Brain Cancer (cont.)

Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

View Full Profile

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

View Full Profile

Types of Treatments for Brain Cancer

Treatment of brain cancer is usually complex. Most treatment plans involve several consulting doctors.

• The team of doctors includes neurosurgeons (surgical specialists in the brain and nervous system), oncologists, radiation oncologists (doctors who practice radiation therapy), and of course, your primary health-care provider. A patient's team may include a dietitian, a social worker, a physical therapist, and probably other specialists.



• The treatment protocols vary widely according to the location of the tumor, its size, grade, and type, the patient's age, and any additional medical problems that the person may have.



• The most widely used treatments are surgery, radiation therapy, and chemotherapy. In some cases, more than one of these treatment types is used.

Most people with a brain tumor undergo surgery.

• The purposes of surgery are to confirm that the abnormality seen on the brain scan is indeed a tumor, to assign a grade to the tumor, and to remove the tumor. If the tumor cannot be removed, the surgeon will take a sample of the tumor to identify its type and grade.



• In some cases, mostly in benign tumors, symptoms can be completely cured by surgical removal of the tumor. A neurosurgeon will attempt to remove the tumor when possible.

Patients may undergo several treatments and procedures before surgery.

• They may be given a steroid drug, such as dexamethasone (Decadron), to relieve swelling.



• They may be treated with an anticonvulsant drug, such as levetiracetam (Keppra), phenytoin (Dilantin), or carbamazepine (Tegretol), to relieve or prevent seizures.

Overview of surgery for resection of brain tumor

The intent of surgery for tumors is to remove as much of the tumor as is safely possible with the minimal possible loss in brain function. The large majority of patients undergo this procedure under general anesthesia. Some surgeries are done awake or under light sedation for the purpose of mapping language function. For surgery done under general anesthesia, an endotracheal tube is placed, while for those done awake, a laryngeal mask airway (or no airway) is placed and the patient is deeply sedated. The head is appropriately positioned using a clamp system that holds the skull motionless. An image-guided navigation system is often used to help determine the precise location of the incision. The scalp is prepped, after the hair is clipped, the planned incision line is infiltrated with local anesthesia, and the scalp is then incised and pushed aside to expose the skull bone. A portion of the skull is temporarily cut away and the lining tissues of the brain are opened. If it is necessary to determine whether brain function is compromised, the patient is awakened from sedation in order to respond as mapping procedures are carried out.

In either case, tumor resection is then carried out. A portion of the tumor is usually sent to a pathologist for analysis. The surgeon may also decide to place biodegradable polymer wafers that deliver chemotherapy drugs (Gliadel wafers) into the tumor cavity. Once the tumor resection is complete, the membranes surrounding the brain are closed and the skull is closed, often with the use of titanium plates and screws that help hold it rigidly in its desired position. The scalp is closed; some surgeons use drains placed under the scalp for a day or two after surgery to minimize the accumulation of blood or fluid.

• Stereotactic radiosurgery is a newer "knifeless" technique that destroys a brain tumor without opening the skull. CT or MRI scan is used to pinpoint the exact location of the tumor in the brain. High-energy radiation beams are trained on the tumor from different angles. The radiation destroys the tumor. Equipment used to do radiosurgery varies in its radiation source; a gamma knife uses focused gamma rays, and a linear accelerator uses photons, while heavy-charged particle radiosurgery uses a proton beam.



• The advantages of knifeless procedures are that they have fewer complications and the recovery time is much shorter. Disadvantages include the lack of tissue available to send to a pathologist for diagnosis and brain swelling that can occur after the radiation therapy.



• If patients have excess cerebrospinal fluid buildup, a thin plastic tube called a shunt may be placed to drain the fluid. One end of the shunt is placed in the cavity where fluid collects, and the other is threaded under the skin to another part of the body. The fluid drains from the brain to a site from which the fluid can be easily eliminated.

Radiation therapy (also called radiotherapy) is the use of high-energy rays to kill tumor cells and stop them from growing and multiplying.

• Radiation therapy is sometimes used for people who cannot undergo surgery. In other cases, it is used after surgery to kill any tumor cells that may remain.



• Radiation therapy is a local therapy. This means that it affects only cells in its path. It does not harm cells elsewhere in the body or even elsewhere in the brain.

Radiation can be administered in either of two ways.

• External radiation uses a high-energy beam of radiation targeted at the tumor. The beam travels through the skin, the skull, healthy brain tissue, and other tissues to get at the tumor. The treatments are usually given five days a week for about four to six weeks. Each treatment takes only a few minutes. The gamma knife and cyber knife are two terms that describe methods that use external radiation to kill cancer cells in the brain.



• Internal or implant radiation uses a tiny radioactive capsule that is placed inside the tumor itself. The radiation emitted from the capsule destroys the tumor. The radioactivity of the capsule decreases a little bit each day; the amount of radioactivity of the capsule is carefully calculated to run out when the optimal dose has been given. You need to stay in the hospital for several days while receiving this treatment.

Chemotherapy is the use of powerful drugs to kill tumor cells.

• A single drug or a combination may be used.



• The drugs are given by mouth or through an IV line. Two drugs, temozolomide (Temodar) and bevacizumab (Avastin), have recently been approved for the treatment of malignant gliomas. They are more effective and have fewer adverse effects when compared with older drugs. Temozolomide has another advantage in that it is administered orally, eliminating the need for intravenous lines and hospital stays for chemotherapy.



• Chemotherapy is usually given in cycles. A cycle consists of a short period of intensive treatment followed by a period of rest and recovery. Each cycle lasts a few weeks.



• Most regimens are designed so that two to four cycles are completed. There is then a break in the treatment to see how the tumor has responded to the therapy.



• The side effects of chemotherapy are well known and are very difficult to tolerate for some people. They include nausea and vomiting, mouth sores, loss of appetite, loss of hair, and many others. Some of these side effects can be relieved or improved by medication.

New therapies (for example, use of nanotechnology to deliver drugs to tumor cells) for cancer are being developed all the time. When a therapy shows promise, it is studied in laboratories and improved as much as possible. It is then tested on people with cancer; these tests are called clinical trials.

• Clinical trials are available for virtually every kind of cancer.



• The advantage of clinical trials is that they offer new therapies that may be more effective than existing therapies or have fewer side effects.



• The disadvantage is that the therapy has not been proven to work or does not work in everyone.



• Many people with cancer are eligible for participation in clinical trials.



• To find out more, ask your health-care provider. A list of clinical trials is available at the web site of the National Cancer Institute.

There are many "holistic" and other treatments for brain tumors cited in Internet sites, health magazines, and other publications (for example, Transfer Factor, Cellect, Vitalzym). Most of these have no scientific data to reinforce their claims and, when visiting these sites, readers are urged to read the fine print as most say the product(s) are not intended to treat specific diseases. Patients should discuss any such substances with their doctors before buying and using these items. Some are listed by the FDA as dietary supplements and warn that they have not been proved to be effective or safe.