How Brain Tumors Are Treated

A brain tumor requires surgical treatment and, in some instances, chemotherapy or radiation. The treatment is tailored to the type of brain tumor, the size of the tumor, the location in the brain, and the number of tumors in the brain and elsewhere in the body. Treatment may consist of a one-time surgical removal of the whole tumor, or it may involve repeated interventions if the tumor is known to be aggressive or if it recurs.

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Prescriptions

Medications used for brain tumors include chemotherapy, hormonal treatments, anticonvulsants, and pain medications. Chemotherapy works to shrink or eliminate brain tumors, while the other prescription medications are used to control symptoms while the tumor is being treated.

Chemotherapy

Chemotherapy for brain tumors is tailored to the type of tumor, which is determined with a biopsy examination.

Some chemotherapeutic regimens include:

• Temodar (temozolomide) is a recommended chemotherapeutic medication for people who have glioblastoma multiforme (GBM), a tumor with a particularly poor prognosis. Temozolomide is usually given daily for five days every 28 days for six to 12 cycles. Temozolomide increases the risk of hematologic complications such as thrombocytopenia (low platelet count, which can lead to bleeding issues), so blood tests must be checked 21 and 28 days into each cycle of treatment. Other side effects include nausea, fatigue, and a decreased appetite. 
• A combination of chemotherapeutics called procarbazine, lomustine, and vincristine (PCV) is another option in the treatment of brain tumors. The combination may cause reduced immune function, bruises, or bleeding. Fatigue, nausea, numbness, and tingling may also occur.
• Gliadel (carmustine) is a chemotherapeutic medication that is implanted in the brain in the form of a wafer that gradually disintegrates to produce its tumor-fighting effect. Gliadel wafers may decrease the size of some malignant brain tumors. Potential side effects include infection and brain swelling.
• Avastin (bevacizumab) is an antibody that binds to vascular endothelial growth factor (VEGF). This therapy interferes with the production of new blood vessels that provide nutrients to the growing tumor. It has been associated with neutropenia (decreased immunity), hypertension, and thromboembolism (blood clots). 

Hormone Treatments

Hormonal treatments may be needed as a replacement therapy when a hormone secreting pituitary tumor is removed.

Anticonvulsants

Anti-seizure medications are used to control seizures caused by a brain tumor. You may need to take an anticonvulsant even after your tumor is completely removed, because scar tissue, which can trigger seizures, may remain.

Corticosteroids

Most people experience some swelling and inflammation as a result of a brain tumor. If the swelling is a significant issue, you may need to take oral or IV (intravenous) steroids to reduce the inflammation. Generally, you would only need to take steroids for a limited time, but the need for steroids may recur if the inflammatory swelling recurs. 

Pain Medications

Depending on the severity of your tumor-induced pain or post-surgical pain, you may need prescription pain medication. This may include prescription NSAIDs, opiates, anesthetics, or anticonvulsants that are used for pain control, such as Neurontin (gabapentin).

Radiation

Radiation therapy uses powerful radiation energy directed toward the tumor to destroy cancer. Often, radiation is done prior to surgery to reduce the size of a brain tumor.

Techniques used in radiation therapy for brain tumors:

• Involved-field radiation therapy (IFRT) focuses on a 1- to 3-centimeter margin around the tumor to reduce the destruction of healthy, normal cells.
• Image-guided radiation therapy (IGRT) uses CT scans or x-rays during radiation for more pinpointed treatment.
• 3D conformal radiotherapy (3D-CRT) uses special software to make treatment plans to reduce irradiation of normal brain.
• Intensity-modulated RT (IMRT) varies radiation across treatment areas, which is useful when the tumor is near sensitive areas of the brain. 
• Fractionated radiation therapy delivers multiple small doses over a prolonged period of time. 
• Stereotactic radiosurgery (SRS) delivers precise, high-dose radiation to small targets in the brain. 
• Radiation may also be delivered by placing radioisotope seeds in the resection cavity or the tumor itself, leading to continuous dose delivery. 

One of the side effects of radiation therapy includes radiation necrosis, which is the death of normal brain tissue due to radiation. Other complications include blood vessel narrowing, hair loss, and headaches. 

For each type of brain tumor, a maximum dose of radiation is calculated. Radiation that exceeds it has no anticipated additional benefit, but may come with increased side effects.

Specialist-Driven Procedures

Often, surgery is needed to remove as much of a tumor as possible. In general, the removal of a brain tumor is the best way to prevent growth and recurrence. Surgeons are faced with the great challenge of taking out the entire tumor while preserving normal brain tissue.

After surgery, the tumor removed is examined under a microscope to determine whether the margins (the areas surrounding the tumor) are cancerous or normal tissue. 

• Craniotomy: This is the most 'open' type of brain surgery, in which a section of the skull is removed, the meninges (membranes covering the brain and spinal cord) are opened, and your surgeon has a view of the brain and the tumor. It takes time to recover from a craniotomy, and this type of surgery is often needed for large tumors. 
• Neuroendoscopy: When the tumor can be accessed without opening the skull, your surgeon may opt to make a small hole in the skull or even reach the tumor through the deep openings inside the nasal cavity. He is able to visualize the area by threading a thin tube with a camera through the opening; special instruments are used to remove the tumor. Neuroendoscopy may be used to remove smaller tumors or tumors that are in deep regions of the brain. 
• Laser ablation: This is a minimally invasive procedure in which a laser is used to reduce or completely destroy the tumor using thermal energy. It requires anesthesia, in contrast to radiation therapy, which directs radiation to an area without an incision or anesthesia. 

There are several risks of brain surgery, and these apply to all types of brain surgery. 

• Swelling with an accumulation of fluid in brain tissue, called cerebral edema, may occur. This can cause neurological problems such as numbness, weakness, or difficulty with speaking or movement. Cerebral edema may be reduced by medications such as corticosteroids and tends to go away on its own within a few weeks. If fluid buildup or swelling is persistent, you may need to have a ventriculoperitoneal shunt placed to reduce excess fluid volume. 
• Blood clots may form more readily after brain surgery, so preventive treatments may be needed.
• Injury to nearby structures can occur. If the tumor is at the skull base, for example, cranial nerves in the area may be at risk during the surgery. 

Sometimes surgery may not be possible if a tumor is in an area of the brain that is near major blood vessels or in the brainstem, where vital functions could be disrupted. It may also be impossible for you to have surgery if your body cannot safely tolerate the procedure.

Even after brain surgery, malignant tumors and metastatic tumors can recur. Nevertheless, surgery can help improve your response to chemotherapy and radiation, improve quality of life, and prolong survival, even if your tumor is aggressive.

Over-the-Counter Therapies

Over-the-counter medications can help you with some of the symptoms of a brain tumor, but cannot treat the condition itself. 

There are a number of over-the-counter pain medications that you can take for your headaches. Tylenol (acetaminophen), Advil (ibuprofen), Aleve (naproxen sodium), and Excedrin are commonly used.

Though you may have used these medications prior to being diagnosed with a brain tumor, know that some of them can increase the risk of bleeding—a particular concern if you are healing from surgery. Discuss the best options for pain relief with your healthcare provider so you can be sure that your approach is a safe one.

Self-Care

What you do at home can help protect you from complications and ease symptoms during treatment. Here are a few helpful strategies:

• Monitoring of vital signs: A large brain tumor or one that's near the brainstem can affect your breathing and heart functioning. A device to monitor your vital signs when you are at home, particularly when you are sleeping, can alert you or your loved ones to sudden changes that require emergency medical care. Your healthcare provider might recommend and write a prescription for a pulse oximeter, for example, which can monitor your pulse and your approximate oxygen level.  
• Wound care: If you have had brain surgery, you need to protect and care for your wound as it heals, following your healthcare provider's instructions. You might need to change bandages in between your healthcare provider's appointments. If you have any bleeding, leaking fluid, fever, or pain, contact your healthcare provider immediately. 
• Shunt maintenance: If you have had a ventriculoperitoneal shunt placed, you will be given detailed instructions on how to manage and monitor it.
• Vision aids: If a brain tumor has affected your vision, you may need reading glasses, a magnifying glass, or other practical ways to be able to see and read until your tumor is treated. 

Complementary Medicine (CAM)

There have been some studies showing that alternative treatments may help relieve some of the symptoms of brain tumors. Brain tumors cannot be treated with alternative therapies, although some studies suggest that alternative therapies may hold some promise in conjunction with traditional methods.

• Ginger: Ginger, whether eaten in fresh form or used in tea, can reduce nausea and headaches. Brain tumors are often associated with headaches, and chemotherapy often causes nausea.  
• Poliovirus: The poliovirus is being studied in a research setting for the treatment of brain tumors among people with GBM, medulloblastoma, and other tumors. At this point, results look promising and the treatment is approved by the U.S. Food and Drug Administration (FDA) for use in clinical research trials. 
• Acupuncture: An alternative remedy that is largely considered safe, acupuncture can improve pain in some people with side effects of chemotherapy.  
• Chinese herbs: Extracts of the herbs yiru tiaojing (YRTJ) granule and peony-glycyrrhiza decoction were used in a laboratory setting for treatment of prolactin-secreting pituitary tumor cells. The extract diminished the hormone secretion in the laboratory setting but has not been used in humans, and no recommended dosing or method has been developed for cancer treatment. 
• Evodiamine (EVO): A component of Evodia rutaecarpa, an herbal remedy, Evodiamine (EVO) was used in a laboratory setting with glioblastoma tumor cells. It induced apoptosis (cell death) of glioblastoma cells. Again, this was in a laboratory setting, and it was used in a cellular solution, so there are no recommendations regarding the use of this herb in humans with brain tumors.