Treatment Options

Most patients’ treatment begins – if possible – with surgery to remove as much of the tumor as possible without damaging critical healthy tissue. Thankfully, neurosurgery and imaging technology, tools, and techniques have improved – and continue to do so – over the past decade. Many new advances are available to help surgeons at top brain tumor centers remove brain tumors with more precision and completeness. Patients should discuss and understand their surgery and the different surgical options now available for patients with their medical team.

Radiation therapy (also called “radiotherapy,” “irradiation,” or simply “radiation”) is another standard treatment that many patients with a brain tumor will receive. Radiation therapy involves the use of x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors by damaging their DNA. Radiation sources can be placed within the brain at the time of surgery to target residual tumor cells (internal radiation therapy or brachytherapy through applications such as GammaTile or Xoft). Radiation may also come from a machine outside the body (external-beam radiation therapy). As with surgery, there are now many newer and emerging radiation technologies, tools, and techniques, including radiosurgery (also called stereotactic radiosurgery) and proton beam therapy.

Chemotherapy (often abbreviated as “chemo”) refers to chemical compounds – or drugs – that kill or slow the growth of fast-growing cells, like cancer cells. It is prescribed when surgery and/or radiation are not enough to remove a tumor and is used most often for treatment of malignant tumors. Chemotherapy can be provided to the patient in three forms:

• Chemotherapy wafers inserted directly into a resection cavity (the area in the brain where the tumor was located) during surgery.
• Intravenous (IV) chemotherapy provided by injection (or infusion) of the drug directly into a patient’s vein.
• Oral chemotherapy administered via a pill that is taken by mouth.

A number of different chemotherapies are approved for use in brain tumors:

• Temozolomide (or Temodar or TMZ): An oral chemo drug most often prescribed to patients with high-grade gliomas.
• Nitrosourea: A class of chemotherapies that include two drugs – Lomustine (CCNU) and Carmustine (BCNU or BiCNU) – sometimes used in treatment of malignant gliomas. Carmustine is sometimes given to patients via a chemotherapy wafer called Gliadel Wafer. Lomustine is sometimes administered as part of a three-drug combination called PCV, which also includes the chemotherapy drugs Procarbazine and Vincristine (Onocovin).
• On rare occasions the chemotherapy drug Irinotecan (Camptosar) is sometimes used “off-label” in gliomas.

A type of treatment that uses drugs targeting the specific changes and molecular alterations in tumors that drive their growth. Some targeted therapies block the action of certain enzymes, proteins, or other molecules involved in the proliferation and spread of cancer cells and often require that the tumor is tested to check whether it contains a target for which there is an available drug. Targeted therapies may also be designed to home in on and attack tumor cells specifically, causing less harm to normal cells. For brain tumors, there have been two targeted treatments approved and sometimes used in treatment:

• Avastin (bevacizumab): An anti-cancer drug that targets tumor-induced new blood vessel formation. It is currently approved to treat recurrent glioblastoma patients.
• Afintor/Everolimus: Approved to treat a very rare brain tumor called subependymal giant cell astrocytoma (SEGA) associated with a condition known as tuberous sclerosis (TS).

A medical device (a wearable cap connected to a battery pack in a backpack) called “Optune” Optune Gio is a wearable, portable, FDA-approved device. It treats a type of brain cancer called glioblastoma (GBM) in adult patients aged 22 years or older. Optune Gio works by creating Tumor Treating Fields (TTFields). TTFields are electric fields that help slow down or stop cancer cell division and may destroy some cancer cells. TTFields therapy is delivered right into the area of your body where the cancer is located, using 4 adhesive patches called transducer arrays. TTFields are specifically targeted; they have not been shown to significantly affect healthy cells.

Many clinical trials evaluating new potential drugs to treat brain tumors are ongoing. Clinical trials – though the treatments are still “investigational” (or experimental) and not yet FDA approved – can sometimes be the best avenue for patients with difficult to treat brain tumors to access the most cutting-edge emerging treatments and improve the opportunities of finding a new treatment that may be effective for them (and for other future patients). Patients and caregivers can search for clinical trials using the NBTS Clinical Trial Finder.

To help manage side effects of the tumor and/or treatments administered, many patients are provided with: anti-seizure/anti-epileptic medications to control seizures caused by a brain tumor; steroids to reduce brain swelling and inflammation; pain relievers; anti-nausea, antibiotics, and other medication to combat chemo-related side effects. Additionally, some patients find benefit from other measures of palliative care, including certain diets, eastern medicine, yoga, meditation, acupuncture, etc.