Brain Tumor Treatment
If you are diagnosed with a brain tumor, your doctor will discuss the best options to treat it. This depends on several factors, including the location and type of the cancer and your general health.
Your treatment for a brain tumor will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Surgery
Surgery is a primary treatment for many brain tumors.
In some cases, the entire tumor can be removed during surgery.
When complete removal is not possible, doctors may recommend surgery to reduce the tumor’s size, relieve symptoms or help determine what other treatments are needed.
Craniotomy
Craniotomy is the most common surgery for brain tumors. The procedure involves opening the skull to reach the tumor. Some brain tumors can be removed with little or no damage to the brain.
Craniotomies can take anywhere from 4 hours to 12 hours depending on the size and location of the tumor. Most require a three- to four-night hospital stay.
In addition to the standard craniotomy, there are slightly modified craniotomies that can help surgeons remove as much of the tumor as possible without harming healthy brain tissue.
Awake craniotomy
Most craniotomies are performed under general anesthesia, but some patients undergo awake craniotomies. During these procedures, patients are woken up during the surgery to interact with the surgical team. This helps doctors avoid damaging key structures in the brain. Learn more about awake craniotomies.
Craniotomy with intraoperative MRI
If a patient has a large or complex tumor, doctors may use an intraoperative MRI during the procedure. This gives the surgeon a real-time image of the entire tumor throughout the operation. Surgeons use these images to help them remove as much of the tumor as possible while protecting normal, healthy brain tissue.
Fluorescence-guided craniotomy
Some brain tumors look like healthy brain tissue, making it harder for surgeons to determine which tissue should be removed and which should remain.
In these situations, doctors use a special solution, called a contrasting agent, to help them identify cancer tissue. Patients drink the contrasting agent a few hours before surgery. The solution is absorbed by tumor cells. The cells then turn pink, helping doctors remove the tumor without damaging healthy tissue.
Recovering from surgery
Recovery from brain tumor surgery depends on the size and location of the tumor. Most side effects are temporary, but in rare cases they are permanent. These side effects include impacts on speech and movement.
Patients should begin therapy to help improve their speech and/or movement the day after surgery. These can include speech therapy, physical therapy and occupational therapy. They usually begin walking with physical therapy and performing basic tasks like brushing teeth with occupational therapy. In some cases, the therapists may recommend a short stay in rehabilitation facility after they are discharged from the hospital.
Laser Interstitial Thermal Therapy
Laser interstitial thermal therapy (LITT) is a treatment for primary and metastatic brain tumors that are hard to reach with conventional surgery or do not respond to stereotactic radiosurgery.
During the procedure, doctors implant a laser catheter into the tumor and heat it to temperatures high enough to kill cancer cells.
Getting LITT treatment
LITT is a minimally invasive treatment. In most cases it can be performed with just a two- to three-millimeter incision in the scalp. Only a very small area of hair needs to be shaved and the procedure itself takes just a few minutes to perform. Patients are put under general anesthesia and usually spend just one night in the hospital.
Recovering from LITT
Most patients who get LITT can go home the day after treatment and can quickly return to normal activities like cooking, working and grocery shopping.
Side effects of LITT include a mild headache caused by swelling in the area of LITT treatment. This is typically managed with a small dose of steroids over a short period of time.
Radiation Therapy
Radiation therapy uses powerful, focused beams of energy to kill cancer cells.
Radiation therapy may be able to kill tumors. It can also stop or slow the growth of brain tumors that cannot be removed with surgery. It is often given after surgery to treat any remaining cancer cells and prevent the tumor from growing back. It can also be used alone or in combination with other treatments.
There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue. These techniques include the following.
Learn more about radiation therapy.
Intensity modulated radiotherapy
Intensity modulated radiation therapy (IMRT), focuses multiple radiation beams of different intensities directly on the tumor for the highest effective dose. There are different types of IMRT treatment, including volumetric modulated arc therapy, or VMAT.
Getting IMRT
Patients receiving IMRT treatment first start with a CT scan simulation. This helps doctors plan the angles and shapes of the radiation beams that will be used for treatment. During simulation, brain tumor patients will be fitted with a mesh mask. The mask will hold the patient’s head in an exact position during treatment. This helps doctors deliver the appropriate amount of radiation to the tumor while limiting exposure to healthy tissue. Patients can see and breathe through the mask without any trouble.
IMRT treatments usually begin about one week after simulation. Most patients get one treatment a day, Monday through Friday, for six weeks. Other patients only need three to five weeks of treatment.
Each session lasts around 30 minutes total. Most of this time is used to set up the treatment. The radiation is delivered for just five to 10 minutes in most cases. Patients usually don’t feel anything during treatment. There’s no anesthesia, though patients with claustrophobia may need light sedation.
Proton therapy
Proton therapy is a type of radiation therapy. It is similar to standard radiation therapy, but it uses a different type of energy that may allow doctors to target tumors with more accuracy, better limiting damage to nearby healthy tissue. This may reduce side effects and allow the tumor to get the full dose of radiation.
Learn more about proton therapy.
Getting proton therapy
The process of getting proton therapy is very similar to IMRT. Patients start with a CT scan simulation to help plan the angles and shapes of the radiation beams that will be used for your treatment. Patients are also fitted with a mesh mask during the simulation. This mask holds the patient’s head in an exact position, ensuring that the tumor receives the full dose of radiation while limiting exposure to healthy tissue. Patients can see and breathe through the mask without trouble.
Most brain tumor patients receive proton therapy from Monday-Friday for six weeks. In general, each session lasts around 45 minutes.
Radiation therapy side effects
Brain tumor patients who get radiation therapy usually don’t experience side effects for the first half of treatment. Side effects usually start in the second half, including:
- Fatigue
- Hair loss at the treatment site
- Mild skin irritation, similar to a slight sunburn
- Headaches
- Brain swelling that may cause the brain tumor symptoms to worsen or recur. This is usually mild and temporary and can be treated with medications.
Long-term side effects
Radiation therapy to the brain can cause side effects that appear several months to years after treatment is complete. Potential side effects include an increased risk of stroke, changes in memory and processing speed, and changes in hormone function.
These side effects depend on the location of the tumor and how much radiation the patient gets. Overall, though, serious side effects are rare, and the benefits of radiation therapy far outweigh the risks.
Chemotherapy
Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing.
Chemotherapy is a standard treatment for many primary brain tumors. Patients are closely monitored while on chemotherapy, and their treatment may be adjusted based on how they respond to the therapy.
Learn more about chemotherapy.
Getting chemotherapy
There are different chemotherapy treatment plans for different types of brain cancer. Many patients get chemotherapy pills, either on its own or in combination with radiation therapy.
Other patients need a combination of pills and IV infusions. There are various treatment plans to deliver these drugs.
Chemotherapy side effects
Side effects depend on the exact chemotherapy the patient receives. Common side effects can include fatigue, nausea and hair loss. Certain chemotherapies can cause nerve pain, called neuropathy.
Chemotherapy can also lead to drops in blood cell production. During treatment, the patient’s blood counts will be closely monitored to ensure they stay in a safe range.
Patients should talk to their doctors about ways to prevent or minimize the side effects of chemotherapy.
Learn more about the side effects of chemotherapy.
Targeted Therapy
Targeted therapy drugs are designed to stop or slow the growth of cancer on a cellular level. They are designed to interfere with, or target, molecules or genes that support the spread of cancer.
Targeted therapy is an option for patients with certain low-grade gliomas that have a mutation to the IDH gene. A small number of other brain cancers can also be treated with targeted therapy, including some cancers with BRAF gene mutations.
Read more about targeted therapy.
Getting targeted therapy
Brain tumor patients on targeted therapy get the medicine orally, as a pill. Patients take these pills once a day for as long as they are effective.
Targeted therapy side effects
Side effects for brain tumor patients receiving targeted therapy are generally mild. Some patients experience gastrointestinal issues such as diarrhea, constipation and nausea/vomiting. Patients should talk to their care team about ways to treat these side effects.
Learn more about targeted therapy side effects.
Angiogenesis inhibitors
Angiogenesis is the process of creating blood vessels. Some tumors make blood vessels very quickly. The increased blood supply to the tumor helps it grow rapidly. Angiogenesis inhibitors, or anti-angiogenic therapy, disrupt the creation of these blood vessels.
Angiogenesis inhibitors are used to treat primary brain tumors. They can also be used to treat radiation necrosis, a side effect of radiation therapy to the brain.
Learn more about angiogenesis inhibitors.
Getting angiogenesis inhibitors
Angiogenesis inhibitors are given once every two to three weeks through an IV infusion. Infusions typically take 30-90 minutes, depending on how the patient reacts to the medication. The number of sessions changes from patient to patient.
Angiogenesis inhibitor side effects
Brain tumor patients taking this medication generally tolerate it well. In many cases, patients actually feel better after receiving this treatment.
Some patients experience infusion reactions, such as hives or shortness of breath while they are getting the drug. These are easily treated.
The most common side effect is high blood pressure, which can be treated with standard blood pressure medications.
The drug also can cause rare but serious complications, such as stroke, blood clots, bleeding and poor wound healing. Patients showing symptoms of these side effects should immediately call their care team or go to the nearest emergency room.
Tumor treating fields
Tumor treating fields emit radio waves in the brain that are meant to slow or stop the multiplication of cancer cells. This treatment requires patients to shave their heads and wear an adhesive skull cap with wires attached to a battery pack for 18 hours a day.
Tumor treating fields side effects
Side effects of tumor treating fields are usually mild. Patients report skin irritation and a tingling sensation on the scalp. Other, less common side effects, include headaches, muscle twitching and trouble sleeping.
Your care team can help you manage side effects of this treatment.
Clinical Trials
Clinical trials are a key part of MD Anderson's mission to end cancer. MD Anderson uses clinical trials to find better ways to prevent, diagnose and treat cancer. Trials could include new treatments or new combinations of existing treatments.
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Brain tumors are treated in our Brain and Spine Center and our Proton Therapy Center.
Craniotomy vs. craniectomy: What’s the difference?
A craniotomy and a craniectomy are surgical procedures used to treat conditions in the brain. They are both performed by neurosurgeons.
Their names may sound similar, but the two procedures serve different purposes. Here, I’ll explain the differences between a craniotomy and a craniectomy.
How is a craniotomy different from a craniectomy?
First, let's get to the root of each word to help you understand the difference between a craniotomy and a craniectomy.
Craniotomy
‘Crani-‘ refers to the skull. The suffix ‘otomy’ – is a derivative of the Greek ‘-tomia,’ which means ‘to cut.’ So, craniotomy means, by definition, to cut the bone.
During a craniotomy, the neurosurgeon cuts through the skull to release and elevate a piece of the skull. This allows them to access tumors in the brain.
After removing the tumor, the surgeon puts the piece of bone back in place, securing it with small screws and plates.
Craniectomy
Again, ‘crani-‘ refers to the skull, but ‘-ectomy’ means ‘to cut out.’ So, craniectomy means to cut out the bone.
Much like a craniotomy, when performing a craniectomy, the neurosurgeon removes part of the skull to get to the brain. But they don’t replace it. Often, at a later date, the neurosurgeon replaces the removed bone with an artificial mesh or another material. This second procedure is known as a cranioplasty.
Why would you need a craniotomy?
A craniotomy is the most common surgery to treat brain tumors. We perform craniotomies so we can get to the brain and surgically remove the tumor.
A craniotomy is also used to treat other types of brain lesions, such as:
- aneurysms,
- arteriovenous malformations and
- hematomas, non-cancerous collections of blood in the brain.
Why would you need a craniectomy?
Craniectomies are most commonly done to relieve pressure due to swelling in the brain caused by:
- stroke,
- brain bleeding or
- traumatic brain injury.
At MD Anderson, we rarely need to perform craniectomies because most of the time we can control swelling in the brain when we remove brain tumors.
What is the recovery time for a craniotomy and a craniectomy?
The time it takes to recover from a craniotomy or a craniectomy depends on what we do to the brain and the complexity of the surgery.
Most patients spend anywhere from a few days to two weeks in the hospital after a craniotomy or craniectomy.
Some brain tumor patients can resume normal activities fairly quickly once they return home; for others, it may take longer. It could take several months to heal from a craniotomy or craniectomy fully. It depends on your situation.
Your doctor will talk to you about what to expect during recovery and answer any questions you may have.
Frederick Lang, M.D., is a neurosurgeon and chair of Neurosurgery at MD Anderson.
Request an appointment at MD Anderson online or call 1-877-632-6789.
My brain tumor story: From caregiver to patient
As a child and adolescent psychiatrist in Puerto Rico, I always tell my patients that in any situation, no matter how hard or difficult it is, there’s always something positive that we can learn. Now, I know how true this statement really is.
I learned this first-hand when I started dealing with brain tumors in the summer of 2014 -- first as a relative, then as a friend and finally, as a patient myself. Along the way, I developed more compassion for my own patients and learned the value of a good support system.
Here’s my story.
My father-in-law’s brain tumor
On July 23, 2014, our family received the devastating news that my father-in-law had a brain tumor. It was glioblastoma, a very aggressive type of brain cancer. His neurosurgeon told us that because of the tumor’s location, it was too dangerous to perform surgery in Puerto Rico. He referred us to MD Anderson’s Sujit Prabhu, M.D., for a second opinion.
Less than 24 hours after we reached out, Dr. Prabhu responded. We made an appointment with him and arrived at MD Anderson’s Brain and Spine Center two weeks later.
My father-in-law was scheduled for surgery right away. His craniotomy took place in the BrainSuite®, a special operating room with an integrated MRI, something not all hospitals have. Dr. Prabhu and his team were able to remove most of the tumor, giving my father-in-law a chance to live longer with better quality of life. We were so happy with the surgery that I told my husband, “If I ever get something in my head, I want Dr. Prabhu to be my doctor.” Sadly, my father-in-law’s tumor grew back nine months later, and he passed away in August 2015.
My friend’s brain tumor
Fast forward a few years to September 2017. Hurricane Irma hit Puerto Rico, followed quickly by Maria, a Category 5 hurricane that left the whole island without electricity and water.
Then, another disaster struck. Just two weeks after Hurricane Maria made landfall, my best friend called to let me know her husband, Alfredo, was in the intensive care unit with a brain tumor. I could not believe that another person I knew well was going through this.
Alfredo’s neurosurgeon wanted him to be transferred to another facility. I contacted Dr. Prabhu, who helped us get Alfredo transferred to MD Anderson. Alfredo had surgery with Dr. Prabhu in October 2017 and has now fully recovered from his left frontal meningioma.
My own brain tumor diagnosis
I can’t recall when my own brain tumor symptoms really started. Who wouldn’t have headaches after enduring two hurricanes, no electricity or water for months, hours-long lines to get gas and 13 people suddenly living in my house — all while still working at the hospital and trying to help those who had lost everything? But my best friend thought my symptoms were too similar to Alfredo’s. She insisted I get a brain MRI. After several months, I finally agreed.
On Feb. 1, 2018, I learned I had a left frontal meningioma -- the same type of brain tumor that Alfredo had. I was in complete denial and shock. One of the first people I called was Dr. Prabhu. He was surprised, but his words of encouragement made me feel so much better. Still, the first few days after my diagnosis were hard. I felt completely lost and depressed. I could not believe this was really happening to me.
Help from my support system
One thing that really helped was taking a trip with my husband right after my brain tumor diagnosis. We went to a beach resort in the Dominican Republic, where I had time to think, cry, calm down and finally get some sleep.
I also reached out to another girlfriend who’d been diagnosed with a meningioma. She spent hours talking with me, and her advice and support really made a difference. As a psychiatrist, referring patients to support groups is something I do frequently, but now I truly realize how important these support systems are.
My brain tumor surgery and recovery
My brain surgery took place on March 20. It was very difficult for my husband to sit in the same waiting room for a third time. But prayers from my family and friends helped us both stay focused, calm and optimistic.
Dr. Prabhu completely removed the tumor during a seven-hour craniotomy. And, because it was a grade I tumor, I didn’t need any additional treatment.
Coping with the side effects of surgery was harder than I thought it would be. I had frequent headaches and felt dizziness and nausea. I also felt like there was a heavy weight on my head. Although I felt depressed, it helped me appreciate the burden that many of my own patients feel.
It took two months for me to start feeling like myself again and return to work. Now, more than six months after my surgery, I feel great, even though I know my recovery continues.
Gratitude for MD Anderson and perspective
Being able to go to MD Anderson was a blessing. I strongly believe that everything happens for a reason. And my experience at MD Anderson has not only given me a second chance at life, but also a better understanding of my own patients. By sharing my story, I hope others realize that no one is alone in this journey.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
My brain tumor story
My brain tumor diagnosis came suddenly. I had no pain, headaches or any kind of warning. On Oct. 3, 2016, I had difficulty conveying my thoughts during a casual conversation at lunch. By 5 p.m., I just didn’t feel right and had difficulty communicating and texting. Our son, a physician, suggested I go to the ER for a CT scan.
My husband and I did just that, and the world changed at 6 p.m. when the radiologist confirmed I had a large brain tumor. We headed to MD Anderson two days later.
My brain tumor surgery
At the MD Anderson Brain and Spine Center, we met with the most amazing and empathetic neurosurgeon, Sherise Ferguson, M.D. I immediately felt at ease knowing I was getting the best care available. She scheduled a craniotomy for the following Friday.
I had no symptoms, so I went shopping on Saturday and to dinner that night. But on Sunday morning, I awoke confused and weak. We immediately went to the MD Anderson Emergency Center.
After an MRI on Sunday, my surgery was moved up to the next day: Oct. 10. Dr. Ferguson operated on me for 12 hours and removed more than 95% of the brain tumor, which turned out to be glioblastoma.
When I awoke, she told me that she had done her job and that my job was to listen to the therapists, do my therapy and rest. She said my husband was in charge of everything else. I am so lucky to have had his love and support through all of this.
Regaining mobility after my craniotomy
I didn’t feel any pain when I awoke after surgery, but I couldn’t move my right leg or arm. I could only wiggle my right thumb a little bit. Three days later, I was released from the ICU into recovery, then rehab.
The results from that point on were nothing short of miraculous. My days started with speech and cognitive therapy with Jaimie. Then I would do an hour of physical therapy with Liz, Reggie and Hillary, have lunch, and Taylor would start another hour of occupational therapy.
Within a few days, I could move my arm, then leg a little bit. Two weeks after surgery, I was getting my hair done, walking with a walker and writing to-do lists for my husband! Many people wanted to visit me, but my days were so full of therapy and exercise that I refused all requests. Instead, I completely focused on Dr. Ferguson’s orders to listen to my therapists and rest. By Oct. 27, I began walking without the aid of a walker and was soon walking all over the hospital. I even participated in a hospital-wide scavenger hunt!
The therapists taught me not just to exercise, but the fundamentals of safety as well. They even brought the car to the front door so I could practice getting in and out. I was discharged on Nov. 2 and released from speech therapy, but I continued my occupational and physical therapy as an outpatient. Thank you, Raymond, Lejoe and Shammi!
My amazing doctors, nurses and therapists took excellent care of me and pushed me to get better each day. Their positive attitudes were contagious. Everyone from the receptionists to the car valets were considerate and truly caring.
Soon after discharge, I met with radiation oncologist Jing Li, Ph.D., and neuro-oncologist Carlos Kamiya Matsuoka, M.D. Together they planned a six-week regime of radiation and chemotherapy, which I completed just before Christmas.
Life after brain tumor treatment
Today, I am home and fully mobile. Thanks to my therapists, I can even carry my 18-pound, 5-month-old grandson around the house. I continue to do my exercises and feel even better every day. My faith, family and friends are my rock.
While I know everyone’s experience is different, I feel blessed to have never felt bad from surgery, radiation or chemotherapy. I know I have a second chance after my craniotomy, and I look forward to spending time with family and friends every day.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.