Once a brain tumor has been detected and graded, your team of specialists in neuro-oncology, radiation oncology, surgery and pathology will work together to assess your best course of treatment for your specific type of brain cancer. This will include formulating a coordinated plan of personalized treatment consistent with the highest standards of care. Your treatment will be tailored to the type, grade, location, and size of your brain tumor as well as your age and general health. It may include a combination of surgery, radiation, and chemotherapy.
Brain Tumor Surgery
Surgery is the standard first treatment for most brain tumors; if the tumor is located in an accessible place, your WellStar neurosurgeon will remove as much of it as possible. You may be awake during the surgery, and be asked to move a leg, count, say the alphabet, or tell a story; this helps the surgeon protect important parts of the brain.
Some tumors are small and easy to separate from surrounding brain tissue, allowing complete removal. Others can't be separated or are near sensitive parts of the brain, so only as much as is safe is removed; even removing a portion of the tumor may alleviate symptoms.
WellStar neurosurgeons are trained in advanced neuro-oncological techniques for removing brain tumors safely, sometimes without making a large incision. They use high definition scopes and video to remove some tumors through small “keyhole” openings in the skull or sinuses.
Possible side effects of brain surgery include swelling and fluid buildup, which can be treated with steroids or placement of a drain (shunt), and infection. Brain surgery may also harm normal brain tissue, causing cognitive, perceptive or personality problems, as well as seizures. Most of these problems improve or disappear with time, as the brain heals, but some may be permanent; you may need physical, occupational, or speech therapy.
Brain Tumor Radiation Therapy
Radiation therapy for brain tumors uses high-energy electromagnetic beams, like x-rays, to kill tumor cells. Radiation can come from a machine outside your body (external radiation therapy).
In external radiation therapy, a large machine aims beams or radiation at your head. Since cancer cells may invade normal brain tissue, the radiation may be targeted at the tumor any nearby brain tissue, or the whole brain. Treatment depends on your age and health, and the type and size of the tumor. The most common method of delivering radiation to brain tumors is fractionated external beam therapy, in which the radiation dose is divided over several weeks, usually five days a week, to help protect healthy brain tissue. Each treatment lasts only a few minutes.
Variations of external radiation therapy include use of computers to closely target the tumor to lessen collateral damage; use of proton beams instead of x-rays; and sterotactic radiation therapy, in which narrow beams of x-rays or gamma rays are aimed at the tumor from different angles while the head is fixed in a rigid frame. At WellStar, our CyberKnife program delivers state-of-the-art brain radiation with pinpoint accuracy.
Internal radiation therapy isn't commonly used for treating brain tumors, but is under study. A small implant called a seed is placed inside the brain near the tumor, and give off radiation for months. They do not need to be removed.
Some people have few or no side effects from radiation therapy; a few have nausea for several hours after treatment, and many feel very tired with each treatment. External radiation therapy often causes hair loss from the part(s) of the scalp through which radiation passed; hair usually grows back in a few months. It may also make the skin on the scapl and ears red, dry, and tender.
Occasionally, radiation causes the brain to swell, causing headaches or a feeling of pressure; you will be monitored for signs of this problem. Radiation rarely kills healthy brain tissue, and may harm the pituitary gland.
Brain Tumor Chemotherapy
Chemotherapy the use of drugs to destroy tumor cells, is used to treat brain tumors. Chemotherapy drugs may be given by mouth or injected. Side effects may include nausea, vomiting, loss of appetite, headache, fever and chills, weakness, and susceptibility to infection; some of these can be mitigated with medication.
Another method of chemotherapy delivery, used in some adults with high-grade glioma, is via wafers that are implanted in the brain during tumor surgery. Over several weeks, the dime-sized wafers dissolve, releasing the drug directly into the brain.
Brain Tumor Targeted Drug Therapy
Targeted drug therapy differs from standard chemotherapy in that it focuses on the genetic and molecular mechanisms underlying the cancer. By blocking thesemechanisms, they can cause cancer cells to die. These therapies are new and many are still in clinical trials. One such drug is bevacizumab (Avastin®), which inhibits the growth of blood vessels, cutting off the tumor's blood supply, killing it.