For a cancerous tumor, even if it cannot be cured, removing it can relieve symptoms from the tumor pressing on the brain. Sometimes, surgery cannot be performed because the tumor is located in a place the surgeon cannot reach, or it is near a vital structure. These tumors are called inoperable. If the tumor is inoperable, the doctor will recommend other treatment options that may also include a biopsy or removal of a portion of the tumor. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have.
Learn more about the basics of surgery. Radiation therapy is the use of high-energy x-rays or other particles to destroy tumor cells. Doctors may use radiation therapy to slow or stop the growth of a brain tumor.
Brain Tumors - Classifications, Symptoms, Diagnosis and Treatments
It is typically given after surgery and possibly along with chemotherapy. A doctor who specializes in giving radiation therapy to treat a tumor is called a radiation oncologist. The most common type of radiation treatment is called 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 a specific number of treatments given over a set period of time.
Conventional radiation therapy. The treatment location is determined based on anatomic landmarks and x-rays. In certain situations, such as whole brain radiation therapy for brain metastases, this technique is appropriate. For more precise targeting, different techniques are needed. Using images from CT and MRI scans see Diagnosis , a 3-dimensional model of the tumor and healthy tissue surrounding the tumor is created on a computer.
This model can be used to aim the radiation beams directly at the tumor, sparing the healthy tissue from high doses of radiation therapy. Intensity modulated radiation therapy IMRT. It can deliver higher doses of radiation to the tumor 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 tumor. Proton therapy.
Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy tumor cells. Proton beam therapy is typically used for tumors when less radiation is needed because of the location. This includes tumors that have grown into nearby bone, such as the base of skull, and those near the optic nerve.
Stereotactic radiosurgery. Stereotactic radiosurgery is the use of a single, high dose of radiation given directly to the tumor and not healthy tissue. It works best for a tumor that is only in 1 area of the brain and certain noncancerous tumors. It can also be used when a person has more than 1 metastatic brain tumor. 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 tumor. A cyber knife is a robotic device used in radiation therapy to guide radiation to the tumor, particularly in the brain, head, and neck regions.
Fractionated stereotactic radiation therapy. Radiation therapy is delivered with stereotactic precision but divided into small daily doses called fractions and given over several weeks, in contrast to the 1-day radiosurgery. This technique is used for tumors located close to sensitive structures, such as the optic nerves or brain stem.
- Malignant brain tumour (brain cancer).
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With these different techniques, doctors are trying to be more precise and reduce radiation exposure to the surrounding healthy brain tissue. Depending on the size and location of the tumor, the radiation oncologist may choose any of the above radiation techniques. In certain situations, a combination of multiple techniques may work best. Short-term side effects from radiation therapy may include fatigue, mild skin reactions, hair loss, upset stomach, and neurologic symptoms, such as memory problems.
Most side effects go away soon after treatment is finished. Also, radiation therapy is usually not recommended for children younger than 5 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. Systemic therapy is the use of medication to destroy tumor cells. This type of medication is given through the bloodstream to reach tumor cells throughout the body.
Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating a tumor with medication. Systemic therapies may also be given by a neuro-oncologist. Common ways to give systemic therapies include an intravenous IV tube placed into a vein using a needle or in 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.
Each of these types of therapies is discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. The medications used to treat a brain tumor are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements.
Herbs, supplements, and other drugs can interact with the medications used for a brain tumor. Learn more about your prescriptions by using searchable drug databases. Chemotherapy is the use of drugs to destroy tumor cells, usually by keeping the tumor cells from growing, dividing, and making more cells. A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.
As explained above, chemotherapy to treat a brain tumor is typically given after surgery and possibly with or after radiation therapy, particularly if the tumor has come back after initial treatment. Some drugs are better at going through the blood-brain barrier.
Photodynamic therapy of malignant brain tumours
These are the drugs often used for a brain tumor. Gliadel wafers are one way to give the drug carmustine. These wafers are placed in the area where the tumor was removed during surgery. For people with glioblastoma and high-grade glioma, the latest standard of care is radiation therapy with daily low-dose temozolomide Temodar. This is followed by monthly doses of temozolomide after radiation therapy for 6 months to 1 year. A combination of 3 drugs, lomustine Gleostine , procarbazine Matulane , and vincristine Vincasar , have been used along with radiation therapy.
This approach has helped lengthen the lives of patients with grade III oligodendroglioma with a 1p19q co-deletion see Biogenetic markers in the Grades and Prognostic Factors section when given either before or right after radiation therapy. It has also been shown to lengthen lives of patients after radiation therapy for a low-grade tumor that could not be completely removed with surgery.
Clinical trials on the use of chemotherapy to delay radiation therapy for patients with low-grade glioma are also ongoing. Patients are monitored with a brain MRI every 2 to 3 months while receiving active treatment. Patients often have regular MRIs to monitor their health after treatment is finished and the tumor has not grown.
If the tumor grows during treatment, other treatment options will be considered. The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite and diarrhea. These side effects usually go away after treatment is finished. Rarely, certain drugs may cause some hearing loss.
Others may cause kidney damage. Patients may be given extra fluid by IV to protect their kidneys. This type of treatment blocks the growth and spread of tumor cells while limiting the damage to healthy cells. Not all tumors have the same targets, and some tumors may have more than 1 target. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible.
In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments. Talk with your doctor about the possible side effects for a specific medication and how they can be managed. This type of treatment uses a noninvasive portable device that interferes with the parts of a cell that are needed for tumor cells to grow and spread.
The available device is called Optune. Alternating electrical field therapy may be an option for people newly diagnosed with glioblastoma or for those with recurrent glioblastoma.