Treatment Options for Brain Cancer

Surgery is a part of treatment for many brain cancers. During surgery, a neurosurgeon will try to remove as much of the tumor as possible without affecting the function of your brain.

Surgery is often done by craniotomy. This is where a small opening is made in your skull, allowing for access to your brain. You may be under general or local anesthesia during surgery.

While operating, a neurosurgeon can use various techniques to help them safely remove your tumor without damaging the surrounding tissue. These can include:

• cortical mapping
• functional MRI
• fluorescent dye

Using surgery in combination with other brain cancer treatments like radiation therapy (RT) may be able to eliminate smaller, less aggressive cancers. But this can be more challenging for cancers that are larger or more aggressive.

Surgery can also be used for other purposes. These include inserting a shunt or drain to reduce intracranial pressure or placing an Ommaya reservoir to help deliver chemotherapy (chemo).

RT uses high-energy radiation to destroy cancer cells. It’s often given for brain cancer using a radiation source located outside of your body. This is called external beam RT.

Radiation has the potential to damage healthy brain tissue, so several methods have been developed to help lower this risk. An example of one is conformational RT, which makes a 3D image of your tumor and shapes the radiation to fit to it.

You may receive RT after surgery to help kill any remaining cancer cells. RT may also be one of the main treatment options if your cancer can’t be operated on. This may be the case if your cancer is:

• very extensive
• located deep within your brain
• found at or around an area that’s vital for brain function

Chemo uses drugs that disrupt the ability of cancer cells to grow and divide. It can be used along with other treatment types, such as surgery or RT, or alone when other treatments haven’t been effective.

While many chemo drugs are given directly into your bloodstream or taken orally, this isn’t always possible with brain cancer. The reason is that many chemo drugs can’t cross the blood-brain barrier.

As such, some chemo may be given directly into your cerebrospinal fluid. Other types of chemo may also be given as a wafer that’s placed in your brain during surgery.

A few examples of chemo drugs used for brain cancer, either alone or in combination, are:

• carmustine
• lomustine
• procarbazine
• temozolomide
• vincristine

Targeted therapy uses drugs that target specific markers on or in cancer cells. Currently, there are only a handful of targeted therapy drugs used for brain cancer.

Bevacizumab (Avastin) inhibits a protein that promotes the growth of blood vessels around tumors. It’s given by an intravenous (IV) line and may be used to treat glioblastoma.

Everolimus (Afinitor) blocks the activity of a protein involved in cell growth and division. It’s taken as a pill and is used for some types of astrocytomas.

Alternating electric field therapy exposes a tumor to electric fields that affect its ability to grow. This type of therapy involves the use of a wearable device called the Optune system that generates those electric fields.

The Optune system is used for people who recently received a diagnosis of glioblastoma or those who have recurrent glioblastoma.

Clinical trials evaluate potentially new or improved ways to treat a disease or disorder. They’re essential for testing the safety and effectiveness of new treatments before they’re made more widely available.

One type of treatment that’s being heavily researched for brain cancer is immunotherapy. This is a type of cancer treatment that helps your immune system respond to cancer. It’s already used for many other cancer types.

For some people with brain cancer, receiving treatment through a clinical trial may be recommended. This is particularly true if you have a cancer that:

• is rare or very aggressive
• has a limited number of approved treatment options
• hasn’t responded to conventional treatments
• has come back after treatment

If you’re interested in a clinical trial for brain cancer, talk with your medical care team. They can recommend clinical trials you may qualify for.

You can also find clinical trials through the website of the National Brain Tumor Society or by searching ClinicalTrials.gov.

The outlook for people with brain cancer depends on many factors. These include:

• the type of brain cancer you have
• the grade of the cancer, which estimates how quickly the tumor may grow
• where the tumor is in your brain
• how large the tumor is
• whether or not the tumor can be removed using surgery and, if so, how much of the tumor can be removed
• the presence of certain genetic changes in the tumor cells
• your age and overall health

For example, the 5-year relative survival rate for adults ages 20–44 years old with diffuse astrocytoma, a slow-growing cancer, is 73%. In contrast, the 5-year relative survival rate is 22% in the same age group for glioblastoma, an aggressive cancer.

If you’ve recently received a diagnosis of brain cancer, your medical care team will consider all of the factors above to give you a better idea of your individual outlook.

There are a few different treatments for brain cancer. Typically, surgery is a part of treatment, if possible. Additional treatments that are commonly used either alone or in combination with other treatments are RT and chemo.

The outlook for someone with brain cancer depends on several factors, including but not limited to the type of cancer, its grade, and your age and overall health.

If you’ve received a diagnosis of brain cancer, have an open conversation with your medical care team about your treatment options and outlook.