Stereotactic Radiosurgery Institute
Brain Tumor Treatment Options:
Brain Tumors are almost always discovered by imaging scans with Magnetic Resonance Imaging (MRI) or Computed (Axial) Tomography (CT or CAT). Once a suspected tumor is seen on the scan, there are multiple options of how to proceed. The benefits and risks of each option should be evaluated carefully to try to determine the best treatment for each patient and each tumor.
Surgery and Non-Surgical
- Description of Radiosurgery
- Radiosurgery is a technique using specialized equipment to focus a high dose of radiation on the tumor to kill as much of it as possible. The original forms of radiosurgery are performed in one day. The radiation is focused very sharply and precisely on the tumor while protecting the surrounding normal tissue by minimizing the radiation there.
- Benefits of Radiosurgery
Can be used even after regular Radiation Therapy, previous Radiosurgery, and open Surgery in most cases.
Most treatments for Benign Brain Tumors and Brain Metastases are curative for the targeted tumors. If the original cancer is not well controlled, new Brain Metastases may appear, but these can usually be treated effectively again with Stereotactic Radiosurgery.
Can be done in one day. Some forms done over a longer time.
Can Treat Malignant and Benign Brain Tumors.
Usually done with the patient awake with a mild sedative taken orally to keep the patient comfortable.
Avoid risks of General Anesthesia and recovery from it since almost all cases are done with a local anesthetic.
Avoid risks of Infection in the brain since the brain is not physically touched or exposed during the procedure.
Avoid almost all risks of Bleeding in the brain since the brain is not physically manipulated during the procedure.
- Risks of Radiosurgery
- Can cause damage to parts of brain surrounding tumor or target treated. This can cause symptoms or problems depending on the parts of the brain affected.
- As the tumor dies and is absorbed by the body, some patients develop an inflammatory response and swelling in the brain which can cause increased symptoms.
- Radiation Therapy
- Description of Radiation Therapy
- Radiation Therapy is a technique using specialized equipment to treat Brain Tumors and other Body Tumors with daily doses of radiation usually over a period of about two to six weeks.
- Benefits of Radiation Therapy
- Can be used effectively for most Malignant and Rapidly Growing tumors. Not very effective, however, for most Benign Tumors, Slowly Growing Tumors, or Certain Types of Cancer such as Brain Metastases from Malignant Melanoma or Renal Cell Carcinoma.
- Risks of Radiation Therapy
- More normal tissue is treated with target than Stereotactic Radiosurgery.
- Whole Brain Radiation therapy, which is typically given for treatment of Brain Metastases can only be given effectively only once. There is an increased risk of Whole Brain Radiation Therapy in terms of causing memory and cognitive problems similar to Alzheimer's Disease.
- Craniotomy / Craniectomy
- Description of Craniotomy / Craniectomy
- Craniotomy and Craniectomy are Open Surgery procedures. They involve cutting open the skin and tissues down to the skull. An opening is then cut in the skull to allow access to the brain cavity. The coverings of the brain are then opened to operate on the Brain Tumors(s). When finishing the operation, the part of the bone removed from the skull to allow access to the brain is replaced in a Craniotomy, but not in a Craniectomy.
- Benefits of Craniotomy / Craniectomy
- If the tumor can be completely removed, it may be a curative procedure, particularly for Benign Tumors and well encapsulated Brain Metastases.
- Tumor tissue is obtained for pathological examination. This is the best way to determine exactly what type of tumor the patient has.
- Tumor tissue becomes available for other testing, such as susceptibility to certain types of chemotherapy or genetic testing.
- Pressure on the brain from the tumor can be mechanically removed since the tumor is gone or reduced in size.
- Risks of Craniotomy / Craniectomy
- Almost always done under General Anesthesia. There are significant risks to being asleep under heavy medications for surgery.
- Since there is cutting into the tissues, there is risk of infection at the surgical site.
- There is risk of bleeding from cutting arteries, veins, and capillaries.
- There can be poor healing of the surgical site causing leakage of cerebrospinal fluid.
- Cutting through normal brain to get to the tumor can cause problems with functions that part of the brain controls.
- Traction or pressure on normal part of the brain to keep them out of the way while operating on the tumor can cause those parts of the brain to malfunction.
- Removing functional parts of the brain or nerves because they could not be surgically separated from the tumor.
- Endoscopic Surgery
- Stereotactic Biopsy
- Description of Chemotherapy
- Chemotherapy is medication given to the patient typically by a medical oncologist to try to kill or control Cancer.
- Most forms of Chemotherapy are stopped by the Blood Brain Barrier and therefore are not useful for the treatment of Brain Tumors directly.
- Benefits of Chemotherapy
- Chemotherapy goes through the whole body and may kill cancer cells that would otherwise travel through the bloodstream, lodge in the brain, grow, and cause Brain Metastases or Metastases to other parts of the body.
- Some Cancers in the body may be cured by Chemotherapy.
- Many Cancers in the body are controlled for extended times with the use of Chemotherapy.
- Risks of Chemotherapy
- Side effects are usually due to toxic effects of the Chemotherapy on normal body parts. For example: severe diarrhea when it affects the gastrointestinal system, infections when the white blood cell count is reduced, and bleeding when platelet counts get too low.
- Integrative Therapy
- Description of Observation
- Observation typically means continuing the present course of treatment despite a change or new finding noted on a Scan (MRI or CT), physical examination, or symptom. Rather than embarking on a new treatment modality right away, the current course of treatment is continued.
- Benefits of Observation
- In certain cases, after treatment, there can be pseudoprogression of a tumor noted on the patient's scans, physical examination, or symptoms reported. Although the picture may look worse in some cases, the tumor may be dying and the situation will improve with time.
- There may be artifacts or erroneous signals which suggest a new tumor or tumor progression on scans. Repeat scans after some time may show resolution of these signals.
- The patient may have a delayed response to treatment and additional time is required to see improvement.
- Risks of Observation
- The main risk of Observation is that the tumor may be progressing. If that occurs, treatment of the larger tumor may be more difficult and carry increased risks.
This list and discussion are provided as a general overview on choices that should be considered when deciding on how to treat a Brain Tumor. The decision of how to proceed needs to be made by the patient, physicians caring for them, and family in most cases.
We have successfully treated many types of Brain Tumors with Stereotactic Radiosurgery.