Brain Tumor Treatments

Brain tumors are the growth of abnormal or uncontrolled cells in the brain. Brain tumors can either be primary, meaning they develop in the brain and rarely spread to other parts of the body, or they can be metastatic, meaning they develop as cancerous cells in other parts of the body and spread to the brain.

Treatment options for brain tumors may include:

Shunting;
Surgery;
Radiation therapy; and
Chemotherapy.

After a tumor has been graded, it may be staged, which determines how much it has spread beyond the initially invaded organ. Because brain tumors in adults may spread to other areas of the brain but rarely spread to other parts of the body, there is no standard staging system. Childhood tumors are graded but not staged because brain tumors in children rarely spread to other areas of the body.

WHEN IS IT INDICATED?

Surgery. A variety of factors determine the patient's need for surgery and how quickly the surgeon needs to perform the procedure. Problems caused by the tumor also play a factor. In addition to removing a brain tumor, or as much of it as possible, surgery is usually indicated for biopsy of the tumor to determine exactly what kind of cancer the physician is treating. The biopsy may be performed separately or as part of the surgical procedure.

Ventriculo-peritoneal shunt placement. Shunting is typically indicated in children who are experiencing intracranial pressure.

Radiation therapy. Radiation therapy may be indicated if the tumor is malignant (cancerous), when some of the tumor remains in the brain after surgery, if the cancer recurs, or for patients who are unable to undergo surgery.

Chemotherapy. Chemotherapy is often recommended for people with highly aggressive tumors or tumors that reappear after other treatment methods, such as surgery, have been performed.

PRE-PROCEDURE GUIDELINES

Ventriculo-peritoneal shunt placement. Patients are usually instructed not to eat anything after midnight the night before the surgery.

Surgery. Patients may be prescribed steroids for several days prior to surgery to reduce brain swelling (if any) and anticonvulsants may be given prior to surgery to prevent seizures.

Before surgery, the surgeon may require additional tests, including computed tomography (CT) scan, magnetic resonance imaging (MRI), angiogram, and magnetic resonance angiography (MRA).

Radiation Therapy. Before radiation therapy begins, the physician or a radiation oncologist will simulate the radiation session using CT scanning or regular x rays to determine the type of radiation therapy needed and to pinpoint the direction of the therapy.

Chemotherapy. There are usually no pre-treatment guidelines for chemotherapy.

WHAT TO EXPECT Ventriculo-peritoneal shunt placement surgery. To remove blockage of cerebrospinal fluid, the neurosurgeon places a small, flexible plastic tube called a shunt in the brain.

The tube may be temporary or permanent and can be inserted before or after tumor removal.

Surgery. Surgery is often the first treatment for brain tumors. In addition to removing as much of the tumor as possible, the physician may use surgery to obtain a biopsy of the brain tumor.

Once the surgeon has access to the brain, the goal is to remove as much of the tumor as safely possible. In some cases, the surgeon will be able to remove only part of the tumor because of the patient's brain anatomy, the type of tumor, and the way the tumor may have spread in the brain. In tumors that are more difficult to remove, the surgeon may choose to cauterize the tumor with a laser, meaning burn part of the tumor with a special laser to destroy tumor cells, or use an ultrasound device that emits ultrasound waves to break it up. The tumor matter is then suctioned from the brain.

Radiation therapy. Radiation therapy is considered a standard treatment for malignant brain tumors. For external radiation therapy, the patient is instructed to lie still on a treatment table while a radiation technologist administers radiation by directing the high-energy particles or beams directly to the area of the tumor.

Types of non-invasive radiation therapy that a physician may use include fractionated radiation therapy, hyperfractionated radiation therapy, and stereotactic radiosurgery.

An invasive type of radiation therapy is called brachytherapy or interstitial radiotherapy. In brachytherapy, the surgeon or neurointerventionalist implants tiny radioactive seeds or pellets directly into the tumor through a thin, flexible tube called a catheter. The seeds may remain in the tumor or tumor area for weeks or months or may remain permanently.

Side effects to radiation therapy that may occur at time of treatment include headaches, fatigue, and nausea. Early-delayed side effects may include sleepiness, loss of appetite, and apathy. Late-delayed side effects may include short-term memory loss and decline in thinking, reasoning, perception, and judgment.

Chemotherapy. Chemotherapy is administered as pills or intravenously and destroys cancer cells or damages them in a way that will prevent them from multiplying. Side effects from chemotherapy may include nausea, vomiting, and loss of appetite.

New therapies. Immunotherapy is currently in clinical trials to evaluate if it will be safe and effective for children. Immunotherapy uses medications to stimulate the body's own disease-fighting cells, called immune cells, to fight cancer.

POST-PROCEDURE GUIDELINES

Ventriculo-peritoneal shunt placement surgery. Patients will be instructed to keep the incision sites clean to avoid infection. Patients are instructed to keep the incision site dry as long as the stitches are in place. The physician will also schedule regular visits with patients to ensure that the shunt is draining properly.

Surgery. Immediately following surgery, patients spend the first 24 hours in a critical care unit for observation. Patients usually remain in the hospital for up to 5 days or longer, depending on the patient and the surgical outcome. After being discharged, the physician or surgeon will provide patients with a detailed list of instructions to follow while recovering from the surgery.

Other than resting after radiation therapy and chemotherapy, patients can usually resume everyday activities following these treatments. Because of the potential side effects with chemotherapy, patients may want to discuss with their physicians temporary changes to their diet and any foods to avoid.

POSSIBLE COMPLICATIONS

Ventriculo-peritoneal shunt placement surgery. Complications of ventriculo-peritoneal shunt placement may include excessive bleeding in the brain, blood clot, and infection.

Surgery. Some possible complications following a craniotomy may include infection, stroke, and brain damage.

Radiation therapy. In general, some complications that may occur because of radiation therapy may include death of brain tissue, called necrosis, and neurological problems.

Complications of brachytherapy may include wound infection, swelling in the brain, and hemorrhage.

LIFESTYLE ADJUSTMENT

After treatment is complete, the tumor is removed or has stopped growing, and the patient has returned home, he or she will be scheduled for regular follow up visits every 2 to 4 months to monitor the tumor for recurrence. During these visits, the physician may order diagnostic imaging tests such as CT scan or MRI to evaluate the patient.

The tumor, or the surgery to remove the tumor, may affect the parts of the patient's brain that control speech, coordination, or other skills. To help the patient cope with and overcome these effects, the physician may recommend that patients undergo rehabilitative therapy, physical therapy, speech therapy, and occupational therapy.

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