Brain Tumor Treatment Options

Surgery is often the first-line treatment for accessible brain tumors. The primary goal is to remove as much of the tumor as possible without damaging critical brain functions. Techniques like awake craniotomy and intraoperative MRI have enhanced the surgeon’s ability to resect tumors safely and precisely. In some cases, such as with low-grade gliomas or benign tumors like meningiomas, complete surgical resection can be curative. However, for more aggressive tumors like high-grade gliomas, surgery is usually followed by additional therapies.

Radiation therapy uses high-energy beams, such as X-rays or protons, to destroy tumor cells. It can be used post-surgery to kill remaining cancer cells or as a standalone treatment when surgery is not feasible. Techniques like stereotactic radiosurgery (SRS) deliver precise radiation doses to the tumor while minimizing exposure to healthy brain tissue. For certain tumors, like brain metastases, SRS is highly effective. Fractionated radiotherapy, where smaller doses are given over several sessions, is used for larger or less well-defined tumors.

Chemotherapy employs drugs to kill cancer cells or inhibit their growth. For brain tumors, chemotherapy can be systemic (administered orally or intravenously) or localized (such as wafers implanted in the surgical cavity releasing chemotherapy directly into the tumor site). Drugs like temozolomide have been effective, particularly for glioblastoma multiforme, the most aggressive brain tumor. However, the blood-brain barrier can limit the effectiveness of some systemic chemotherapy drugs in treating brain tumors.

Targeted therapy focuses on specific abnormalities within cancer cells. By blocking these abnormalities, targeted drugs can cause cancer cells to die. For example, bevacizumab, an angiogenesis inhibitor, is used for recurrent glioblastoma. It works by inhibiting the formation of new blood vessels that tumors need to grow. Targeted therapies are generally less harmful to normal cells than chemotherapy and radiation therapy.

Immunotherapy is a newer area in brain tumor treatment, aiming to boost the body’s natural defenses to fight the cancer. It includes checkpoint inhibitors, cancer vaccines, and cell-based therapies. For instance, dendritic cell vaccines are being explored in clinical trials for glioblastoma, aiming to train the immune system to recognize and attack tumor cells. While promising, immunotherapy for brain tumors is still largely experimental and available primarily through clinical trials.

Tumor Treating Fields (TTF) is a novel cancer therapy modality that utilizes low-intensity, alternating electric fields to disrupt cell division, ultimately inhibiting tumor growth and causing cancer cell death. This treatment is non-invasive and represents a significant advancement in the management of certain types of tumors, particularly in glioblastomas. TTF is primarily known under the brand name Optune, which has received FDA approval for specific cancer treatments.

Supportive care, also known as palliative care, is crucial for brain tumor patients. It focuses on relieving symptoms and improving quality of life including helping to manage side effects of other treatments. Treatments may include medications for pain, seizures, or edema; physical therapy to improve mobility and strength; occupational therapy; and psychological support. Supportive care is an integral part of the treatment plan, regardless of the tumor stage.

Clinical trials for brain tumors are crucial for advancing the treatment and understanding of these complex conditions. They evaluate potential new drugs to treat brain tumors. They are investigational and not FDA approved but can at times be the best option for patients with difficult to treat brain tumors.