Brain Cancer Treatment

Brain cancer treatment can involve several different modalities of treatment. The specific mix of treatments any one patient with be recommended depends on many factors, including the type of tumor, tumor location and size and patient-specific features such as age and general health and symptoms.

While more malignant tumors, such as malignant gliomas like glioblastoma multiforme, will often have several forms of treatment used against them, even benign tumors may be responsive to radiation treatments and their management may require radiation treatments, with or without surgery. This is particularly true with the newer "focused-beam" types of radiation treatment. In some cases tumors will be treated primarily with only radiotherapy, avoiding surgery for many patients.

The three most common general types of brain cancer treatment are surgery, radiation therapy (radiotherapy) and chemotherapy. Each will be discussed further below.

Surgery

Generally, the goal of most brain cancer surgery is to remove as much of the tumor as possible. However, because brain cancers involve the brain, it can be difficult in many cases to remove the entire tumor. In some cases the tumor is very deep and access to the tumor is difficult and must traverse normal brain tissue. In some cases the tumor can be positioned very closely to critical structures which could cause significant neurological dysability if injured during surgery. In these cases, surgical removal of the tumor may not be possible or only a portion of the tumor may be removed. In its simplest form, a small surgery, sometimes through a very small opening, may only biopsy the tumor, removing a tiny piece so that it can be assessed by a pathologist in order to make a diagnosis.

As with all types of treatment, surgery does have some risks associated with it. Any surgery has anesthesia risk, risks of bleeding and risks of infection. However, because brain tumors are situated in or closely associated with normal brain tissue, there is also the risk of injury to normal brain. While neurosurgeons generally plan their operations to avoid damage to normal structures, injury to the brain and surrounding structures can occur in some cases. In some of these cases this injury can result in new neurological symptoms after surgery.

Radiation Treatment (Radiotherapy)

Radiation is sometimes used as an adjuvant to surgery, meaning that after surgery radiation therapy is used to attempt to treat any remaining cancer cells. In some cases this treatment is reserved until the remaining tumor is seen to change or grown while following with MRI scans. Additionally, in some patients radiation treatment may be used alone, without surgery. This is done in some patients with small tumors, in patients with tumors known to be very sensitive to radiation (such as some lymphomas and germinomas, for example), in patients with a multiple tumors, in patients with a tumor which is in a location which makes surgical treatment difficult or risky, or in patients who have some other reason that surgery would be contraindicated.

In the early days of radiation therapy, radiation could not be focused on a small point easily and therefore most brain cancer treatments involved whole brain radiation which exposed both tumor and normal brain to high levels of radiation. While this can help control some tumors, it can also cause long-lasting damage to parts of the normal brain as well. While whole brain radiation is sometimes used today for patients with widespread or multiple tumors, most radiation brain cancer treatment is now done by various forms of focused beam radiation. These techniques use a very tighly focused beam of radiation that can be accurately delivered to the area of the tumor from multiple angles. This helps to maximize the exposure of the tumor to radiation while minimizing the exposure of the surrounding brain. Various forms of these treatments exist, including Gamma Knife, Varian, CyberKnife and others.

These forms of focused-beam radiation treatments can be used as either radiosurgery or radiotherapy. Radiosurgery uses a single, high-dose radiation treatment to a tumor. Radiotherapy delivers multiple, small doses of radiation to a tumor over time. Early research has shown that for some types of tumors radiotherapy is more effective and has less risk of side effects. However, both types of treatments are used in various settings.

Chemotherapy