How Are Brain Tumors Treated?
There are three types of treatment for brain tumors:

• Surgery
• Radiation therapy
• Chemotherapy

Patients with brain tumors often need all three types of treatment.

Special Treatments Need Special Doctors
The following specialists treat brain tumors:

• Neurosurgeon—a doctor who specializes in brain surgery
• Radiation oncologist—a doctor who specializes in using radiation to treat cancer
• Neuro-oncologist—a doctor who specializes in the medical care of patients with brain tumors. Their job includes managing chemotherapy and other medications related to the treatment and care of patients with brain tumors

What Are The Goals Of Treatment?
The goals of treatment for brain tumors are:

• Remove as much of the tumor as possible with surgery
• Use radiation and/or chemotherapy to destroy as many of the remaining tumor cells as possible
• Use radiation and/or chemotherapy to put any tumor cells that might be left into a non-dividing or inactive state

Surgery

What Are The Goals Of Surgery?

• Biopsy the tumor to make a diagnosis
• Remove as much of the tumor as possible

Biopsy And Diagnosis
After the tumor size and location are seen on the MRI and CT scan, the next step is to plan for a biopsy and surgery. A biopsy is done at the beginning of the surgery. A small sample of tissue is removed from the tumor. This is called a “biopsy.” The biopsy tissue is given to a neuro-pathologist who will examine the tissue and make an initial diagnosis. This is called a “frozen section diagnosis.” This first diagnosis is made by the neuro-pathologist during surgery so the neurosurgeon has some information about what type of tumor is present. 

This beginning diagnosis will be discussed with you and your family right after surgery. In some cases the final diagnosis can be different from the initial diagnosis, so treatment plans are not made until the final pathology report is made. The final report can take as long as a week after surgery. You may go home before that final diagnosis is made.

Removing The Tumor
After the initial diagnosis is made, the neurosurgeon will do the surgery to remove as much of the tumor as possible. The surgeon has to take out the tumor tissue but also protect the other parts of your brain. The amount of tumor that can be safely removed from a patient’s brain is different for each person.  It depends on the size and location of the tumor.

Tumors in some brain areas can be removed with little injury to the nearby normal parts of the brain. In other brain areas, surgery would be too damaging so only a biopsy is done. Because brain tumors spread into the brain tissue around the tumor, surgery leaves some tumor cells behind. Brain surgeons make decisions about the benefits and risks of each surgery. Their goal is for your symptoms to be the same or better after the tumor is removed. Surgery helps because:

• It removes as much tumor as possible
• Less tumor means better success with chemotherapy and radiation therapy
• Removing the tumor reduces the pressure on other parts of the brain

What Happens After Surgery?
During your recovery, you will meet several people who are a part of your care team. Your team will include a neuro-oncology fellow, neurology residents, nurse practitioners, specialist nurses, social workers and physical and occupational therapists.

How Long Will I Be In The Hospital?
Most patients recover quickly after brain tumor surgery. Many people are able to leave the hospital within a few days. Some patients go directly home, and others benefit from a stay at a rehabilitation hospital. A case manager will help you make plans for going home, or to a rehabilitation center.

Before leaving the hospital after surgery, another MRI scan is done. This MRI is used for comparison with all future MRIs.

Radiation Therapy

What Happens During Radiation Therapy?
Most patients undergo a series of radiation treatments starting about two to four weeks after surgery. Radiation therapy is an important part of the treatment of brain tumors. A radiation oncologist, a doctor who designs and supervises radiation treatments, will oversee your radiation therapy.

Before radiation treatments start, you will have a planning session called a “simulation.” The set up and positioning for your radiation treatment will be decided during the simulation. A CT scan or MRI of your head is used for planning the radiation set up.

Radiation treatments are done daily, Monday through Friday, for 4 to 6 weeks. Each treatment takes only a few minutes. You will not feel or see the radiation. Radiation does not hurt. Patients are seen weekly by their radiation oncologists, and a nurse is available every day in the radiation treatment area.

An MRI is done about four weeks after the end of radiation therapy. This MRI will be compared with the one done after surgery and all future MRIs of your brain. Most of the time this scan will show no change from the MRI you had right after surgery.

What Are The Side Effects Of Radiation Therapy?
Most side effects from radiation therapy are mild and can be managed easily at home. The side effects depend upon the characteristics of your brain tumor. Your risk of side effects is best determined and explained by your radiation oncologist. Common side effects are:

• Hair loss in the area being treated. Sometimes this hair loss is permanent.
• Skin redness, dryness, or irritation in the areas exposed to radiation.
• Fatigue, usually starting the second or third week of treatment. For many, a nap is helpful every afternoon.
• Nausea affects some patients. It can be managed with medication if it occurs.
• Headaches are not common and can be managed with standard headache medications. Speak to your neuron-oncologist before taking any medications.

Chemotherapy

What Happens During Chemotherapy?
Chemotherapy helps control the growth of brain tumors. Several different types of chemotherapy drugs are used. For many brain tumors, radiation and chemotherapy are given at the same time. In addition to standard chemotherapy, there are research studies called clinical trials that test new drugs. Ask your neuro-oncologist about the clinical trials that are available for you.

What Are The Side Effects Of Chemotherapy?
Chemotherapy drugs work by destroying cells that are dividing to make new cells. Although chemotherapy is used to destroy dividing tumor cells, normal cells in the body that are dividing may also be killed. The side effects of chemotherapy are caused by the damage to these normal cells. The cells that are usually affected by chemotherapy are the cells in your bone marrow and digestive tract.

Chemotherapy Can Cause:

• Fatigue (getting tired easily) due to a low red blood cell count (anemia)
• Infections or catching illnesses because of a low white blood cell count
• Bleeding or bruising due to a low platelet count
• Nausea, vomiting and diarrhea.

Other Treatment Concerns

Fertility

• Chemotherapy can affect fertility in men and women.
• Menstrual periods may become irregular or stop as a result of chemotherapy.
• To keep open the possibility of having children in the future, sperm and eggs can be banked for storage before beginning treatment.
• Talk with your doctor about your fertility concerns.

Seizures
Seizures can occur in patients with brain tumors before, during, and after treatment. There are several different types of seizures. The most common types are:

• Twitching of the face, arm or leg, or clouded thinking but without becoming unconsciousness
• Total body shaking and being completely unconsciousness

Will These Treatments Cure My Brain Tumor?
The current treatments for brain tumors are helpful, but right now there is no complete cure available.  The two reasons for this are:

• Tumor cells get into surrounding brain tissue and cannot be completely removed with surgery.
• Most brain tumor cells are partly resistant to radiation and chemotherapy, and can survive the treatments.

Each patient’s tumor is different, even if you have the same type of brain tumor and treatment as someone else. Your neuro-oncologist will talk with you about the usual outcomes of your brain tumor. This is called your prognosis.

Many patients read about their tumor in books and on the World Wide Web. It is important to realize that statistics about survival are based on studies of large groups of patients and do not apply to an individual patient.