Treatment

After surgery, now what?
Maybe you are cured. Do you need follow-up?

Some brain tumors can be cured by surgery. These include acoustic neurinomas, many meningiomas, pituitary adenomas, pinealomas, pilocytic astrocytomas and some others. Nonetheless, you should go for MRI scans every 3-6 months for the first year following surgery – and every 1-2 years thereafter – to be sure that the tumor is not returning.

Until the initial causes of brain tumors are discovered, no one should breathe a sigh of relief upon having a surgeon tell you "I got it all out. It was benign. You're cured". The surgeon may speak with absolute assurance, and may ultimately prove to be correct. But what if the surgeon was wrong? Always remember that it’s easier and safer to remove a small tumor than a large one. And checking for possible recurrence is excellent insurance toward your future health. If your tumor is destined to recur, it would be best to find out as soon as possible.

If you need adjuvant treatment; find an experienced neuro-oncologist and/or radiation oncologist

A neuro-oncologist prescribes chemotherapy. A radiation oncologist administers radiation therapy. So which is best for treatment of a brain tumor: radiation therapy, chemotherapy or both? This will depend on the actual type of tumor you have (which is why correct pathology is so important). Even then it's controversial. Regardless, you need an experienced physician to guide you.

There are many oncologists as well as many radiation oncologists in the United States. Every medical center has such physicians on board, as well as "excellent equipment". But here is where you have to be careful. You want a radiation oncologist with experience in the treatment of brain tumors. Furthermore, in many cases a general oncologist will not be as knowledgeable as a neuro-oncologist when it comes to the treatment of brain tumors. A general oncologist treats all types of cancers but many have limited experience with brain tumors. Neuro-oncologists are neurologists with special expertise in the treatment of brain tumors. They understand and know how to deal with the neurological problems that brain tumor patients might have during a course of treatment.

Radiation Therapy

It is important to differentiate between radiation therapy and radiosurgery. Radiosurgery, delivered by the Gamma Knife or a stereotactic linear accelerator (LINAC), is best for relatively small, circumscribed tumors – meaning boundaries between the tumor and surrounding brain are definite and sharp. While many metastatic tumors are good candidates for radiosurgery, the majority of brain tumors are not. Patients with gliomas (glioblastoma, oligodendroglioma, astrocytoma, mixed glioma) carry tumors that are infiltrating lesions, where the tumor cells coexist with intact brain tissue. Killing tumor cells with radiosurgery, also kills the brain tissue in which the tumor cells reside. In addition, these tumor cells can be found far beyond the CT and MRI-defined abnormalities, the targeting method on which radiosurgery is based.

Unlike radiosurgery, standard radiation therapy is not given in one single treatment. Instead, radiation therapy is a series of daily treatments usually administered over a six week period in "fractions": part of the total dose given every day 5 days a week for six weeks.

There are some new twists: a) conformal radiation therapy in which the radiation dose is better focused on the MRI or CT-defined abnormality, or b) fractionated stereotactic radiosurgery where the patient's head is fitted in a re-locatable brace for each fraction of a course of radiation therapy. Though these sound good in theory, so far there is no evidence that either of these new approaches is any better than standard radiation therapy in prolonging the survival of patients with brain tumors. 

If radiation therapy is recommended, where should you have it? The therapy harnesses radiation energy, which is transmitted in small units of electromagnetic radiation called photons, delivered by a linear accelerator (LINAC). Photons in Los Angeles, California are no different than photons in Elmira, New York, and the equipment used to deliver those photons is most likely identical.

The only determining factor then is the person designing the radiation therapy plan and supervising the therapy. You want to be sure you are under the care of someone with considerable experience in radiation therapy – and more specifically, radiation therapy for brain tumors. In general, your best bet is to be treated by one of the nation’s large medical centers where a lot of brain tumor surgery is done.

Read Radiation Therapy for Brain Tumors, Understading Your Treatment Options, by ASTRO (American Society for Therapuetic Radiology and Oncology).  First published in 2004, this brochure helps patients and their families understand how radiation therapy is used to primary and metastatic brain tumors. It explains how radiation oncologists use 3D-CRT, IMRT, stereotactic radiotherapy, proton therapy, brachytherapy and radiosensitizers to treat tumors in the brain.  Available in pdf and html formats.

Chemotherapy and Protocols

If your tumor is the type that is not cured by surgery, additional treatment along with close follow-up will be needed. This is where things really get confusing. There are many different experimental methods to treat brain tumors in North America. These feature radiation therapy, perhaps a radiosurgical boost and many varieties of chemotherapy. Which is best?

Any given brain tumor can be treated in a number of different ways. The best way, also called “protocol,” depends upon the advice of the individual physician and what his/her associated institution is doing for that tumor at that time. Protocol? This term is best defined as, "experimental". Patients are being placed on one mode of therapy and compared with the progress of patients treated with a different mode of therapy.

What exactly is being compared? There are only three things the doctors look for: toxicity from the treatment (side effects and damage), time to recurrence (how long it takes the tumor to come back) and survival (how long the patient lives on this treatment). Many will also record quality of life measures such as the Karnofsky scale. The ultimate goal is to find an effective and safe treatment that will help future patients. If you get lucky there is a chance that the new treatment being studied in the protocol may also help you.

Nonetheless, many protocols are pushed by institutions and doctors despite lack of scientific evidence that their treatment is significantly better than others that are more established and understood. Protocols are now hyped on the internet or in newspapers (such as USA Today). All the hype is basically marketing. After all, if any of these hundreds of treatments being touted were proven to be significantly more effective than the others, wouldn't everybody be using it? Wouldn't there be just one treatment regimen instead of many? It is important to not get sucked in by false promises of those more interested in the marketing business.

The Brain Tumor Foundation has close associations with many academic medical centers – where serious professionals are working together in a multi-center group effort trying to find the "best" treatment.


There are four general therapeutic tools at our disposal (click for in-depth description):


See Research for information on the latest treatments.

Read about Future Possibilities for treating brain tumors.