Brain Cancer Treatment Options
Navigating a brain cancer diagnosis can feel overwhelming, but understanding the available brain cancer treatment options is a useful first step. This article covers the main therapies used for brain tumors and the factors that shape each patient’s treatment plan.
Key Takeaways
- Brain cancer treatment is highly individualized, based on the tumor’s type, grade, size, location, and the patient’s overall health.
- A multidisciplinary team — typically a neuro-oncologist, a neurosurgeon, a radiation oncologist, and a medical oncologist, along with other providers — plans and coordinates care.
- Surgery, radiation therapy, and chemotherapy are the primary treatment modalities, often combined.
- Newer options include targeted therapy, immunotherapy approaches still under study, and tumor-treating fields, a device approved by the FDA for certain glioblastoma cases.
- Supportive care — managing side effects, rehabilitation, and palliative care — is part of treatment from diagnosis onward, not just at the end of care.
Understanding Brain Cancer Treatment Options
A brain cancer diagnosis brings a range of treatment decisions. The main goals of treatment are to remove or shrink the tumor, control its growth, ease symptoms, and preserve neurological function and quality of life as much as possible.
Factors Influencing Treatment Choices
Choosing among brain cancer treatment options depends on several factors: the tumor’s specific kind and grade, where it sits and how large it is, and the patient’s age, general health, and neurological status. Molecular and genetic features of the tumor can also matter — certain markers, for example, have been linked to how well a tumor responds to chemotherapy or radiation, and this information can help shape the treatment plan.
The Multidisciplinary Care Team
Brain cancer treatment is usually planned and delivered by a multidisciplinary team. This commonly includes a neuro-oncologist, a neurosurgeon, a radiation oncologist, and a medical oncologist; depending on the case, a neurologist or a social worker may also be part of the group. Bringing these specialists together helps ensure that all options for treating brain cancer are considered and coordinated around the patient’s needs.
Primary Brain Cancer Treatment Types
Several primary treatment modalities are used for brain cancer, alone or in combination, depending on the tumor’s characteristics.
Surgical Approaches
Surgery is often the first treatment considered for brain tumors that can be reached without unacceptable risk to brain function. The surgical goal is to take out as much of the growth as it is safe to do, since this can ease pressure on the brain and help control symptoms; tumors that are deep-seated or growing into surrounding tissue may instead be debulked (partially reduced) rather than fully removed. For tumors located near areas that control movement, language, or other key functions, some centers use an awake craniotomy, in which the patient is kept awake during part of the operation so the team can test brain function in real time and limit damage to healthy tissue. When surgery isn’t safe or possible, a biopsy — including a stereotactic biopsy for hard-to-reach tumors — can still be done to obtain tissue and guide the choice of other treatments.
Radiation and Chemotherapy
Radiation therapy uses high-energy beams to damage cancer cells and slow tumor growth. It is usually given from outside the body, using approaches such as 3-dimensional conformal treatment, IMRT (which shapes and varies the strength of the beams), stereotactic radiosurgery — a single, precisely focused high dose — or proton beam therapy, which can spare more of the surrounding healthy tissue. Placing radioactive material directly into the tumor site is technically demanding and is used less often than it once was. Radiation commonly follows surgery or is used when surgery isn’t an option.
Chemotherapy uses drugs to kill cancer cells or stop them from dividing. Depending on the tumor, it may be taken by mouth, given intravenously, injected into the cerebrospinal fluid, or, in some cases, placed directly into the brain as a dissolvable wafer at the time of surgery. Temozolomide, taken by mouth, has become the standard chemotherapy given together with radiation for many malignant gliomas, including glioblastoma; the specific drug and schedule still depend on the tumor type and the patient’s overall condition.
Exploring New Treatments for Brain Cancer
Research in neuro-oncology continues to expand the options for treating brain cancer, particularly for tumors that are aggressive or have come back after initial treatment.
Targeted Therapies and Immunotherapy
Targeted therapy uses drugs designed to interfere with specific molecules that cancer cells rely on to grow. Bevacizumab, for instance, is a monoclonal antibody used in recurrent glioblastoma; it blocks a protein called VEGF that tumors need to build the new blood vessels that feed them. Other drugs aimed at similar growth-signaling pathways are being studied. Because these drugs target specific processes rather than all fast-dividing cells, their effects on healthy tissue can differ from those of traditional chemotherapy.
Immunotherapy aims to use a patient’s own immune system against cancer. For brain tumors, this remains an active area of research; approaches being studied include dendritic cell vaccines, which expose immune cells to material from the tumor to try to trigger an immune response, and gene therapy. These approaches are still investigational for most brain tumors, and clinical trials are the main way patients can access them.
Emerging Techniques and Clinical Trials
Tumor-treating fields is a wearable, non-invasive device that delivers alternating electrical fields through the scalp to interfere with cancer cell division; the FDA has approved this device for certain glioblastoma cases, including for use together with temozolomide. Enrolling in a clinical trial is often the main route to these new treatments for brain cancer before they become widely available, and the results from those trials also help refine future treatment guidelines.
Supportive Care During Brain Cancer Treatment
Supportive care addresses the physical, emotional, and practical challenges that come with brain cancer and its treatment, and it is offered alongside — not instead of — cancer-directed treatment.
Managing Side Effects
Brain tumors and their treatment can cause side effects such as headaches, nausea, seizures, changes in memory or mood, and fatigue, which is a common side effect of both radiation and chemotherapy. Corticosteroids such as dexamethasone are commonly used to reduce swelling around the tumor, and anticonvulsant medication is used for patients who have seizures. Anti-nausea medication and other supportive drugs are added as needed. Physical therapy and occupational therapy can help patients manage movement or daily-activity difficulties that result from the tumor or its treatment.
Rehabilitation and Palliative Care
Rehabilitation: after surgery or other intensive treatment, physical therapy and occupational therapy can help patients regain strength, mobility, and skills for daily living; additional therapies may be recommended for specific difficulties, such as communication or swallowing problems, based on individual needs.
Palliative care: this type of care focuses on relieving the symptoms and stress of a serious illness and improving quality of life for the patient and family, and it can be offered at any point during treatment, not only at the end of life. A palliative care team, which may include physicians, nurses, social workers, and other specialists, works alongside the main treatment team to manage pain, nausea, fatigue, and other distressing symptoms, and to support family members and caregivers.
Making Informed Brain Cancer Treatment Decisions
Understanding the available brain cancer treatment types and what they involve can help patients and families feel more confident about the choices ahead.
Seeking Second Opinions
Because brain tumors can be complex to diagnose and treat, getting a second opinion from another specialist is common, and treating physicians usually welcome the request rather than being troubled by it. A second opinion can confirm the diagnosis, offer additional perspective on treatment strategies, and help make sure that reasonable options for treating brain cancer have been considered.
Long-Term Follow-Up and Monitoring
After initial treatment, ongoing follow-up typically includes repeat MRI scans, neurological examinations, and monitoring for new symptoms. These visits are used to watch for recurrence and to manage any lasting side effects of treatment, and the schedule is adjusted based on the individual’s tumor type and treatment history.
Frequently Asked Questions About Brain Cancer Treatment
What are the initial steps after a brain cancer diagnosis?
After a brain cancer diagnosis, the care team typically starts with detailed imaging, such as an MRI, and often a biopsy to confirm the tumor type. Based on these results, the multidisciplinary team presents brain cancer treatment options tailored to the tumor’s characteristics and the patient’s overall health, and a second opinion is often recommended before treatment begins.
How are side effects of brain cancer treatment managed?
Side effects such as fatigue, nausea, headaches, seizures, and swelling around the tumor are managed with a combination of medications — including anticonvulsants and corticosteroids — along with supportive therapies. Physical therapy and occupational therapy can also help with movement or daily-activity difficulties that come up during or after treatment.
Is a cure possible for all types of brain cancer?
It depends on the tumor. Some low-grade or benign brain tumors can be completely removed by surgery, which can be curative. More aggressive tumors, such as glioblastoma, usually cannot be completely removed, and treatment instead focuses on controlling the disease, extending life, and maintaining quality of life. A complete cure isn’t guaranteed for higher-grade tumors, but newer treatments continue to improve outcomes for some patients.
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