Brain Tumor
Treatment
Treatment for brain tumors depends on a number of factors including
the type, location and size of the tumor as well as the patient's age
and general health. Treatment methods and schedules differ for children
and adults.
Brain tumors are treated with surgery, radiation therapy and
chemotherapy. Our doctors also are studying a vaccine for treating a
recurrent cancer of the central nervous system that occurs primarily in
the brain, known as glioma.
Depending on your needs, several methods may be used. Our team
includes neurosurgeons, medical oncologists, radiation oncologists,
nurses, a dietitian and a social worker, who work together to provide
the best possible care.
Before treatment begins, most patients are given steroids, drugs that
relieve swelling or edema. Your may receive anticonvulsant medicine to
prevent or control seizures.
If hydrocephalus is present, you may need a shunt to drain
cerebrospinal fluid. A shunt is a long, thin tube placed in a ventricle
of the brain and then threaded under the skin to another part of the
body, usually the abdomen. It works like a drainpipe. Excess fluid is
carried away from the brain and is absorbed in the abdomen. In some
cases, the fluid is drained into the heart.
Surgery
Surgery is the usual treatment for most brain tumors. To remove a
brain tumor, a neurosurgeon makes an opening in the skull. This
operation is called a craniotomy. Whenever possible, the surgeon
attempts to remove the entire tumor. If the tumor cannot be completely
removed without damaging vital brain tissue, your doctor may remove as
much of the tumor as possible. Partial removal helps to relieve symptoms
by reducing pressure on the brain and reduces the amount of tumor to be
treated by radiation therapy or chemotherapy.
Some tumors cannot be removed. In such cases, your doctor may do only
a biopsy. A small piece of the tumor is removed so that a pathologist
can examine it under a microscope to determine the type of cells it
contains. This helps your doctor decide which treatment to use.
Sometimes, a biopsy is done with a needle. Doctors use a special head
frame (like a halo) and CT scans or MRI to pinpoint the exact location
of the tumor. The surgeon makes a small hole in the skull and then
guides a needle to the tumor. Using this technique to do a biopsy or for
treatment is called stereotaxis.
Other advanced techniques during surgery include brain mapping
to find functional pathways near tumors, endoscopy to perform biopsies
and open spinal fluid pathways through a small scope and advanced
frameless stereotaxic computer assisted tumor resections. Intraoperative
MRI also is available to help maximize tumor removal.
Radiation Therapy
Radiation therapy, also called radiotherapy, is the use of
high-powered rays to damage cancer cells and stop them from growing. It
is often used to destroy tumor tissue that cannot be removed with
surgery or to kill cancer cells that may remain after surgery. Radiation
therapy also is used when surgery is not possible.
Radiation therapy may be given in two ways. External radiation comes
from a large machine. Generally, external radiation treatments are given
five days a week for several weeks. The treatment schedule depends on
the type and size of the tumor and your age. Giving the total dose of
radiation over an extended period helps to protect healthy tissue in the
area of the tumor.
External radiation may be directed just to the tumor, the surrounding
tissue or the entire brain. Sometimes the radiation is also directed to
the spinal cord. When the whole brain is treated, the patient often
receives an extra dose of radiation to the area of the tumor. This boost
can come from external radiation or from an implant.
Radiation also can come from radioactive material placed directly in
the tumor, or implant radiation therapy. Depending on the material used,
the implant may be left in the brain for a short time or permanently.
Implants lose a little radioactivity each day. The patient stays in the
hospital for several days while the radiation is most active.
The stereotactic radiosurgery, is another way to treat brain tumors. The
Gamma Knife isn't actually a knife, but a radiation therapy technique
that delivers a single, finely focused, high dose of radiation precisely
to its target. Treatment is given in just one session. High-energy rays
are aimed at the tumor from many angles. In this way, a high dose of
radiation reaches the tumor without damaging other brain tissue.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. The doctor may
use just one drug or a combination, usually giving the drugs orally or
by injection into a blood vessel or muscle. Intrathecal chemotherapy
involves injecting the drugs into the cerebrospinal fluid.
Chemotherapy is usually given in cycles. A treatment period is
followed by a recovery period, then another treatment period and so on.
Patients often don't need to stay in the hospital for treatment and most
drugs can be given in the doctor's office or clinic. However, depending
on the drugs used, the way they are given and the patient's general
health, a short hospital stay may be necessary.
Advances in chemotherapy include direct placement into the tumor
cavity using a new technique called convection enhanced delivery