titanium. Tumors in the region of the pituitary gland can sometimes be removed through the nose and do not require a craniotomy. A resection is called a “gross total resection” when there is no obvious tumor visible on a brain scan performed soon after surgery. If a portion of the tumor can still be seen on a post-operative brain scan, it is called a “subtotal resection.”
Stereotactic surgery: A precise computerized map of the brain is made using an MRI or CT scan. The neurosurgeon uses this map during surgery to precisely locate the tumor and to navigate around critical brain structures during resection or biopsy of the tumor, a technique that is known as “intraoperative image guidance.”
Microscopic surgery: A microscope is used during surgery for detailed evaluation of brain and tumor tissue.
Radiation therapy is the use of beams of energy called “ionizing radiation” to slow or stop the growth of tumor cells. Radiation oncologists are the physicians who manage radiation therapy. They determine the most appropriate form and amount of radiation to be delivered according the type, size, and location of the tumor.
Types of radiation therapy
Fractionated radiotherapy: A specific dose of radiation is delivered in parts rather than all at once. Radiation is usually delivered in daily sessions five days per week for two to seven weeks. The radiation oncologist determines the treatment schedule.
Focused radiation = radiation that is directed only at the tumor.
Whole brain radiation therapy = radiation is directed at the entire brain. This form of radiation is used in cases where there are multiple tumors or a tumor spreads over a large area of the brain.
Stereotactic radiosurgery = A single high-dose of radiation is delivered precisely to one or more small tumors on an outpatient basis. Novalis BrainLab®, Gamma Knife® and CyberKnife® are brand names of types of stereotactic radiosurgery.
Chemotherapy is the use of powerful medications to slow or stop the growth of tumors. Oncologists are the physicians who prescribe and manage chemotherapy. Neuro-oncologists are oncologists who specialize in treating nervous system cancers. Chemotherapy can be given by mouth, through an I.V., or directly into the brain during surgery.
Standard versus Experimental Treatment
Standard treatment is a commonly accepted form of treatment for a certain medical condition. It is based on either experimental data, expert opinion or both. Experimental treatment is treatment that is currently being tested in clinical trials (research studies). An experimental treatment may become a standard treatment if it is proven to be more effective than current standard treatments.
Most people who have been treated for a brain tumor will require long term follow-up with routine brain scans, neurological exams, and visits to one or more of the healthcare providers involved in their treatment. This is to monitor the response to treatment and to watch for tumor recurrence.