Information on treatment options and guidance on making decisions.
Choosing Standard of Care
The standard of care is the treatment path that relies only on the most highly-tested, FDA-approved approaches. Standard treatments include surgery, radiation and/or chemotherapy.
Surgery is the usual next step when symptoms and imaging suggests the you may have a brain tumor. Surgery is important to determine the precise diagnosis via biopsy. It involves removing as much of the tumor as possible, 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.
Chemotherapy
Chemotherapy is drug treatment for cancers or tumors. It is commonly used in combination with surgery and radiation.
Tumor Treating Fields
A newer treatment in which a device worn on the head to generates electrical fields that interfere with tumor growth.
Questions To Ask
Deciding which treatment is best can feel overwhelming. Talk with your treating doctor about all the possible treatment options. You have choices.
Choosing Clinical Trials
For patients with brain tumors, clinical trials are treatment options to consider. Trials are available at any stage and may offer a chance for a better outcome or improved quality of life.
Aggressive brain tumors remain one of the hardest forms of cancer to treat. The gold standard of medical research is clinical trials, which are really a kind of collaboration between willing patients and clinicians exploring a new treatment approach. Not only are they the key to medical advancement, they are a way for patients to receive cutting-edge care that could make a difference in their survival.
What is a clinical trial?
Information on what clinical trials evaluate and the four different types of research trials.
Why Participate In A Clinical Trial?
The benefits and risks of participating in a clinical trial.
How To Find A Brain Tumor Clinical Trial
When you should seek out a clinical trial and available brain tumor clinical trials.
Clinical Trial Phases
Clinical trials follow a series of steps, called phases, which are outlined.
Questions To Ask About Trials
Questions to ask your doctor to help you determine if a clinical trial is right for you.
How To Participate?
Describes what the eligibility criteria often includes.
Surgery
It is critical to remove as much of the brain tumor as possible, while not damaging healthy tissue. Brain tumor surgery is most successful when it is performed by a neurosurgeon with a great deal of experience. As a patient, you have the right to seek out multiple opinions. This can help to answer questions that you have and confirm the surgical plan. Seeking a second (or even a third) opinion may also be encouraged by your surgeon or your insurance plan. Talk to your surgeon about your plans to seek out a second opinion, for recommendations on who to see and the time frame that is recommended to seek the opinion.
Surgery serves two important purposes:
- Removes as much of the brain tumor as possible.
- Provides a biopsy (sample) of the type of the cells for an accurate diagnosis.
Other benefits of surgery:
- Relieves symptoms by reducing pressure on the brain.
- Reduces the amount of tumor to be treated by radiation or chemotherapy.
The tumor size and location play a role in surgery options. The most common surgery for brain tumors is a craniotomy, which involves opening the skull. Besides a craniotomy, laser microsurgery, ultrasound aspiration and biopsy (stereotactic or open) are minimally invasive procedures that may be an option.
Prior to surgery, a brain tumor patient may receive steroids to reduce brain tissue swelling and medication to control seizures.
Possible Side Effects and Risks of Surgery
Brain surgery is a major surgical procedure, often requiring time in the ICU, inpatient hospital stay and sometimes time in a rehab facility. It can take a lot out of you. Your body will need to adjust.
The operation itself and the swelling of your brain after surgery may make the symptoms you are already experiencing worse or may cause new symptoms to occur. See what symptoms are associated with various areas of the brain and discuss any changes you see with your health care provider.
Below is a list of rare but possible side effects that can occur with surgery. The risks of surgery and possible side effects are different for each person. Use this list to talk to your doctor to understand if you are at risk for these and what can be done to prevent them or treat them if they occur.
Possible side effects:
- Neurologic problems
- Bleeding
- Blood clots
- Infection
- Stroke
- Seizure
- Swelling of the brain
- CSF (cerebrospinal fluid) leak
- Nerve damage
- Paralysis of muscles
- Wound (surgical incision) healing problems
These side effects can be minimized when procedures are performed by a qualified neurosurgeon.
Radiation
Radiation is a common treatment for brain tumors and can be used alone or combined with surgery and/or chemotherapy.
Three delivery options exist for radiation therapy:
- External delivery
- Traditional form of radiation therapy.
- Directs radiation at the tumor and the area surrounding it.
- Treatment occurs five days a week, with length of treatments depending on the tumor type.
- Internal delivery
- Also known as brachytherapy.
- Places radioactive pellets directly in the brain, which release a measured dosage of radiation daily.
- Patients are frequently hospitalized when the pellets are most active.
- Stereotactic radiosurgery
- Patient is fitted with a frame to stabilize the head.
- Imaging technique finds the exact location of tumor cells.
- Instrument precisely targets radiation dose to the tumor while not affecting surrounding healthy tissue.
Possible Side Effects and Risks of Radiation
Radiation treatment often produces swelling of the brain. This can often make your symptoms feel worse at first but can be controlled by taking steroids.
Possible side effects:
- Redness and irritation in the mouth
- Dry mouth
- Difficulty swallowing
- Changes in or loss of taste
- Nausea
- Fatigue
- Hair loss
- Short and long term cognitive and neurologic problems
- Skin changes such as redness, flaking and swelling
Talk to your physician about effects you are having and ways side effects can be managed.
Chemotherapy
Chemotherapy is drug treatment for cancers or tumors. The goal of chemotherapy is to kill as many of the tumor cells as possible and to put remaining tumor cells into a non-dividing, sleeping state for as long as possible to slow the growth of the tumor.
It is most commonly prescribed in combination with surgery and radiation. It may also be the initial treatment or used alone to treat recurring tumors. Depending on the type and tumor grade, it is taken in pill form orally or by injection (IV).
Drugs Approved to Treat Brain Tumors
These drugs are approved by the FDA for use in adult brain tumors. The drug names link to the National Cancer Institute’s drug information summary that includes more information about the use of the drug, research results and ongoing clinical trials. There may be drugs used in brain tumors that are not listed here.
Source: National Cancer Institute
A patient may receive one chemotherapy drug at a time or in combination with different drugs at the same time.
For more information on the treatment of specific tumors, The National Comprehensive Cancer Network (NCCN) publishes guidelines developed and reviewed by leading experts in the field.
Possible Side Effects and Risks of Chemotherapy
Tumor cells are fast-growing. Traditional chemotherapy is designed to attack fast-growing cancer cells ability to grow and divide. However, some normal cells are also fast-growing (such as hair follicles, bone marrow and stomach cells) and so are often affected by chemotherapy.
Possible side effects:
- Hair loss
- Nausea/Vomiting
- Diarrhea
- Low blood counts
- Low red blood cells (anemia): fatigue
- Low white blood cells (leucopenia or neutropenia): risk of infection
- Low platelet count (thrombocytopenia): risk of bleeding
Newer approaches to chemotherapy target specific pathways in the tumor responsible for tumor growth or use the body’s immune system to fight the cancer. Side effects associated with these newer treatments may be different than those from traditional chemotherapy. Talk to your physician about effects you are having and ways side effects can be managed.
Tumor Treating Fields
mor-treating fields are a newer treatment option for brain tumors that use a device worn on the head that generates electromagnetic fields to locally block cell division. The treatment is FDA-approved for glioblastoma and commonly used in combination with chemotherapy.
The device that generates tumor-treating fields is known as Optune. It consists of an array of electrical nodes that are customized to most directly the patient’s cancer, attached to a 3 pound device worn in a pouch that powers the fields. Patients wear the nodes on their head all the time while they are in treatment, and the device is usually operating for at least 18 hours each day.
For more about Optune, read our interview with manufacturer’s chief scientist.
Possible Side Effects and Risks of Tumor-Treating Fields
The most common side effects from using Optune / tumor-treating fields are scalp irritation and headache.
Possible side effects:
The following adverse reactions were considered related to Optune when using the device alone. Other effects may be observed when combining with chemotherapy.
- Scalp irritation from device use
- Headache
- Malaise
- Muscle twitching,
- Fall
- Skin ulcer
Talk to your physician about effects you are having and ways side effects can be managed.
Questions To Ask About Treatments
Deciding which treatment is best can feel overwhelming. Talk with your treating doctor about all the possible treatment options. You have choices. Here are some questions to ask to help you determine the best treatment for you.
- If I want a second opinion, who do you recommend that I see?
- What are the treatment options available?
- What is the standard treatment versus clinical trials?
- How long do I have to make decisions about my course of treatment (when do I need to start this treatment)?
- How long will I be on this treatment?
- Will insurance cover the treatment?
- How will the treatment be administered (oral or IV)?
- Are there alternative treatment options?
- How do you determine if the treatment is effective?
- How often do you recommend I get MRIs?
- What are common treatment side effects and how do you manage them?
- Are there long-term effects of the treatment that I should be aware of?
- Can I work and/or resume activities while in treatment?
