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 usually is the first treatment for brain tumors. Even when complete removal is not possible surgery may be able to:
- Help reduce the tumor’s size
- Relieve symptoms
- Help doctors decide what other treatments are needed
The most common surgery for brain tumors is craniotomy, which involves opening the skull. Some brain tumors can be removed with little or no damage to the brain. However, many grow in areas that make them difficult or impossible to remove without destroying important parts of the brain.
Brainsuite® iMRI
When a brain tumor is in a challenging location, our neurosurgeons can use this innovative open MRI system that allows them to view the tumor during surgery. This helps them remove as much of the tumor as possible without damaging other parts of the brain. MD Anderson’s Brainsuite is the first in the world of its type.
Radiation Therapy
Radiation therapy may be able to stop or slow the growth of brain tumors that cannot be removed with surgery. It may be used:
- Alone
- With chemotherapy to help the radiation work better or lessen effect on normal parts of the brain
- With targeted therapies to destroy remaining cancer cells
New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target brain tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
MD Anderson uses the most advanced radiation treatment methods, including:
- Gamma Knife radiosurgery, which is not really surgery. It delivers a pinpoint dose of radiation from hundreds of angles.
- Focused radiation therapy, which is aimed directly at the tumor and immediately surrounding area
- Whole-brain radiation therapy, which may be needed if you have two or more brain tumors in different locations
- Intensity-modulated radiotherapy (IMRT), which shapes the radiation beam to the shape of the brain tumor and lessens exposure to the rest of the brain
- Proton therapy
Proton Therapy
The Proton Therapy Center at MD Anderson is one of the largest and most advanced centers in the world. It’s the only proton therapy facility in the country within a comprehensive cancer center.
Proton therapy delivers high radiation doses directly to the brain tumor site, with no damage to nearby healthy tissue. It may be used to treat tumors in very sensitive areas, including in the skull base and along the spine.
Laser Interstitial Thermal Therapy
Laser interstitial thermal therapy (LITT) is performed by implanting a laser catheter into the tumor and heating it to temperatures high enough to kill the tumor.
The treatment is minimally invasive, often requiring little more than a 2-millimeter incision in the scalp, and takes just a few minutes to perform. Most patients can go home the day after treatment and can quickly return to normal activities.
LITT is currently being used to treat patients with primary and metastatic brain tumors, but can also help patients who do not respond to stereotactic radiosurgery or have radiation necrosis (tissue death caused by radiation treatment).
Chemotherapy
MD Anderson offers the most up-to-date and advanced chemotherapy options for brain tumors. These drugs may be taken orally or by injection. They may be given alone or with other treatments.
Chemotherapy often is not as effective for brain cancer as some other types of cancer. This is because of the blood-brain barrier, small blood vessels in the brain and spinal cord that protect the brain from harmful substances. They also may act as a shield against chemotherapy drugs.
Targeted Therapies
These new drugs target the specific gene changes that cause cancer. MD Anderson is at the forefront of discovering these agents. Many of our brain tumor clinical trials include analysis of the molecular profiles of patients' tumors.
Brain tumors are treated in our Brain and Spine Center and our Proton Therapy Center.
A brain tumor diagnosis and treatment can bring many questions. That’s why John de Groot, M.D., co-leader of our Glioblastoma Moon Shot™, and Jeffrey Weinberg, M.D., recently took time to answer questions submitted online by brain tumor patients and caregivers.
Here are their responses to eight of the top questions we received about brain tumor treatment.
What treatment options are available for patients facing a brain tumor recurrence?
Weinberg: If there’s a mass that can be safely removed, we remove it. This may alleviate symptoms and allows us to verify whether it’s truly a recurrence, or something else (like dead tissue) that just looks like a tumor on the MRI. Removing the tumor tissue also allows us to perform molecular analysis to see if the patient is eligible for a clinical trial.
What if my brain tumor is inoperable?
Weinberg: Whether a brain tumor is operable depends on its size, location, the symptoms it’s causing and the experience of the operating team. We perform many second opinions for patients with “inoperable” tumors. Because of the experience of our neurosurgeons and the technology available at MD Anderson, we’re able to safely operate on many tumors that would be considered inoperable somewhere else.
We also have options to treat inoperable tumors without physically removing them, including laser interstitial thermal therapy (LITT).
How and why are low-grade gliomas treated differently than more aggressive brain tumors like glioblastoma?
de Groot: “Low-grade glioma” typically refers to a grade II astocytoma or oligodendroglioma. Several recent Phase III clinical trials have shown that oligodendroglioma is very treatable and that patients with this disease can live for many years after treatment. With good survivorship for low-grade gliomas, we want to minimize the potential impact of aggressive therapy to the brain, which can affect quality of life.
How do you treat cancer that spreads to the brain from elsewhere in the body?
de Groot: Solid tumor cancers such as lung cancer, breast cancer and melanoma can spread to the brain. These tumors are called brain metastases. For a single tumor, we may consider surgery. If there are multiple tumors, radiation or radiosurgery is typically used. Now, targeted therapy and immunotherapy are also options for some patients.
Weinberg: We recently started a tumor board for patients with metastatic disease. This allows MD Anderson oncologists to meet with our neuro-oncology, neurosurgery and central nervous system radiation oncology teams to create a tailored treatment plan for each patient with brain metastases.
What are the most promising developments in brain tumor treatment?
Weinberg: We’re discovering and treating metastatic brain tumors when they’re smaller, thanks to earlier MRIs. For primary brain tumors, we’re now imaging functional brain nerves (which control movement, speech and other important functions) with greater accuracy and using that information in our surgical plan. That makes surgery safer.
Metabolic imaging is a new technique that helps us interpret changes in the tumor that develop over time. It’s also helping us differentiate between tumor regrowth and lesions caused by brain tumor treatment.
Laser interstitial thermal therapy is another promising development that appears to be very effective in treating certain tumors. Laser interstitial thermal therapy works by inserting a probe directly into the tumor and heating it enough to destroy the tumor from the inside. Real-time MRI temperature monitoring makes it possible to do this safely.
What’s the status of developing immunotherapy for glioblastoma?
de Groot: We’re currently introducing immunotherapy treatments to glioblastoma patients through clinical trials. From what we’re seeing, the checkpoint inhibitors that have worked in melanoma and lung cancer are probably not a home run for glioblastoma. We’re now testing combination therapies that combine a checkpoint inhibitor with another therapy in clinical trials.
Other immunotherapy trials use a patient’s own cells, like T cells or natural killer cells, and reprogram them to attack the brain tumor. We’re hopeful that immunotherapy will make a big difference for glioblastoma.
What other types of clinical trials are available for brain cancer?
de Groot: Besides immunotherapy, we have two other types of clinical trials:
- Targeted therapy for tumors that have specific molecular markers
- Biologic therapies using Delta-24, a cancer-killing virus developed at MD Anderson
We also have trials for meningioma, leptomeningeal disease and other brain tumors. See our brain tumor clinical trials here.
What’s your advice for brain tumor patients and caregivers?
de Groot: You’re an individual, not a statistic. You’re not going to have the same experience as other brain tumor patients. Live every day to its fullest and stay optimistic, with the expectation that none of us can predict exactly what’s going to happen.
Weinberg: Remember, it might be your first time going through brain tumor treatment, but it’s not ours.
Watch answers to more brain tumor questions in this Facebook video Q&A.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
