Methods of Treatment
People with brain tumors have several treatment options. Depending on
the tumor type and stage, patients
may be treated with surgery,
radiation therapy,
or chemotherapy. Some
patients receive a combination of treatments.
In addition, at any stage of disease, patients may have treatment to control
pain and other symptoms of the cancer, to relieve the side effects of therapy,
and to ease emotional problems. This kind of treatment is called
symptom management,
supportive care,
or palliative care.
The doctor is the best person to describe the treatment choices and
discuss the expected results.
A patient may want to talk to the doctor about taking part in a clinical
trial, which is a research study of new treatment methods. The section on
"The Promise of Cancer Research" has more
information about clinical trials.
Surgery is the usual treatment for most brain tumors. Surgery
to open the skull is called a
craniotomy. It is performed
under general anesthesia.
Before surgery begins, the scalp is shaved. The surgeon then makes an
incision in the scalp and uses a special type of saw to remove a piece of
bone from the skull. After removing part or all of the tumor, the surgeon
covers the opening in the skull with that piece of bone or with a piece
of metal or fabric. The surgeon then closes the incision in the scalp.
These are some questions a person may want to ask the
doctor before having surgery:
How will I feel after the operation?
What will you do for me if I have pain?
How long will I be in the hospital?
Will I have any long-term effects? Will my hair grow back?
Are there any side effects from using metal or fabric to
replace the bone in the skull?
When can I get back to my normal activities?
What is my chance of a full recovery?
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Sometimes surgery is not possible. If the tumor is in the brain stem
or certain other areas, the surgeon may not be able to remove the tumor
without damaging normal brain tissue. Patients who cannot have
surgery may receive radiation or other treatment.
Radiation therapy (also called radiotherapy) uses
high-energy rays to kill tumor cells. The radiation
may come from x-rays,
gamma rays,
or protons. A
large machine aims radiation at the tumor and the tissue close
to it. Sometimes the radiation may be directed to the entire
brain or to the spinal cord.
Radiation therapy usually follows
surgery. The radiation kills tumor
cells that may remain in the area.
Sometimes, patients who cannot have
surgery have radiation therapy
instead.
The patient goes to a hospital or clinic for radiation therapy.
The treatment schedule depends on the type and size of the tumor
and the age of the patient. Each treatment lasts only a few minutes.
Doctors take steps to protect the healthy
tissue around the brain tumor:
Fractionation—Radiation
therapy usually is given five days a week for several weeks.
Giving the total dose of radiation over an extended period helps to
protect healthy tissue in the area of the tumor.
Hyperfractionation—The patient gets smaller doses of radiation
two or three times a day instead of a larger amount once a day.
Stereotactic radiation therapy—Narrow beams of radiation are directed
at the tumor from different angles. For
this procedure, the patient wears a rigid head frame. An MRI or CT scan creates pictures of the tumor's exact
location. The doctor uses a computer to
decide on the dose of radiation needed, as well as the sizes and angles of the
radiation beams. The therapy may be given
during a single visit or over several visits.
3-dimensional conformal radiation therapy—A computer
creates a 3-dimensional image of the tumor and nearby brain tissue.
The doctor aims multiple radiation beams to the exact shape of the
tumor. The precise focus of the
radiation beams protects normal brain tissue.
Proton beam radiation therapy—The source of radiation is protons rather than x-rays. The doctor aims the proton beams at the
tumor. Protons can pass through healthy tissue
without damaging it.
These are some questions a person may want to ask the
doctor before having radiation therapy:
Why do I need this treatment?
When will the treatments begin? When will they end?
How will I feel during therapy? Are there side effects?
What can I do to take care of myself during therapy?
How will we know if the radiation is working?
Will I be able to continue my normal activities during
treatment?
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Chemotherapy, the use of drugs to kill cancer cells, is sometimes
used to treat brain tumors. The drugs may be given by mouth or by injection.
Either way, the drugs enter the bloodstream and travel throughout the body.
The drugs are usually given in cycles so that a recovery period follows
each treatment period.
Chemotherapy may be given in an outpatient part of the hospital, at the
doctor's office, or at home. Rarely, the patient may need to stay in
the hospital.
Children are more likely than adults to have chemotherapy. However,
adults may have chemotherapy after surgery and radiation therapy.
For some patients with
recurrent cancer
of the brain, the surgeon removes the tumor and implants
several wafers that contain chemotherapy. Each wafer is about the size
of a dime. Over several weeks, the wafers dissolve, releasing the drug
into the brain. The drug kills cancer cells.
Patients may want to ask these questions about
chemotherapy:
Why do I need this treatment?
What will it do?
Will I have side effects? What can I do about them?
When
will treatment start? When will it
end?
How often will I need checkups?
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