Standard-of-Care Treatment

Standard of care means the best approved treatments we have to treat brain tumors. Standard treatments include surgery, radiation, and chemotherapy. You may receive one or all of these.

Surgery is the preferred first step when a brain tumor is suspected (based on symptoms and imaging tests). Surgery is important to determine the precise diagnosis, to remove as much of the tumor as can be safely removed, and may help to reduce brain swelling and symptoms. Depending on the type of tumor and tumor grade, radiation and chemotherapy may be used in addition to surgery.

• Low-grade Tumor Treatments (grade I) – These brain tumors are often treated by surgery alone and then monitored by a physician. These tumors tend to be not aggressive.
• Low-grade Tumor Treatments (grade II) – Whether additional treatment is needed after surgery for grade II tumors is dependent on the tumor type, tumor remaining after surgery, and other characteristics of the tumor (such as biomarkers and how fast the tumor is growing). In some cases, radiation therapy as well as chemotherapy is given.
• High-grade Tumor Treatments (grade III and IV) – These brain tumors are more difficult to remove and require surgery as well as additional treatments including radiation, chemotherapy or a clinical trial. High-grade tumors are malignant tumors and can grow quickly.

While a tumor may show characteristics from one or more tumor grades, doctors treat patients based on the highest-level tumor grade. Should they recur, low-grade tumors can sometimes become high-grade tumors.

The National Comprehensive Cancer Network (NCCN) publishes guidelines on the treatment of specific types and grades of tumors. These guidelines (which can be accessed by creating a profile) are developed and reviewed by leading experts in the field.

Potentially beneficial clinical trials are often available prior to surgery. When you are first diagnosed (or if you have a recurrence), talk to your doctor about all of your treatment options.

For many reasons, brain tumors may be difficult to treat compared to other cancers. First, it is difficult to remove all of the tumor. Unlike cancers where the surgeon can remove the affected organ, the surgeon cannot remove the whole brain and often cannot even remove all of the tumor they can see because of the risk of brain damage. Second, the blood-brain barrier, which prevents materials from the blood (such as harmful chemicals) from entering the brain and spinal cord, can also keep out many types of chemotherapy, limiting effective treatment options. Third, radiation therapy can damage healthy brain tissue.

Yet there is hope. In recent years, doctors, scientists, and researchers have found ways to improve survival rates and quality of life for brain tumor patients. Surgeries are more precise, understanding of which tumors respond to chemotherapy has improved, and techniques for delivering radiation therapy have become more precise. Doctors continue to search for better treatments everyday.